[1]胡伊凌,邓烈华,吴家园.血清可溶性肿瘤抑制因子2、丙酮酸脱氢酶激酶4、瓜氨酸化组蛋白H3水平与脓毒症心肌损伤及其预后的关系分析[J].陕西医学杂志,2026,(4):473-479.[doi:DOI:10.3969/j.issn.1000-7377.2026.04.007]
　HU Yiling,DENG Liehua,WU Jiayuan.Analysis of the relationship between serum sST2,PDK4,CitH3 levels and septic myocardial injury and its prognosis[J].,2026,(4):473-479.[doi:DOI:10.3969/j.issn.1000-7377.2026.04.007]
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血清可溶性肿瘤抑制因子2、丙酮酸脱氢酶激酶4、瓜氨酸化组蛋白H3水平与脓毒症心肌损伤及其预后的关系分析

《陕西医学杂志》[ISSN:1000-7377/CN:61-1281/TN]

卷:
期数:
2026年4期
页码:
473-479
栏目:
临床研究
出版日期:
2026-04-05

文章信息/Info

Title:
Analysis of the relationship between serum sST2,PDK4,CitH3 levels and septic myocardial injury and its prognosis
作者:
胡伊凌1; 邓烈华2; 吴家园3
（1.广东医科大学公共卫生学院，广东 湛江 524023；2.广东医科大学附属医院重症医学科，广东 湛江 524001；3.广东医科大学附属医院临床试验服务中心，广东 湛江524001）
Author(s):
HU Yiling1 ; DENG Liehua2; WU Jiayuan3
（1.School of Public Health,Guangdong Medical University,Zhanjiang 524023，China；2.Department of Critical Care Medicine,The Affiliated Hospital of Guangdong Medical University,Zhanjiang 524001,China；3.Clinical Trial Service Center,The Affiliated Hospital of Guangdong Medical University,Zhanjiang 524001,China）
关键词:
脓毒症心肌损伤; 可溶性肿瘤抑制因子2; 丙酮酸脱氢酶激酶4; 瓜氨酸化组蛋白H3; 预测效能; 预后
Keywords:
Septic myocardial injury; Soluble suppression of tumorigenicity 2; Pyruvate dehydrogenase kinase 4; Citrullinated histone H3; Predictive effectiveness; Prognosis
分类号:
R 542.2
DOI:
DOI:10.3969/j.issn.1000-7377.2026.04.007
文献标志码:
A
摘要:
目的：探讨血清可溶性肿瘤抑制因子2（sST2）、丙酮酸脱氢酶激酶 4（PDK4）、瓜氨酸化组蛋白 H3（CitH3）水平与脓毒症心肌损伤及其预后的关系。方法：采用前瞻性队列研究设计，选取收治的320例脓毒症患者，根据心肌损伤发生情况将患者分为心肌损伤组（136例）和对照组（184例）。检测血清sST2、PDK4、CitH3水平，心肌损伤指标[肌钙蛋白I（cTnI）、肌酸激酶同工酶（CK-MB）]和超声心动图指标[左室舒张末期内径（LVED-D）、左室收缩末期内径（LVESD）、左室射血分数（LVEF）、每搏输出量（SV）、心输出量（CO）、二尖瓣口舒张早期最大流速与心房收缩期最大流速比值（E/A）]。Pearson相关系数描述sST2、PDK4、CitH3表达与心肌损伤指标和超声心动图指标之间相关性。多因素Logistic回归分析影响脓毒症心肌损伤患者预后的因素，受试者工作特征曲线（ROC）分析sST2、PDK4、CitH3单独及联合检测对脓毒症心肌损伤患者预后的预测价值。结果：心肌损伤组血清sST2、PDK4、CitH3、cTnI、CK-MB水平，LVED-D、LVESD高于对照组（均P＜0.05），LVEF、SV、CO、E/A低于对照组（均P＜0.05）。心肌损伤组血清sST2、PDK4、CitH3水平与cTnI、CK-MB、LVED-D、LVESD呈正相关（均P＜0.05），与LVEF、SV、CO、E/A呈负相关（均P＜0.05）。多因素Logistic回归结果显示，APACHE Ⅱ评分、cTnI、sST2、PDK4、CitH3是脓毒症心肌损伤患者预后不良的危险因素（均P＜0.05）。sST2、PDK4、CitH3预测脓毒症心肌损伤患者预后的AUC分别为0.816、0.833、0.839，高于APACHE Ⅱ评分、cTnI（均P＜0.05）。联合sST2、PDK4、CitH3预测脓毒症心肌损伤患者预后的AUC为0.945，高于单独预测（P＜0.05）。结论：脓毒症心肌损伤患者血清sST2、PDK4、CitH3水平增高与心肌损伤加重以及预后不良有关，三者在脓毒症心肌损伤预后预测中具有较高的价值。
Abstract:
