血清激活素A和肾上腺髓质素前体水平与心脏瓣膜置换术后并发肺部感染患者病情严重程度及预后的关系分析  

Relationship between levels of serum activin A and pro-adrenomedullin and severity and prognosis of patients with pulmonary infection after cardiac valve replacemen

作　　者：李薇 许昌海 李保银 孙畅 崔岩 LI Wei;XU Chang-hai;LI Bao-yin;SUN Chang;CUI Yan(The Intensive Care Department,the General Hospital of the Northern Theater Command of the People’s Liberation Army of China,Shenyang 110000,China;Cardiovascular Surgery,the General Hospital of the Northern Theater Command of the People’s Liberation Army of China,Shenyang 110000,China)

机构地区：[1]中国人民解放军北部战区总医院重症医学科,辽宁省沈阳市110000 [2]中国人民解放军北部战区总医院心外科,辽宁省沈阳市110000

出　　处：《中国心血管病研究》2025年第2期109-114,共6页Chinese Journal of Cardiovascular Research

基　　金：辽宁省科学技术计划项目(2022JH2/101800015)。

摘　　要：目的探讨血清激活素A(ACTA)和肾上腺髓质素前体(pro-ADM)与心脏瓣膜置换术后并发肺部感染(PI)病情严重程度及预后的关系。方法连续纳入2022年4月至2023年5月于北部战区总医院行心脏瓣膜置换术后并发PI患者100例作为PI组,同时按照连续纳入的原则选择同期行心脏瓣膜置换术后未并发PI患者100例作为非PI组。采用临床PI评分(CPIS)评估PI组病情,将PI组进一步分为轻度PI组(6~7分)34例、中度PI组(8~9分)38例、重度PI组(10~12分)28例。根据术后1年情况,将PI组进一步分为不良预后组30例、良好预后组70例。收集PI患者临床资料;采集PI组确诊时和非PI组住院期间复查时空腹静脉血,用酶联免疫吸附法检测血清ACTA、pro-ADM。多因素Logistic回归分析血清ACTA、pro-ADM对心脏瓣膜置换术后并发PI患者预后的影响。绘制ROC曲线,评价血清ACTA、pro-ADM对心脏瓣膜置换术后并发PI患者预后的预测价值。结果PI组血清ACTA、pro-ADM水平高于非PI组[(46.24±5.66)ng/L比(17.29±4.67)ng/L;(3.08±0.34)nmol/L比(1.09±0.27)nmol/L,P<0.05]。PI组三组比较,轻度PI组、中度PI组、重度PI组血清ACTA、pro-ADM水平依次升高[(40.80±4.31)ng/L比(47.28±3.42)ng/L比(51.45±3.43)ng/L;(2.75±0.21)nmol/L比(3.09±0.19)nmol/L比(3.46±0.17)nmol/L,P<0.05]。两组纽约心脏协会(NYHA)心功能分级、CPIS评分、主动脉阻断时间、体外循环时间比较差异有统计学意义(P均<0.05)。NYHA分级Ⅲ~Ⅳ级、CPIS评分高、主动脉阻断时间长、体外循环时间长、ACTA高、pro-ADM高为心脏瓣膜置换术后并发PI患者预后的独立危险因素(P均<0.05)。血清ACTA联合pro-ADM预测心脏瓣膜置换术后并发PI患者预后的曲线下面积大于二者单独预测[0.880比0.784比0.785,P<0.05]。结论血清ACTA、pro-ADM水平升高与心脏瓣膜置换术后并发PI患者病情加重和预后不良密切相关,二者联合检测对患者预后有较高的预测价值。Objective To investigate the relationship between serum activin A(ACTA)and pro-adrenomedullin(pro-ADM)and the severity and prognosis of pulmonary infection(PI)after cardiac valve replacement.Methods Consecutive enrollment of 100 patients who underwent heart valve replacement and developed PI at Northern Theater General Hospital from April 2022 to May 2023 was conducted as the PI group.Meanwhile,based on the principle of consecutive enrollment,another 100 patients who underwent heart valve replacement but did not develop PI during the same period were selected as the non-PI group.The clinical PI score(CPIS)was used to assess the condition of the PI group,which was further classified into 34 cases in the mild PI group(6-7 points),38 cases in the moderate PI group(8-9 points)and 28 cases in the severe PI group(10-12 points).According to the situation at 1 year after the operation,the PI group was further classified into the poor prognosis group(30 cases)and the good prognosis group(70 cases).The clinical data of patients with PI were collected.The fasting venous blood was collected at the time of diagnosis in the PI group and at the time of rechecking in the non-PI group,and the serum ACTA and pro-ADM were detected by enzyme linked immunosorbent assay.The effects of serum ACTA and pro-ADM on the prognosis of patients with PI after cardiac valve replacement were analyzed by multifactorial Logistic regression.ROC curves were plotted to evaluate the predictive value of serum ACTA and pro-ADM on the prognosis of patients with PI after cardiac valve replacement.Results The serum levels of ACTA and pro-ADM were higher in the PI group compared to the non-PI group[(46.24±5.66)ng/L vs.(17.29±4.67)ng/L;(3.08±0.34)nmol/L vs.(1.09±0.27)nmol/L,P<0.05].When comparing the three subgroups within the PI group(mild,moderate,and severe PI),the serum levels of ACTA and pro-ADM increased sequentially[(40.80±4.31)ng/L vs.(47.28±3.42)ng/L vs.(51.45±3.43)ng/L;(2.75±0.21)nmol/L vs.(3.09±0.19)nmol/L vs.(3.46±0.17)nmol/L,P<0.05].The

关 键 词：心脏瓣膜置换术 肺部感染 激活素A 肾上腺髓质素前体 预后 

分 类 号：R654.7[医药卫生—外科学]