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中华危重症医学杂志(电子版)

中华危重症医学杂志(电子版) ›› 2022, Vol. 15 ›› Issue (03) : 183 -188. doi: 10.3877/cma.j.issn.1674-6880.2022.03.002

论著

二维斑点追踪超声心动图联合lncRNA-肺腺癌转移相关转录因子1对脓毒症心肌病的早期诊断价值
乐元洁1, 王卫栋1, 贲志飞2,†()   
  1. 1. 315010　浙江宁波，中国科学院大学宁波华美医院急诊重症监护室
    2. 315010　浙江宁波，中国科学院大学宁波华美医院超声科
  • 收稿日期:2021-09-23 出版日期:2022-06-30
  • 通信作者: 贲志飞
  • 基金资助:
    浙江省医药卫生科技计划项目(2020ky83); 宁波市重点扶植学科(2022F16)

Early diagnostic value of two-dimensional speck-tracking echocardiography combined with long non-coding RNA and metastasis associated in lung adenocarcinoma transcript 1 in septic cardiomyopathy

Yuanjie Le1, Weidong Wang1, Zhifei Ben2,†()   

  1. 1. Department of Emergency Intensive Care Unit, Ningbo Huamei Hospital, University of Chinese Academy of Sciences, Ningbo 315010, China
    2. Department of Ultrasonography, Ningbo Huamei Hospital, University of Chinese Academy of Sciences, Ningbo 315010, China
  • Received:2021-09-23 Published:2022-06-30
  • Corresponding author: Zhifei Ben
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乐元洁, 王卫栋, 贲志飞. 二维斑点追踪超声心动图联合lncRNA-肺腺癌转移相关转录因子1对脓毒症心肌病的早期诊断价值[J]. 中华危重症医学杂志(电子版), 2022, 15(03): 183-188.

Yuanjie Le, Weidong Wang, Zhifei Ben. Early diagnostic value of two-dimensional speck-tracking echocardiography combined with long non-coding RNA and metastasis associated in lung adenocarcinoma transcript 1 in septic cardiomyopathy[J]. Chinese Journal of Critical Care Medicine(Electronic Edition), 2022, 15(03): 183-188.

目的

探讨二维斑点追踪超声心动图（2D-STE）联合长链非编码RNA（lncRNA）-肺腺癌转移相关转录因子1（MALAT1）对脓毒症心肌病（SCM）的诊断价值。

方法

选择2019年1月至2021年1月中国科学院大学宁波华美医院急诊重症监护室收治的86例脓毒症患者，根据左心室射血分数（LVEF）将86例脓毒症患者分成SCM组（LVEF<50%，37例）及脓毒症无心肌损伤组（LVEF ≥ 50%，49例）。分析两组患者的临床资料、整体纵向应变（GLS）、整体径向应变（GRS）、整体圆周应变（GCS）、血清lncRNA-MALAT1表达水平。采用二元Logistic回归分析影响SCM患者预后的危险因素，并采用受试者工作特征（ROC）曲线分析GLS、血清lncRNA-MALAT1对SCM的早期诊断价值。

结果

SCM组与脓毒症无心肌损伤组患者N末端B型钠尿肽前体（NT-proBNP）[（2 389 ± 2 240）ng/L vs.（1 156 ± 716）ng/L，t = 3.620，P = 0.001]、心肌肌钙蛋白I（cTnI）[（0.60 ± 0.41）μg/L vs.（0.35 ± 0.29）μg/L，t = 3.301，P = 0.001]、GLS[（-18.6 ± 1.6）% vs.（-20.5 ± 2.0）%，t = 4.735，P = 0.001]及lncRNA-MALAT1[（2.4 ± 0.5）vs.（2.0 ± 0.4），t = 4.219，P = 0.001]比较，差异均有统计学意义。二元Logistic回归分析结果显示，NT-proBNP[比值比（OR）= 0.999，95%置信区间（CI）（0.999，1.000），P = 0.033]、cTnI[OR = 0.143，95%CI（0.024，0.839），P = 0.031]、GLS[OR = 0.543，95%CI（0.361，0.817），P = 0.003]和lncRNA-MALAT1[OR = 0.059，95%CI（0.011，0.309），P = 0.001]均为SCM的独立危险因素。ROC曲线分析结果显示，NT-proBNP[曲线下面积（AUC）= 0.697，95%CI（0.588，0.791），P = 0.001]、cTnI[AUC = 0.681，95%CI（0.572，0.778），P = 0.003]、GLS[AUC = 0.766，95%CI（0.667，0.866），P < 0.001]、lncRNA-MALAT1[AUC = 0.735，95%CI（0.630，0.840），P < 0.001]及GLS联合lncRNA-MALAT1[AUC = 0.845，95%CI（0.764，0.926），P < 0.001]均对SCM具有诊断价值，且GLS联合lncRNA-MALAT1的诊断价值更高。

结论

2D-STE联合lncRNA-MALAT1对脓毒症心肌损伤具有一定的诊断意义。

关键词: 脓毒症心肌病, 长链非编码RNA, 肺腺癌转移相关转录因子1, 二维斑点追踪超声心动图
Objective

To investigate the diagnostic value of two-dimensional speck-tracking echocardiography (2D-STE) combined with long non-coding RNA (lncRNA) and metastasis associated in lung adenocarcinoma transcript 1 (MALAT1) in septic cardiomyopathy (SCM).

