基于线粒体损伤指数建立急诊脓毒症患者心肌损伤的诺莫图及其预测效能评价

常东歌; 杨宁; 袁咏梅; 田琦

doi:10.16766/j.cnki.issn.1674-4152.004243

基于线粒体损伤指数建立急诊脓毒症患者心肌损伤的诺莫图及其预测效能评价

doi: 10.16766/j.cnki.issn.1674-4152.004243

郑州大学附属郑州中心医院急诊科，河南郑州 450000

基金项目:

河南省科技攻关项目 242102310120

详细信息

通讯作者:
常东歌，E-mail：donggedoctor@163.com

中图分类号: R631.2 R542.2
计量
- 文章访问数: 1
- HTML全文浏览量: 2
- PDF下载量: 0
- 被引次数: 0
出版历程
- 收稿日期: 2024-10-18
- 网络出版日期: 2026-01-07

Establish Nomogram for myocardial damage in emergency sepsis patients based on mitochondrial damage index, and evaluate its predictive efficacy

Emergency Department of Zhengzhou Central Hospital Affiliated to Zhengzhou University, Zhengzhou, Henan 450000, China

摘要

摘要: 目的基于线粒体损伤指数(MDI)探究急诊脓毒症患者发生心肌损伤的风险指标，并构建诺莫图预测模型，验证其预测效能。方法选取2022年3月—2024年3月于郑州大学附属郑州中心医院确诊并治疗的156例急诊脓毒症患者，根据是否发生心肌损伤分为心肌损伤组(98例)及非心肌损伤组(58例)。入院当天抽取患者外周静脉血，采用流式细胞术检测血清T淋巴细胞亚群和辅助性T细胞(Th)、抑制性T细胞(Ts)的MDI，采用单因素及多因素分析研究影响急诊脓毒症患者心肌损伤的指标，构建诺莫图模型，通过ROC曲线分析诺莫图预测效能。结果心肌损伤组患者高血脂、肺部感染、腹腔感染、合并感染性休克、心室舒张早期和心室舒张末期的血流流速(E/A)比值、CD3⁺、CD4⁺、CD8⁺、Th MDI阳性、Ts MDI阳性均高于非心肌损伤组(P＜0.05)，心室射血分数(EF)低于非心肌损伤组(P＜0.05)。腹腔感染、合并感染性休克、EF、Th MDI阳性及Ts MDI阳性是急诊脓毒症患者发生心肌损伤的影响因素。据此构建诺莫图模型，校准曲线显示一致性指数为0.866(95% CI：0.773~0.945)，H-L拟合优度检验χ²=6.476(P>0.05)，ROC曲线下面积为0.829(95% CI：0.744~0.906)，灵敏度、特异度分别为80.70%、72.00%。结论腹腔感染、合并感染性休克、EF值、Th MDI阳性及Ts MDI阳性是急诊脓毒症患者发生心肌损伤的影响因素，所构建的诺莫图模型对急诊脓毒症患者发生心肌损伤预测效果良好。
- 急诊脓毒症 /
- 心肌损伤 /
- 线粒体损伤指数 /
- 诺莫图
Abstract: Objective The present study investigates the risk index of myocardial damage in patients with emergency sepsis based on mitochondrial damage index (MDI). In addition, the prediction model of Nomograph was constructed to verify its prediction efficiency. Methods A prospective analysis was performed on 156 patients with acute sepsis who were diagnosed and treated in Zhengzhou Central Hospital Affiliated to Zhengzhou University from March 2022 to March 2024, and they were divided into two groups: a myocardial injury group (98 cases) and non-myocardial injury group (58 cases) according to whether myocardial injury occurred. Peripheral venous blood was collected on the day of admission, and the MDI of serum T lymphocyte subsets, helper T cells (Th) and inhibitory T cells (Ts) were detected by flow cytometry. The indicators affecting myocardial injury in patients with emergency sepsis were analyzed by uni-factor and multi-factor analysis, and the prediction efficiency of Nomogram was analyzed by receiver operating characteristic curve (ROC). Results The myocardial injury group exhibited elevated levels of hyperlipidemia, pulmonary infection, abdominal infection, septic shock, E/A, CD3⁺, CD4⁺, CD8⁺, Th MDI positive and Ts MDI positive when compared to the myocardial injury group were higher than those in non-myocardial injury group (P < 0.05), and EF value was found to be lower in the myocardial injury group than that in the non-myocardial injury group (P < 0.05). Peritoneal infection, septic shock, ejection fraction (EF), Th MDI positive and Ts MDI positive are the influential factors for myocardial injury in emergency sepsis patients. The calibration curve demonstrated that the consistency index was 0.866 (95% CI: 0.773-0.945), the H-L goodness-of-fit test (χ²=6.476, P>0.05), and the area under the ROC curve was 0.829 (95% CI: 0.744-0.906). The sensitivity and specificity were found to be 80.70% and 72.00%, respectively. Conclusion Abdominal infection, septic shock, EF, Th MDI positive and Ts MDI positive are the influential factors for myocardial injury in emergency sepsis patients. The Nomograph model established in this study has been shown to be an effective in predicting myocardial injury.
- Emergency sepsis /
- Myocardial injury /
- Mitochondrial damage index /
- Nomogram

