The relationship between thioredoxin 1 and short-term adverse cardiac events in septic cardiomyopathy
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摘要: 目的 分析硫氧还蛋白(Trx)-1与脓毒症心肌病短期主要不良心血管事件(MACE)发生的关系。方法 纳入并分析2020年3月—2023年2月在医院急诊重症监护病房(EICU)内接受诊治的135例脓毒症心肌病患者，入院常规行血液检查及资料评估，以入院28 d的内发生MACE为研究终点，将患者分为MACE组和非MACE(N-MACE)组。采用logistic回归和限制性立方样条法，分析血清Trx-1与脓毒症心肌病短期内发生MACE的关系。结果 本研究中135例脓毒症心肌病患者，入院28 d内发生MACE共52例，发生时间为4~25 d，平均(13.83±5.52) d，发生率为38.52%。MACE组患者体温>38.3℃、慢性肾脏疾病(CKD)比例、急性生理与慢性健康评分(APACHE Ⅱ)、N末端前体脑利钠肽(NT-proBNP)、白细胞介素(IL)-6及Trx-1水平均高于N-MACE组，24 h乳酸清除率、左心室射血分数(LVEF)低于N-MACE组，差异有统计学意义(P < 0.05)。采用logistic回归分析，体温>38.3℃，APACHE Ⅱ评分升高，乳酸清除不足，LVEF减低，血清Trx-1、IL-6水平异常升高与脓毒症心肌病患者入院28 d内MACE风险增加有关(P < 0.05)。采用限制性立方样条法分析，血清Trx-1与脓毒症心肌病患者入院28 d内MACE发生风险呈正向线性关系(P < 0.05)。结论 脓毒症心肌病患者血清Trx-1水平异常升高与入院28 d内发生MACE有关，MACE风险随着血清Trx-1水平升高而增加。Abstract: Objective To analyze the relationship between thioredoxin(Trx) -1 and the occurrence of short-term major adverse cardiac events(MACE) in septic cardiomyopathy.Methods A total of 135 patients with septic cardiomyopathy who received treatment in emergency intensive care unit(EICU) of hospital from March 2020 to February 2023 were included and analyzed. 135 patients underwent routine blood tests and data evaluation upon admission, with MACE occurring within 28 days of admission as the study endpoint. The patients were divided into the MACE group and the non MACE(N-MACE) group. logistic regression and restricted cubic spline method were used to analyze the relationship between serum Trx-1 and short-term MACE in septic cardiomyopathy.Results Among the 135 patients with septic cardiomyopathy in this study, a total of 52 cases of MACE occurred within 28 days of admission, with an average occurrence time of(13.83±5.52) days and an incidence rate of 38.52%, ranging from 4 to 25 days. The MACE group had higher body temperature>38.3 ℃, a higher proportion of chronic kidney disease(CKD), higher acute physiological and chronic health scores (APACHE Ⅱ), and higher levels of N-terminal precursor brain natriuretic peptide(NT-proBNP), interleukin-6(IL-6) and Trx-1 levels compared to the N-MACE group. The 24-hour lactate clearance rate and left ventricular ejection fraction(LVEF) were lower than those of N-MACE group, and the differences were statistically significant (P < 0.05). Logistic regression analysis showed that body temperature higher than>38.3 ℃, APACHE Ⅱ score increased, insufficient lactate clearance, LVEF decreased, abnormal increase of serum Trx-1 and IL-6 levels were related to the increased risk of MACE in patients with septic cardiomyopathy within 28 days of admission(P < 0.05). The restricted cubic spline method showed that there was the positive linear relationship between serum Trx-1 and the risk of MACE within 28 days of admission in patients with septic cardiomyopathy(P < 0.05).Conclusion The abnormal increased in serum Trx-1 levels in patients with septic cardiomyopathy was related to the occurrence of MACE within 28 days of admission, and the risk of MACE increased with the increase in serum Trx-1 levels.
