血清线粒体ATP合酶C亚基水平在脓毒症患者心功能状态及预后评估中的价值  

Value of ATP synthase C subunit in predicting cardiac function and outcomes of sepsis

作　　者：孙莹莹 张瑶璐 张璐瑶 赵光举[1] 洪广亮[1] 李萌芳[1] 吴斌[1] 支绍册[1] 卢中秋[1] Sun Yingying;Zhang Yaolu;Zhang Luyao;Zhao Guangju;Hong Guangliang;Li Mengfang;Wu Bin;Zhi Shaoce;Lu Zhongqiu(Emergency Department,the First Affiliated Hospital of Wenzhou Medical University,Wenzhou 325000,China)

机构地区：[1]温州医科大学附属第一医院急诊医学中心,温州325000

出　　处：《中华医学杂志》2021年第27期2140-2146,共7页National Medical Journal of China

基　　金：浙江重点研发计划(2021C03072);浙江中医药管理局“十三五”重点专科建设项目。

摘　　要：目的探讨血清线粒体ATP合酶C亚基水平在脓毒症患者心功能状态及预后评估中的价值。方法前瞻性纳入2017年1月1日至2018年12月31日在温州医科大学附属第一医院急诊重症监护室(EICU)收住的165例脓毒症患者,男103例(62.4%),女62例(37.6%),年龄(63±14)岁。使用人ATP合成酶脂质结合蛋白(ATP5G1)ELISA试剂盒检测患者入EICU后24 h内的血清ATP合酶C亚基水平。对照组为健康体检者,共45例。收集患者临床资料,根据左室射血分数(LVEF)及临床结局不同进行分组,比较各组之间临床指标的差异,评价血清ATP合酶C亚基水平对脓毒症患者心功能状态及预后评估的价值,分析脓毒症患者心功能状态及预后的独立危险因素。结果脓毒症组血清ATP合酶C亚基水平高于对照组[(116±62)μg/L比(77±34)μg/L,P<0.001]。脓毒症心功能障碍组血清ATP合酶C亚基水平高于心功能正常组(P<0.001),死亡组血清ATP合酶C亚基水平高于存活组(P<0.05)。绘制ATP合酶C亚基、肌酸激酶同工酶(CK-MB)、B型钠尿肽(BNP)、肌钙蛋白I(cTnI)、左房舒张末期内径、左室收缩末期内径、左室舒张末期容量、左室收缩末期容量受试者工作曲线(ROC)来评估脓毒症患者心功能障碍,曲线下面积(AUC)分别为0.928、0.661、0.837、0.814、0.703、0.831、0.794、0.765,其中ATP合酶C亚基截断值、灵敏度、特异度分别为139.44 ng/L、100%、75.2%。logistic回归分析得出ATP合酶C亚基、BNP、左房舒张末期内径是脓毒症患者心功能障碍的独立危险因素(均P<0.05)。绘制年龄、尿素氮(BUN)、ATP合酶C亚基、急性生理学与慢性健康状况评分系统Ⅱ评分(APACHEⅡ)、简化急性生理评分(SAPSⅡ)ROC曲线来评估脓毒症患者预后,其AUC分别为0.719、0.772、0.656、0.868、0.884,其中ATP合酶C亚基的截断值、灵敏度、特异度分别为131.24 ng/L、61.9%、68.7%。logistic回归分析得出年龄、BUN、ATP合酶C亚基、发生心功能障�Objective To investigate the value of serum mitochondrial ATP synthase C subunit level in the evaluation of cardiac functional status and prognosis in patients with sepsis.Methods A total of 165 sepsis patients admitted to the Emergency Intensive Care Unit(EICU)of the First Affiliated Hospital of Wenzhou Medical University from January 1,2017 to December 31,2018 were included,there were 103 males(62.4%)and 62 females(37.6%)with an age of(63±14)years.Human ATP synthase lipid binding protein(ATP5G1)ELISA kit was used to detect the level of serum ATP synthase C subunit within 24 h after admission to EICU,and compared with that in 45 healthy subjects.Clinical data of patients were collected and divided into groups according to different left ventricular ejection fraction(LVEF)and clinical outcomes.The differences in clinical indicators among each group were compared to evaluate the value of serum ATP synthase C subunit level in the evaluation of cardiac functional state and prognosis of patients with sepsis,and the independent risk factors for cardiac functional state and prognosis of patients with sepsis were analyzed.Results Compared with the control group,the level of serum ATP synthase C subunit in the sepsis group was higher((116±62)μg/L vs(77±34)μg/L,P<0.001).Compared with normal cardiac function group,the level of serum ATP synthase C subunit in septic cardiac dysfunction group was higher(P<0.001).Compared with the survival group,the level of serum ATP synthase C subunit in the death group was higher(P<0.05).The receiver operating curve(ROC)was drawn to analyze the value of ATP synthase C subunit,creatine kinase isoenzyme(CK-MB),B-type natriuretic peptide(BNP),troponin I(cTnI),left atrial end diastolic diameter,left ventricular end systolic diameter,left ventricular end diastolic volume,left ventricular end systolic volume in evaluating the cardiac function in patients with sepsis,and the area under the curve(AUC)was 0.928,0.661,0.837,0.814,0.703,0.831,0.794 and 0.765,respectively.The cut-off value,sensit

关 键 词：脓毒症 心功能障碍 ATP合酶C亚基 预后 

分 类 号：R459.7[医药卫生—急诊医学]