Methods

A total of 86 septic patients admitted to the Department of Emergency Intensive Care Unit of Ningbo Huamei Hospital, University of Chinese Academy of Sciences from January 2019 to January 2021 were selected. According to left ventricular ejection fraction (LVEF), 86 septic patients were divided into a SCM group (LVEF < 50%, n = 37) and a non-SCM group (LVEF ≥ 50%, n = 49). Clinical data, global longitudinal strain (GLS), global radial strain (GRS), global circumferential strain (GCS) and serum lncRNA-MALAT1 of the two groups were analyzed. The binary Logistic regression was used to analyze the risk factors affecting the prognosis of patients with SCM, and the receiver operating characteristic (ROC) curve was used to analyze the early diagnostic values of GLS and serum lncRNA-MALAT1 in SCM.

Results

The N-terminal pro-B-type natriuretic peptide (NT-proBNP) [(2 389 ± 2 240) ng/L vs. (1 156 ± 716) ng/L, t = 3.620, P = 0.001], cardiac troponin I (cTnI) [(0.60 ± 0.41) μg/L vs. (0.35 ± 0.29) μg/L, t = 3.301, P = 0.001], GLS [(-18.6 ± 1.6)% vs. (-20.5 ± 2.0)%, t = 4.735, P = 0.001] and lncRNA-MALAT1 [(2.4 ± 0.5) vs. (2.0 ± 0.4), t = 4.219, P = 0.001] all showed significant differences between the SCM group and the non-SCM group. The binary Logistic regression analysis revealed that NT-proBNP [odds ratio (OR) = 0.999, 95% confidence interval (CI) (0.999, 1.000), P = 0.033], cTnI [OR = 0.143, 95%CI (0.024, 0.839), P = 0.031], GLS [OR = 0.543, 95%CI (0.361, 0.817), P = 0.003] and lncRNA-MALAT1 [OR = 0.059, 95%CI (0.011, 0.309), P = 0.001] were independent risk factors for SCM. The ROC curve analysis showed that NT-proBNP [area under the cure (AUC) = 0.697, 95%CI (0.588, 0.791), P = 0.001], cTnI [AUC = 0.681, 95%CI (0.572, 0.778), P = 0.003], GLS[AUC = 0.766, 95%CI (0.667, 0.866), P < 0.001], lncRNA-MALAT1 [AUC = 0.735, 95%CI (0.630, 0.840), P < 0.001] and GLS combined with lncRNA-MALAT1 [AUC = 0.845, 95%CI (0.764, 0.926), P < 0.001] had diagnostic values for SCM. In particular, GLS combined with lncRNA-MALAT1 had the best diagnostic value among these five markers.

Conclusion

The combination detection of 2D-STE and lncRNA-MALAT1 has diagnostic significance on sepsis-induced myocardial injury.

Key words: Septic cardiomyopathy, Long non-coding RNA, Metastasis associated in lung adenocarcinoma transcript 1, Two-dimensional speckle-tracking echocardiography
表1 两组脓毒症患者一般资料比较（ ± s）
组别 例数 年龄（岁） 性别（例，男/女） 去甲肾上腺素剂量（μg·kg-1·min-1） 乳酸（mmol/L） C反应蛋白（mg/L） 降钙素原（μg/L） NT-proBNP（ng/L） cTnI（μg/L）
SCM组 37 58 ± 14 23/14 0.66 ± 0.43 5.6 ± 3.2 223 ± 72 23 ± 19 2 389 ± 2 240 0.60 ± 0.41
脓毒症无心肌损伤组 49 60 ± 12 31/18 0.81 ± 0.43 4.7 ± 2.2 187 ± 86 18 ± 10 1 156 ± 716 0.35 ± 0.29
t/χ2值   0.480 0.011 1.702 1.647 0.834 1.427 3.620 3.301
P值   0.633 0.917 0.092 0.103 0.201 0.157 0.001 0.001
组别 例数 lncRNA-MALAT1 SOFA评分（分） APACHEⅡ评分（分） 感染部位[例（%）]
肺及胸腔 腹腔 泌尿系统 皮肤软组织 其他
SCM组 37 2.4 ± 0.5 9.2 ± 3.0 20.4 ± 5.5 9（24.3） 15（40.5） 6（16.2） 2（5.4） 5（13.5）
脓毒症无心肌损伤组 49 2.0 ± 0.4 8.0 ± 3.4 19.8 ± 4.9 16（32.7） 17（34.7） 8（16.3） 3（6.1） 5（10.2）
t/χ2值   4.219 1.801 0.545 1.137
P值   0.001 0.075 0.587 0.813
表2 两组脓毒症患者2D-STE指标比较（%， ± s）
组别 例数 GLS GCS GRS
SCM组 37 -18.6 ± 1.6 -19.2 ± 2.3 34.9 ± 3.7
脓毒症无心肌损伤组 49 -20.5 ± 2.0 -20.4 ± 2.1 35.8 ± 3.1
t值   4.735 1.206 0.627
P值   0.001 0.173 0.315
表3 脓毒症患者发生SCM的危险因素分析
危险因素 回归系数 标准误 Wald值 P值 OR值 95%CI
NT-proBNP（ng/L） -0.001 0.005 4.523 0.033 0.999 0.999 ~ 1.000
cTnI（μg/L） -1.946 0.903 4.639 0.031 0.143 0.024 ~ 0.839
GLS（%） -0.611 0.208 8.598 0.003 0.543 0.361 ~ 0.817
lncRNA-MALAT1 -2.833 0.846 11.205 0.001 0.059 0.011 ~ 0.309
图1 各指标预测脓毒症患者发生SCM的ROC曲线分析注：SCM.脓毒症心肌病；ROC.受试者工作特征；NT-proBNP. N末端B型钠尿肽前体；cTnI.心肌肌钙蛋白I；GLS.整体纵向应变；lncRNA.长链非编码RNA；MALAT1.肺腺癌转移相关转录因子1
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