核因子-κB与细菌性血流感染脓毒症患者心肌损伤及心功能障碍的相关性  

Correlation between nuclear factor-κB and myocardial injury and cardiac dysfunction in patients with sepsis caused by bacterial bloodstream infection

作　　者：李进[1] 郑爱华 范元 唐丽 莫有海 LI Jin;ZHENG Ai-hua;FAN Yuan;TANG Li;MO You-hai(Chongqing Sha pingba District People's Hospital,Chongqing 400030,China;不详)

机构地区：[1]重庆市沙坪坝区人民医院ICU,重庆400030 [2]重庆市合川区中医院消化科,重庆401520

出　　处：《中华医院感染学杂志》2021年第12期1881-1885,共5页Chinese Journal of Nosocomiology

基　　金：重庆市自然科学基金资助项目(20195486)。

摘　　要：目的探究核因子-κB(NF-κB)在细菌性血流感染所致脓毒症患者中表达及与患者心肌损伤、心功能障碍的相关性。方法纳入2017年1月-2020年6月重庆市沙坪坝区人民医院收治的79例脓毒症患者,根据是否合并脓毒症心肌病分为心肌病组35例与对照组44例,所有患者入科后24 h内均进行NF-κB、炎症因子[C-反应蛋白(CRP)、降钙素原(PCT)、肿瘤坏死因子-α(TNF-α)、血管细胞黏附分子-1(VCAM-1)]、心肌损伤指标[N-末端前体脑钠肽(NT-proBNP)、肌酸激酶同工酶B(CK-MB)、心肌肌钙蛋白(cTnT)]水平检测,并行超声心动图检查评价心功能[每分输出量(CO)、二尖瓣口舒张期流速E/A比值、左室射血分数(LVEF)],采用Spearman相关分析法探究NF-κB水平与炎症因子、心肌损伤指标、心功能指标的相关性,绘制受试者工作特征(ROC)曲线分析NF-κB水平对脓毒症心肌病诊断价值。结果心肌病组血清NF-κB、CRP、PCT、TNF-α、VCAM-1均高于对照组(P<0.05);心肌病组血清NT-proBNP、CK-MB、cTnT均高于对照组(P<0.05);心肌病组CO、E/A值、LVEF均低于对照组(P<0.001)。心肌病组NF-κB与炎症指标CRP、PCT、TNF-α、VCAM-1均呈正相关(r=0.509、0.674、0.682、0.806,P均<0.05),与心肌损伤标志物NT-proBNP、CK-MB、cTnT均呈正相关(r=0.624、0.571、0.428,P均<0.05),与超声心动图CO、E/A值、LVEF均呈负相关(r=-0.547、-0.501、-0.702,P均<0.05)。NF-κB诊断脓毒症心肌病(SIC)的AUC为0.933(95%CI:0.878~0.988,P<0.05),约登指数最大为0.806,此时Cut-off值为72.25 pg/ml,对应灵敏度、特异度分别为0.829、0.977。结论 NF-κB在细菌性血流感染所致脓毒症心肌病患者中呈高表达状态,且与患者炎症水平、心肌损伤及心功能障碍相关,可用于脓毒症心肌病早期诊断。OBJECTIVE To explore the expression of nuclear factor-κB(NF-κB)in patients with sepsis caused by bacterial bloodstream infection and its correlation with myocardial injury and cardiac dysfunction.METHODS A total of 79 patients with sepsis admitted to Chongqing Shapingba District People’s Hospital from Jan.2017 to Jun.2020 were selected,and divided into 35 cases in the cardiomyopathy group and 44 cases in the control group according to whether the patients were complicated with septic cardiomyopathy.The NF-κB,inflammatory factors[C-reactive protein(CRP),procalcitonin(PCT),tumor necrosis factor-α(TNF-α),vascular cell adhesion molecule-1(VCAM-1)]and myocardial injury indexes[N-terminal pro-brain natriuretic peptide(NT-proBNP),creatine kinase isoenzyme B(CK-MB),cardiac troponin(cTnT)]were detected of all patients within 24 h after admission.Echocardiography was used to evaluate cardiac function[cardiac output per minute(CO),mitral valve orifice diastolic velocity E/A ratio,left ventricular ejection fraction(LVEF)].Spearman correlation analysis method was used to explore the correlation between NF-κB level and inflammatory factors,myocardial injury indexes and cardiac function indexes.Receiver operating characteristic(ROC)curve was used to analyze the diagnostic value of NF-κB level on septic cardiomyopathy.RESULTS The levels of serum NF-κB,CRP,PCT,TNF-αand VCAM-1 in cardiomyopathy group were significantly higher than those in control group(P<0.05).The levels of serum NT-proBNP,CK-MB and cTnT in cardiomyopathy group were significantly higher than those in control group(P<0.05).The CO,E/A and LVEF in cardiomyopathy group were significantly lower than those in control group(P<0.001).The level of NF-κB in cardiomyopathy group was positively correlated with inflammatory indicators of CRP,PCT,TNF-αand VCAM-1(r=0.509,0.674,0.682,and 0.806,respectively,all P<0.05),and was positively correlated with myocardial injury markers of NT-proBNP,CK-MB and cTnT(r=0.624,0.571,and 0.428,respectively,all P<0.05),and was nega

关 键 词：细菌性血流感染 脓毒症 心肌病 核因子-ΚB 炎症因子 心肌损伤 心功能障碍 相关性分析 

分 类 号：R459.7[医药卫生—急诊医学]