血清GDF⁃15、ADAMTS13、SDC⁃1水平对脓毒症心肌损伤的早期诊断价值  

The early diagnostic value of serum GDF⁃15,ADAMTS13,and SDC⁃1 in sepsis⁃induced myocardial injury

作　　者：李双凤 高延秋[1] 董睿 张磊 徐亚来[2] 李晓燕[1] 张瑞霞 LI Shuangfeng;GAO Yanqiu;DONG Rui;ZHANG Lei;XU Yalai;LI Xiaoyan;ZHANG Ruixi(Zhengzhou Central Hospital RICU,Zhengzhou,Henan 450001,China;Department of Respiratory and Critical Care Medicine,the Second Affiliated Hospital of Zhengzhou University,Zhengzhou,Henan 450014,China)

机构地区：[1]郑州市中心医院RICU,河南郑州450001 [2]郑州大学第二附属医院呼吸与危重症医学科,河南郑州450014

出　　处：《热带医学杂志》2024年第12期1733-1737,I0002,共6页Journal of Tropical Medicine

基　　金：河南省医学科技攻关联合共建项目(LHGJ20210778);河南省高等学校重点科研项目(23A320036)。

摘　　要：目的探究血清生长分化因子15(GDF⁃15)、血管性血友病因子裂解酶13(ADAMTS13)、多配体蛋白聚糖-1(SDC⁃1)水平对脓毒症心肌损伤(SIMI)的早期诊断价值,以期找到能够指导早期治疗方案的新型标志物。方法选取2021年10月-2023年4月入住郑州市中心医院呼吸重症监护病房(RICU)的脓毒症患者116例为研究对象,以患者是否出现心肌损伤分为SIMI组(n=60)和非SIMI组(n=56)。测定并比较两组患者入院时的临床资料及血清GDF15、ADAMTS13和SDC⁃1水平。多因素Logistic回归分析SIMI发生的影响因素。采用受试者工作特征(ROC)曲线分析血清GDF15、ADAMTS13和SDC⁃1表达水平对SIMI的诊断价值。结果SIMI组性别、年龄、体质量指数、舒张压和收缩压、基础病史、血培养阳性率以及入住RICU时的平均动脉压(MAP)、白细胞(WBC)与非SIMI组比较差异均无统计学意义(P均>0.05)。SIMI组患者急性生理学与慢性健康状况Ⅱ(APACHEⅡ)评分、序贯器官衰竭(SOFA)评分、入住RICU时间及总胆红素(Tbil)、血肌酐(SCr)、降钙素原(PCT)、C反应蛋白(CRP)、GDF⁃15、SDC⁃1水平均高于非SIMI组,血小板(PLT)、ADAMTS13水平低于非SIMI组,差异均有统计学意义(χ^(2)/t=2.198、8.679、2.187、9.907、4.743、9.960、4.746、4.927、4.704、3.630、5.568,P均<0.05)。APACHEⅡ评分、SOFA评分、PCT、GDF⁃15、SDC⁃1表达水平升高是SIMI发生的危险因素,ADAMTS13表达水平升高是SIMI发生的保护因素(OR=3.126、2.579、2.201、2.694、1.553、0.560,P均<0.05)。GDF⁃15、ADAMTS13、SDC⁃1联合检测诊断SIMI的曲线下面积(AUC)为0.870,高于GDF⁃15、ADAMTS13、SDC⁃1单独检测的0.741、0.762、0.763,差异均有统计学意义(Z=3.090、3.061、2.895,P均<0.05)。结论GDF15和SDC⁃1在SIMI患者血清中表达上调,ADAMTS13表达下调,三者可能成为诊断SIMI的有用生物标志物和潜在治疗靶点。Objective To investigate the early diagnostic value of serum growth differentiation factor⁃15(GDF⁃15),a disintegrin like and metalloproteinase with thrombospondin type I motifs 13(ADAMTS13),and syndecan⁃1(SDC⁃1)in sepsis⁃induced myocardial injury(SIMI),and find new markers that could guide the early treatment.Methods A total of 116 sepsis patients admitted to the respiratory intensive care unit(RICU)of Zhengzhou Gentral Hospital from October 2021 to April 2023 were included as the study subjects.The patients with myocardial injury were assigned into SIMI group(n=60)and those without myocardial injury were assigned to non⁃SIMI group(n=56).The clinical data and levels of serum GDF15,ADAMTS13,and SDC⁃1 were measured and compared between two groups upon admission.Multivariate Logistic regression was applied to analyze the influencing factors of SIMI occurrence.Receiver operating characteristic(ROC)curves were applied to analyze the diagnostic value of serum GDF15,ADAMTS13,and SDC⁃1 expression levels for SIMI.Results There was no statistically obvious difference in gender,age,body mass index,diastolic and systolic blood pressure,basic medical history,blood culture positivity rate,and the mean arterial pressure(MAP),white blood cell(WBC)at admission to RICU between the SIMI group and non⁃SIMI group(all P>0.05).The acute physiology and chronic health evaluationⅡ(APACHE II)score,sequential organ failure assessment(SOFA)score,length of stay at RICU,and levels of total bilirubin(Tbil),serum creatinine(SCr),procalcitonin(PCT),C⁃reactive protein(CRP),GDF⁃15,and SDC⁃1 in the SIMI group were all higher than those in the non⁃SIMI group,while the level of platelet(PLT)and ADAMTS13 were lower than that in the non⁃SIMI group(χ^(2)/t=2.198,8.679,2.187,9.907,4.743,9.960,4.746,4.927,4.704,3.630,5.568;all P<0.05).The elevated APACHE II score,SOFA score,PCT,GDF⁃15,and SDC⁃1 expression levels were risk factors for the occurrence of SIMI,while elevated ADAMTS13 expression level was a protective factor f

关 键 词：生长分化因子15 血管性血友病因子裂解酶13 多配体蛋白聚糖-1 脓毒症心肌损伤 

分 类 号：R631[医药卫生—外科学]