HTML全文

图 1 急诊脓毒症患者发生心肌损伤的诺莫图预测模型

Figure 1. Nomogram prediction model for myocardial injury in patients with emergency sepsis

下载: 全尺寸图片幻灯片

图 2 急诊脓毒症患者发生心肌损伤诺莫图预测模型的校准曲线

Figure 2. Calibration curve of the nomogram prediction model for myocardial injury in patients with sepsis in the emergency department

下载: 全尺寸图片幻灯片

图 3 急诊脓毒症患者发生心肌损伤诺莫图预测模型的ROC曲线

Figure 3. ROC curve of the nomogram model predicting the occurrence of myocardial injury in patients with sepsis in the emergency department

下载: 全尺寸图片幻灯片

表 1 2组急诊脓毒症患者一般情况比较

Table 1. Comparison of general conditions between the two groups of patients with acute sepsis

组别	例数	年龄(x±s，岁)	性别[例(%)]		BMI (x±s)	饮酒史[例(%)]	吸烟史[例(%)]	基础病史[例(%)]
组别	例数	年龄(x±s，岁)	男性	女性	BMI (x±s)	饮酒史[例(%)]	吸烟史[例(%)]	糖尿病	高血压	高血脂
心肌损伤组	98	52.18±6.34	52(53.06)	46(46.94)	22.68±3.05	45(45.92)	37(37.76)	20(20.41)	41(41.84)	36(36.73)
非心肌损伤组	58	53.10±7.06	33(56.90)	25(43.10)	21.94±3.28	26(44.83)	20(34.48)	11(18.97)	16(27.59)	11(18.97)
统计量		0.839^a	0.216^b		1.424^a	0.017^b	0.168^b	5.465^b	3.191^b	5.465^b
P值		0.403	0.642		0.157	0.895	0.682	0.019	0.740	0.019

组别	例数	病原菌检出率[例(%)]		合并感染性休克[例(%)]	感染部位[例(%)]				EF (x±s，%)	E/A (x±s)
组别	例数	阳性	阴性	合并感染性休克[例(%)]	肺部感染	腹腔感染	血流感染	其他感染	EF (x±s，%)	E/A (x±s)
心肌损伤组	98	33(33.67)	65(66.33)	78(79.59)	51(52.04)	31(31.63)	14(14.29)	2(2.04)	49.15±4.39	1.28±0.11
非心肌损伤组	58	19(32.76)	39(67.24)	8(13.79)	42(72.41)	5(8.62)	10(17.24)	1(1.72)	56.84±5.81	1.24±0.10
统计量		0.014^b		68.770^b	6.282^b	10.869^b	0.245^b	0.019^b	9.353^a	2.269^a
P值		0.907		＜0.001	0.012	＜0.001	0.621	0.889	＜0.001	0.025
注：^a为t值，^b为χ²值。

下载: 导出CSV

表 2 2组急诊脓毒症患者T淋巴细胞亚群及MDI指标比较

Table 2. Comparison of T lymphocyte subsets and MDI indexes between the two groups of patients with acute sepsis

