脓毒症心肌损伤患者血清PDK4、NLRP3、PTEN水平与预后的相关性分析-东南大学学报医学版

脓毒症心肌损伤患者血清PDK4、NLRP3、PTEN水平与预后的相关性分析

单位：三峡大学第一临床医学院/宜昌市中心人民医院心血管内科, 湖北宜昌 443003

关键词：脓毒症心肌损伤丙酮酸脱氢酶激酶4 NOD样受体蛋白3 10号染色体上缺失的磷酸酶和张力蛋白同源物预后相关性

分类号：R542.2

出版年·卷·期（页码）：2025·44·第三期（473-479）

摘要：

目的: 探讨脓毒症患者血清丙酮酸脱氢酶激酶4(PDK4)、NOD样受体蛋白3(NLRP3)、10号染色体上缺失的磷酸酶和张力蛋白同源物(PTEN)水平与心肌损伤指标及预后的相关性。方法: 收集2021年9月至2023年9月本院收治的首次确诊为脓毒症的355例患者,根据其是否伴有心肌损伤分为脓毒症心肌损伤(SIMI)组(225例)和单纯脓毒症组(130例),并根据患者治疗28 d后的预后存亡情况分为死亡组(56例)和存活组(169例)。采用实时荧光定量PCR(qRT-PCR)检测血清PDK4、NLRP3、PTEN水平;采用全自动生化分析仪检测肌酸激酶同工酶(CK-MB)、心肌肌钙蛋白I(cTnI)、肌红蛋白(Mb)、心型脂肪酸结合蛋白(H-FABP)水平。采用Pearson相关系数法分析SIMI患者血清PDK4、NLRP3、PTEN与心肌损伤指标的关系;采用Cox回归分析SIMI患者预后的影响因素。结果: SIMI组血清PDK4、NLRP3、PTEN及CK-MB、cTnI、Mb、H-FABP水平显著高于单纯脓毒症组(P＜0.05);脓毒症患者血清PDK4、NLRP3、PTEN水平与心肌损伤指标CK-MB、cTnI、Mb、H-FABP均呈正相关(P＜0.05);预后死亡组SIMI患者APACHE Ⅱ评分、SOFA评分、cTnI以及血清PDK4、NLRP3、PTEN水平均高于生存组(P<0.05);APACHE Ⅱ评分、SOFA评分、cTnI、PDK4、NLRP3、PTEN是影响SIMI患者预后的独立危险因素(P<0.05)。结论: SIMI患者血清PDK4、NLRP3、PTEN均高表达,是影响SIMI患者预后的独立危险因素。

Objective: To investigate the correlation on serum levels of pyruvate dehydrogenase kinase 4(PDK4), NOD like receptor protein 3(NLRP3), phosphatase and tensin homolog deleted on chromosome ten(PTEN) with myocardial injury indicators and prognosis in sepsis patients. Methods: From September 2021 to September 2023, Collection of 355 patients with first diagnosis of sepsis admitted to our hospital were gathered and separated into sepsis induced myocardial injury(SIMI) group(225 cases) and sepsis alone group(130 cases) based on whether they had myocardial injury, and were divided into the death group(56 patients) and the survival group(169 patients) according to the prognostic survival of the patients after 28 d of treatment. Real-time fluorescence quantitative PCR(qRT-PCR) was applied to detect serum levels of PDK4, NLRP3, and PTEN. Fully automated biochemical analyzer was applied to detect the levels of creatine kinase isoenzyme(CK-MB), cardiac troponin I(cTnI), myoglobin(Mb), and heart type fatty acid binding protein(H-FABP). Pearson correlation coefficient method was applied to analyze the relationship between serum PDK4, NLRP3, PTEN and myocardial injury indicators in SIMI patients. Cox regression was applied to analyze the factors influencing the prognosis of SIMI patients. Results: The levels of serum PDK4, NLRP3, PTEN, CK-MB, cTnI, Mb, and H-FABP in the SIMI group were obviously higher than those in the sepsis alone group(P<0.05). The levels of serum PDK4, NLRP3, PTEN in sepsis patients were positively correlated with myocardial injury indicators CK-MB, cTnI, Mb, and H-FABP(P<0.05). The APACHE Ⅱ score, SOFA score, cTnI, and serum PDK4, NLRP3, and PTEN levels in the prognostic death group were higher than those in the survival group(P<0.05). APACHE Ⅱscore, SOFA score, cTnI, PDK4, NLRP3, and PTEN were independent risk factors affecting the prognosis of SIMI patients(P<0.05). Conclusion: Serum PDK4, NLRP3, and PTEN are all highly expressed in SIMI patients, and they are independent risk factors affecting the prognosis of SIMI patients.

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