cTnI、ApoA-Ⅰ联合冠状动脉CT血管成像对脓毒症相关心肌损伤的评估价值分析

Evaluation value of cTnI and ApoA-Ⅰ combined with coronary artery computed tomography angiography for myocardial injury in patients with sepsis

摘要:

目的 探讨心肌肌钙蛋白I（cTnI）、载脂蛋白A-Ⅰ（ApoA-Ⅰ）联合CT冠状动脉成像对脓毒症患者心肌损伤的评估价值。方法 回顾性分析2022年1月—2024年12月在梅州市人民医院接受治疗的85例脓毒症患者的临床资料。所有患者均接受冠状动脉CT血管成像检查，并检测患者血清cTnI、ApoA-Ⅰ水平。根据患者发生脓毒症72 h后心肌肌钙蛋白T（cTnT）水平将患者分为心肌损伤组52例和非心肌损伤组33例。采用多因素一般Logistic回归分析脓毒症患者发生心肌损伤的影响因素，绘制受试者工作特征（ROC）曲线评估血清cTnI、ApoA-Ⅰ联合检测对脓毒症患者发生心肌损伤的预测价值。结果 心肌损伤组与非心肌损伤组深在型心肌桥（无狭窄）率、无明显狭窄或斑块率比较，差异均有统计学意义（P <0.05）；心肌损伤组患者的血清cTnI水平高于非心肌损伤组（P <0.05），心肌损伤组患者ApoA-Ⅰ水平低于非心肌损伤组（P <0.05）；多因素一般Logistic分析结果显示：无明显狭窄或斑块［O^R =21.284（95% CI：1.612，281.105）］、深在型心肌桥（无狭窄）［O^R =56.436（95% CI：1.823，1 736.132）］、血清cTnI高［O^R =16.754（95% CI：1.702，164.978）］和ApoA-Ⅰ低［O^R =1 085.952（95% CI：3.811，309 451.857）］均是脓毒症患者发生心肌损伤的危险因素（P <0.05）。ROC曲线分析结果显示，血清cTnI、ApoA-Ⅰ联合检测对脓毒症患者发生心肌损伤的预测敏感性为83.9%（95% CI：0.719，0.931），特异性为92.6%（95% CI：0.798，0.993）。结论 脓毒症并发心肌损伤患者的冠状动脉CT血管成像特点与非心肌损伤患者存在明显差异，cTnI、ApoA-Ⅰ联合检测并冠状动脉CT血管成像可显著提高脓毒症患者心肌损伤的早期识别效能。

Abstract:

Objective To investigate the evaluation value of cardiac troponin I (cTnI), apolipoprotein A-Ⅰ (ApoA-Ⅰ), and coronary artery computed tomography angiography for myocardial injury in septic patients.Methods A total of 85 septic patients admitted to our hospital from January 2022 to December 2024 were enrolled and divided into a myocardial injury group (n = 52) and a non-myocardial injury group (n = 33). All patients underwent coronary artery computed tomography angiography, and serum levels of cTnI and ApoA-Ⅰ were measured. Logistic regression was used to analyze risk factors for myocardial injury, and ROC curves were applied to assess the predictive value of combined cTnI and ApoA-Ⅰ.Results Comparison between the myocardial injury group and the non-myocardial injury group showed that the differences in the rates of non-stenotic deep myocardial bridges and the rates of no obvious stenosis or plaques were statistically significant as determined by the chi-square test (P < 0.05). There were also statistically significant differences in the levels of cTnI and ApoA-Ⅰ between the myocardial injury group and the non-myocardial injury group as tested by the t-test (P < 0.05). Specifically, the serum cTnI level in the myocardial injury group was higher than that in the non-myocardial injury group, while the ApoA-Ⅰ level in the myocardial injury group was lower than that in the non-myocardial injury group. Logistic regression analysis revealed that the presence of no obvious stenosis or plaques [O^R = 21.284 (95% CI: 1.612, 281.105) ], non-stenotic deep myocardial bridges [O^R = 56.436 (95% CI: 1.823, 1 736.132) ], elevated serum cTnI [O^R = 16.754 (95% CI: 1.702, 164.978) ], and decreased ApoA-Ⅰ [O^R = 1 085.952 (95% CI: 3.811, 309 451.857) ] were risk factors for myocardial injury in patients with sepsis (P < 0.05).The ROC curve analysis indicated that the combined detection of serum cTnI and ApoA-Ⅰ for predicting myocardial injury in sepsis patients had a sensitivity of 83.9% (95% CI: 0.719, 0.931) and a specificity of 92.6% (95% CI: 0.798, 0.993).Conclusion Coronary artery computed tomography angiography characteristics differ significantly between septic patients with and without myocardial injury. The combination of cTnI, ApoA-Ⅰ, and coronary artery computed tomography angiography improves early identification of myocardial injury in sepsis.