支链氨基酸代谢物对风湿性心脏瓣膜病体外循环术后低心排血量的预测价值  

Branched-chain Amino Acid Metabolites for Prediction of Low Cardiac Output after External Circulation of Rheumatic Heart Valve Disease

作　　者：温萌[1] 张伟华[1] 马宁 李明[1] 孙晓柯[1] 刘洋[1] 张俭[1] WEN Meng;ZHANG Weihua;MA Ning;LI Ming;SUN Xiaoke;LIU Yang;ZHANG Jian(The First Affiliated Hospital of Zhengzhou University,Zhengzhou 450000,Henan,China)

机构地区：[1]郑州大学第一附属医院,郑州450000

出　　处：《中西医结合心脑血管病杂志》2024年第16期2914-2922,共9页Chinese Journal of Integrative Medicine on Cardio-Cerebrovascular Disease

基　　金：河南省医学科技攻关联合共建项目(No.LHGJ20210315)。

摘　　要：目的:探讨支链氨基酸代谢物对风湿性心脏瓣膜病病人行体外循环术后发生低心排血量事件的预测价值。方法:选取2019年1月—2022年1月我院收治的风湿性心脏瓣膜病病人154例作为研究对象,根据体外循环术后是否出现低心排血量,将病人分为低心排血量组(52例)和非低心排血量组(102例)。对比分析两组病人情况,多因素Logistic回归分析低心排血量事件的影响因素。Cox比例风险模型调整混杂变量,分析支链氨基酸代谢物和传统标志物与低心排血量事件的关联性。GRACE风险评分探讨支链氨基酸和传统标志物结合后对低心排血量的预测能力。Cox回归评价支链氨基酸代谢物和传统标志物之间的交互作用。建立回归方程y=1-1/(1+e-z)预测模型并进行验证。结果:脑钠肽、肌钙蛋白I、亮氨酸、缬氨酸、异亮氨酸等是低心排血量事件的独立危险因素。随着脑钠肽、肌钙蛋白I、亮氨酸、缬氨酸、异亮氨酸水平的升高,与低心排血量事件的关联效应也更强。支链氨基酸代谢物和传统标志物结合,会提高GRACE风险评分对低心排血量的预测能力。异亮氨酸联合脑钠肽前体对低心排血量事件的预测效应最高。经Bootstrap自抽样,预测模型区分度、准确度较好。结论:支链氨基酸代谢物和低心排血量密切相关。支链氨基酸代谢物加入传统标志物中,会提高对低心排血量的预测能力,有助于改善风湿性心脏瓣膜病病人预后。Objective:To investigate the predictive value of branched-chain amino acid metabolites in low cardiac output events after cardiopulmonary bypass in rheumatic valvular heart disease patients.Methods:A total of 154 patients with rheumatic valvular heart disease were selected as the study objects.According to whether low cardiac output occurred after cardiopulmonary bypass,the patients were divided into a low cardiac output group(52 cases)and a non-low cardiac output group(102 cases).The two groups of patients were compared and analyzed,and the important influencing factors of low cardiac output events were analyzed by multivariate Logistic regression.Cox proportional risk model was used to analyze the association of branched-chain amino acid metabolites and traditional markers with low cardiac output events.The GRACE risk score was used to investigate the predictive ability of branched-chain amino acid metabolites combined with traditional markers for low cardiac output.Cox regression was used to evaluate the interaction between branched-chain amino acid metabolites and traditional markers.The prediction model of regression equation y=1-1/(1+e-z)was established and verified.Results:Brain natriuretic peptide precursors,troponin I,leucine,valine,and isoleucine were independent risk factors related low cardiac output events.As the levels of brain natriuretic peptide precursors,troponin I,leucine,valine,isoleucine increased,the association with low cardiac output events became stronger.The combination of branched-chain amino acids and traditional markers could improve the ability of GRACE risk score to predict low cardiac output.Isoleucine combined with brain natriuretic peptide precursors showed the highest predictive effect for low cardiac output events.Through Bootstrap self-sampling,the prediction model showed good differentiation and accuracy.Conclusion:Branched-chain amino acid metabolites are closely associated with low cardiac output.The addition of branched-chain amino acid metabolites to traditional markers w

关 键 词：风湿性心脏瓣膜病 支链氨基酸代谢物 低心排血量 体外循环 脑钠肽 

分 类 号：R654.2[医药卫生—外科学]