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Key words:
- septic cardiomyopathy /
- adverse cardiac events /
- thioredoxin-1
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表 1 脓毒症心肌病并发MACE的资料特征分析
一般资料 MACE组(n=52) N-MACE组(n=83) t/χ2 P 年龄/岁 48.46±9.32 45.82±10.31 1.503 0.135 性别/例(%) 2.405 0.121 男 34(65.38) 43(51.81) 女 18(34.62) 40(48.19) 感染源/例(%) 1.426 0.700 肺部感染 28(53.85) 37(44.58) 腹膜炎 7(13.46) 14(16.87) 泌尿系感染 11(21.15) 18(21.69) 烧伤感染 6(11.54) 14(16.87) 体温/例(%) 10.792 0.001 >38.3℃ 37(71.15) 35(42.17) < 36.0℃ 15(28.85) 48(57.83) APACHE Ⅱ评分/分 25.31±4.18 20.84±3.95 6.246 < 0.001 SOFA评分/分 10.23±2.31 9.66±2.11 1.467 0.145 既往史/例(%) 高血压 15(28.85) 20(24.1) 0.376 0.540 糖尿病 12(23.08) 23(27.71) 0.358 0.550 CKD 12(23.08) 8(9.64) 4.575 0.032 慢阻肺 2(3.85) 6(7.23) 0.190 0.663 血乳酸/(mmol/L) 6.83±1.92 6.35±1.84 1.451 0.149 24 h乳酸清除率/% 44.37±6.85 51.53±8.10 5.506 < 0.001 24 h液体平衡/mL 1 926.35±212.53 1 858.44±233.16 1.703 0.091 LVEF/% 33.42±3.80 36.53±3.37 4.962 < 0.001 行CRRT治疗/例(%) 0.312 0.577 是 20(38.46) 28(33.73) 否 32(61.54) 55(66.27) VIS/分 48.61±8.46 45.76±8.49 1.897 0.060 cTnI/(μg/L) 0.31±0.08 0.29±0.08 1.330 0.186 CK/(U/L) 168.83±25.32 162.15±21.54 1.638 0.104 CK-MB/(U/L) 18.26±4.43 16.95±4.85 1.578 0.117 LDH/(U/L) 262.57±35.45 253.54±31.26 1.551 0.123 NT-proBNP/(pg/mL) 818.25±92.24 762.65±87.83 3.510 0.001 CRP/(mg/L) 192.35±21.26 186.64±23.54 1.616 0.109 PCT/(ng/mL) 36.35±5.24 34.82±6.13 1.490 0.139 IL-6/(pg/mL) 353.26±52.37 312.24±43.42 4.929 < 0.001 D-D/(μg/L) 152.36±23.37 145.53±19.32 1.842 0.068 Scr/(μmol/L) 112.35±18.52 108.44±15.45 1.324 0.188 BUN/(mmol/L) 11.56±3.32 10.53±3.16 1.807 0.073 Trx-1/(ng/mL) 14.45±3.87 10.32±3.18 6.765 < 0.001 
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表 2 血清Trx-1对脓毒症心肌病短期内发生MACE的影响
项目 β SE Wald P OR 95%CI 体温 1.563 0.656 5.677 0.017 4.772 1.319~17.258 APACHE Ⅱ评分 0.310 0.086 12.904 < 0.001 1.363 1.151~1.614 24 h乳酸清除率 -0.111 0.042 7.069 0.008 0.894 0.824~0.971 LVEF -0.279 0.091 9.373 0.002 0.757 0.633~0.905 CKD 0.606 0.862 0.494 0.482 1.834 0.338~9.942 NT-proBNP 0.005 0.004 2.069 0.150 1.005 0.998~1.013 IL-6 0.018 0.008 5.417 0.020 1.018 1.003~1.034 Trx-1 0.389 0.100 15.087 < 0.001 1.476 1.213~1.796 常量 -2.561 4.743 0.292 0.589 - -
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