组别	例数	CD3⁺ (x±s，%)	CD4⁺ (x±s，%)	CD8⁺ (x±s，%)	Th MDI阳性[例(%)]	Ts MDI阳性[例(%)]
心肌损伤组	98	75.98±8.26	41.07±5.86	32.69±3.54	62(63.27)	73(74.49)
非心肌损伤组	58	68.54±7.52	37.99±4.71	30.15±3.85	20(34.48)	27(46.55)
统计量		5.618^a	3.403^a	4.192^a	12.106^b	12.359^b
P值		＜0.001	＜0.001	＜0.001	＜0.001	＜0.001
注：^a为t值，^b为χ²值。

下载: 导出CSV

表 3 变量赋值情况

Table 3. Variable assignment

变量	赋值方法
高血脂	否=0，是=1
肺部感染	否=0，是=1
腹腔感染	否=0，是=1
合并感染性休克	否=0，是=1
EF	以实际值赋值
E/A	以实际值赋值
CD3⁺	以实际值赋值
CD4⁺	以实际值赋值
CD8⁺	以实际值赋值
Th MDI阳性	否=0，是=1
Ts MDI阳性	否=0，是=1

下载: 导出CSV

表 4 急诊脓毒症患者发生心肌损伤的logistic回归分析

Table 4. Logistic regression analysis of myocardial injury in patients with acute sepsis

变量	B	SE	Waldχ²	P值	OR值	95% CI
高血脂	0.527	0.325	2.629	0.115	1.694	1.057~2.331
肺部感染	0.663	0.342	3.758	0.069	1.941	1.270~2.611
腹腔感染	0.798	0.365	4.780	0.047	2.221	1.506~2.936
合并感染性休克	0.965	0.251	14.781	＜0.001	2.625	2.324~3.649
EF	1.094	0.338	10.476	＜0.001	2.986	2.133~3.117
E/A	0.632	0.294	4.621	0.058	1.881	1.305~2.458
CD3⁺	0.615	0.365	2.839	0.095	1.850	1.134~2.565
CD4⁺	0.734	0.405	3.285	0.074	2.083	1.290~2.877
CD8⁺	0.711	0.418	2.893	0.086	2.036	1.217~2.855
Th MDI阳性	0.735	0.288	6.513	0.025	2.085	1.521~2.650
Ts MDI阳性	0.826	0.276	8.957	0.011	2.284	1.743~2.825

下载: 导出CSV

参考文献(20)