Objective:To investigate the relationship between serum levels of soluble suppression of tumorigenicity 2 （sST2）,pyruvate dehydrogenase kinase 4 （PDK4）,citrullinated histone H3 （CitH3） and septic myocardial injury as well as its prognosis.Methods：A prospective cohort study was conducted,a total of 320 patients with sepsis admitted to our hospital from March 2021 to March 2025 were selected and divided into the myocardial injury group （136 cases） and the control group （184 cases） according to the occurrence of myocardial injury.Serum levels of sST2,PDK4,and CitH3 were detected,along with myocardial injury indicators [troponin I （cTnI）,creatine kinaseMB （CK-MB）]and echocardiographic parameters [left ventricular enD-Diastolic diameter （LVED-D）,left ventricular endsystolic diameter （LVESD）,left ventricular ejection fraction （LVEF）,stroke volume （SV）,cardiac output （CO）,ratio of early diastolic maximum flow velocity to atrial systolic maximum flow velocity of mitral valve （E/A）].Pearson correlation coefficient was used to analyze the correlations between serum sST2,PDK4,CitH3 levels and myocardial injury indicators/echocardiographic parameters.Multivariate Logistic regression was performed to identify factors influencing the prognosis of patients with septic myocardial injury.Receiver operating characteristic （ROC） curves were used to evaluate the prognostic value of sST2,PDK4,and CitH3 alone or in combination for patients with septic myocardial injury.Results:Compared with the control group,the myocardial injury group had significantly higher serum levels of sST2,PDK4,CitH3,cTnI,and CK-MB,as well as higher LVED-D and LVESD （all P<0.05）,while LVEF,SV,CO,and E/A were significantly lower （all P<0.05）.In the myocardial injury group,serum sST2,PDK4,and CitH3 levels were positively correlated with cTnI,CK-MB,LVED-D,and LVESD （all P<005）,and negatively correlated with LVEF,SV,CO,and E/A （all P<0.05）.Multivariate Logistic regression analysis showed that APACHE Ⅱ score,cTnI,sST2,PDK4,and CitH3 were independent risk factors for poor prognosis in patients with septic myocardial injury （all P<0.05）.The area under the curve （AUC） of sST2,PDK4,and CitH3 for predicting prognosis was 0.816,0.833,and 0.839,respectively,which were significantly higher than those of APACHE Ⅱ score and cTnI （all P<0.05）.The combined detection of sST2,PDK4,and CitH3 yielded an AUC of 0945 for prognostic prediction,which was significantly higher than that of any single indicator （P<0.05）.Conclusion:Increased serum levels of sST2,PDK4,and CitH3 in patients with septic myocardial injury are associated with aggravated myocardial injury and poor prognosis.These three indicators have high value in predicting the prognosis of septic myocardial injury.

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备注/Memo

备注/Memo:
国家自然科学基金资助项目（82172148）
更新日期/Last Update: 2026-04-05