[1]	FRENCKEN J F, VAN SMEDEN M, VAN DE GROEP K, et al. Etiology of myocardial injury in critically ill patients with sepsis: a cohort study[J]. Ann Am Thorac Soc, 2022, 19(5): 773-780. doi: 10.1513/AnnalsATS.202106-689OC
[2]	秦苏徽, 顿士娟. 脓毒症相关凝血功能障碍患者发病及预后危险因素分析[J]. 中华全科医学, 2021, 19(12): 2020-2023. doi: 10.16766/j.cnki.issn.1674-4152.002225 QIN S H, DUN S J. Analysis of risk factors for the pathogenesis and prognosis of patients with sepsis-associated coagulopathy[J]. Chinese Journal of General Practice, 2021, 19(12): 2020-2023. doi: 10.16766/j.cnki.issn.1674-4152.002225
[3]	LIU C, ZOU Q, TANG H X, et al. Melanin nanoparticles alleviate sepsis-induced myocardial injury by suppressing ferroptosis and inflammation[J]. Bioact Mater, 2022, 24: 313-321.
[4]	LIU H R, XU C Q, HU Q, et al. Sepsis-induced cardiomyopathy: understanding pathophysiology and clinical implications[J]. Arch Toxicol, 2024. DOI: 10.1007/s00204-024-03916-x.
[5]	HOLLENBERG S M, SINGER M. Pathophysiology of sepsis-induced cardiomyopathy[J]. Nat Rev Cardiol, 2021, 18(6): 424-434. doi: 10.1038/s41569-020-00492-2
[6]	TODOROVIC MARKOVIC M, TODOROVIC MITIC M, IGNJATOVIC A, et al. Mortality in community-acquired sepsis and infections in the Faroe Islands: a prospective observational study[J]. Infect Dis Rep, 2024, 16(3): 448-457. doi: 10.3390/idr16030033
[7]	JIANG T, WANG Q, LV J G, et al. Mitochondria-endoplasmic reticulum contacts in sepsis-induced myocardial dysfunction[J]. Front Cell Dev Biol, 2022, 10: 1036225. DOI: 10.3389/fcell.2022.1036225.
[8]	KUROSHIMA T, KAWAGUCHI S, OKADA M. Current perspectives of mitochondria in sepsis-induced cardiomyopathy[J]. Int J Mol Sci, 2024, 25(9): 4710. DOI: 10.3390/ijms25094710.
[9]	SRZIĆ I, NESEK ADAM V, TUNJIĆ PEJAK D. Sepsis definition: what's new in the treatment guidelines[J]. Acta Clin Croat, 2022, 61(Suppl 1): 67-72.
[10]	NASERI A, AKYUZ E, TURGUT K, et al. Sepsis-induced cardiomyopathy in animals: from experimental studies to echocardiography-based clinical research[J]. Can Vet J, 2023, 64(9): 871-877.
[11]	WU F, ZHANG Y T, TENG F, et al. S100a8/a9 contributes to sepsis-induced cardiomyopathy by activating ERK1/2-Drp1-mediated mitochondrial fission and respiratory dysfunction[J]. Int Immunopharmacol, 2023, 115: 109716. DOI: 10.1016/j.intimp.2023.109716.
[12]	张文静, 李晓峰, 孙明明, 等. 线粒体自噬在心肌梗死中的作用及研究进展[J]. 中华全科医学, 2022, 20(7): 1194-1198. doi: 10.16766/j.cnki.issn.1674-4152.002556 ZHANG W J, LI X F, SUN M M, et al. Research progress and function of mitophagy in myocardial infarction[J]. Chinese Journal of General Practice, 2022, 20(7): 1194-1198. doi: 10.16766/j.cnki.issn.1674-4152.002556
[13]	NI D, LIN X F, DENG C H, et al. Energy metabolism: from physiological changes to targets in sepsis-induced cardiomyopathy[J]. Hellenic J Cardiol, 2024, 80: 96-106. doi: 10.1016/j.hjc.2024.05.010
[14]	SONG J Y, FANG X L, ZHOU K X, et al. Sepsis-induced cardiac dysfunction and pathogenetic mechanisms (review)[J]. Mol Med Rep, 2023, 28(6): 227. DOI: 10.3892/mmr.2023.13114.
[15]	CHEN T T, YE L, ZHU J, et al. Inhibition of pyruvate dehydrogenase kinase 4 attenuates myocardial and mitochondrial injury in sepsis-induced cardiomyopathy[J]. J Infect Dis, 2024, 229(4): 1178-1188. doi: 10.1093/infdis/jiad365
[16]	韩永燕, 杨俊礼, 孟会敏, 等. 血尿素氮/白蛋白比值联合可溶性生长刺激表达基因2蛋白对急诊重症监护病房老年脓毒症患者心肌损伤的预警价值[J]. 中华老年医学杂志, 2024, 43(6): 727-732. HAN Y Y, YANG J L, MENG H M, et al. Early warning value of blood urea nitrogen to albumin ratio combined with soluble growth stimulation expressed gene 2 on sepsis-induced myocardial injury in elderly patients in emergency intensive care unit[J]. Chinese Journal of Geriatrics, 2024, 43(6): 727-732.
[17]	SINGAM A. Myocardial injury as a harbinger of multi-organ failure in septic shock: a comprehensive review[J]. Cureus, 2024, 16(2): e55021. DOI: 10.7759/cureus.55021.
[18]	BLIXT P J, NGUYEN M, CHOLLEY B, et al. Association between left ventricular systolic function parameters and myocardial injury, organ failure and mortality in patients with septic shock[J]. Ann Intensive Care, 2024, 14(1): 12. DOI: 10.1186/s13613-023-01235-5.
[19]	陆珏秀, 刘先霞, 闫霖. 左室射血分数在急性心肌梗死中应用的研究进展[J]. 临床医学进展, 2023, 13(2): 1203-1208. LU J X, LIU X X, YAN L. Research progress of left ventricular ejection fraction in acute myocardial infarction[J]. Advances in Clinical Medicine, 2023, 13(2): 1203-1208.
[20]	DE NUNZIO C, GHAHHARI J, LOMBARDO R, et al. Development of a nomogram predicting the probability of stone free rate in patients with ureteral stones eligible for semi-rigid primary laser uretero-litothripsy[J]. World J Urol, 2021, 39(11): 4267-4274. doi: 10.1007/s00345-021-03768-5