脓毒症患者血清FGF-21、MR-proADM、炎性因子与预后的关系分析

目的:探讨血清人成纤维细胞生长因子-21(FGF-21)、肾上腺髓质素前体中段肽(MR-proADM)、炎性因子与脓毒症患者预后的关系。方法:选取2015年9月至2018年9月我院收治的脓毒症患者160例(脓毒症组),按病情严重程度分为轻度脓毒症组(A组)56例、严重脓毒症组(B组)53例,脓毒性休克组(C组)51例,另选取同期50例健康体检者作为健康对照组。检测各组血清FGF-21、MR-proADM和炎性因子[(白细胞(WBC),白细胞介素-6(IL-6),肿瘤坏死因子-α(TNF-α),白细胞介素-10(IL-10)]水平,记录脓毒症患者序贯性器官功能衰竭评分(SOFA)和急性生理学与慢性健康状况评分系统Ⅱ(APACHEⅡ)评分及28 d预后。采用受试者工作特征(ROC)曲线分析FGF-21、MR-proADM、炎性因子单独及联合评估脓毒症预后的价值。采用Spearman相关分析FGF-21、MR-proADM和炎性因子与APACHEⅡ评分、SOFA评分的相关性。结果:脓毒症组血清FGF-21、MR-proADM和炎性因子WBC、IL-6、TNF-α、IL-10水平均明显高于健康对照组(均P0.05),且随着脓毒症病情的加重,患者血清FGF-21、MR-proADM和炎性因子水平逐渐升高。脓毒症患者中28d死亡43例(26.88%),其中A组8例(14.29%)、B组12例(22.64%)、C组23例(45.10%)。ROC曲线分析显示,联合检测评估脓毒症患者病死率的曲线下面积(AUC)、敏感度及特异度均高于单一检测。脓毒症患者血清FGF-21、MR-proADM、WBC、IL-6、TNF-α与APACHEⅡ评分及SOFA评分均呈正相关性(P0.05),此外,IL-10与SOFA评分呈正相关性(P0.05),与APACHEⅡ评分无相关性(P0.05)。结论:脓毒症患者血清FGF-21、MR-proADM水平升高,检测FGF-21、MR-proADM和炎性因子有助于评估脓毒症患者的病情及预后。     

血清Cys-C、TBiL、MR-proADM、AGEs与老年慢性心力衰竭患者心功能和心脏再同步化治疗应答的关系研究

摘要 目的：探讨血清胱抑素C（Cys-C）、总胆红素（TBiL）、肾上腺髓质中段肽（MR-proADM）、晚期糖基化终末产物（AGEs）与老年慢性心力衰竭（CHF）患者心功能和心脏再同步化治疗（CRT）应答的关系。方法：选择2020年3月至2022年1月我院收治的151例接受CRT治疗的老年CHF患者为研究对象,随访6个月,统计治疗应答情况。CRT治疗前检测血清Cys-C、TBiL、MR-proADM、AGEs水平,超声心动图检测心功能,分析血清Cys-C、TBiL、MR-proADM、AGEs与心功能的相关性以及与老年CHF患者CRT治疗应答的关系。结果：151例患者失访1例,余150例患者中无应答48例（无应答组）,应答102例（应答组）。无应答组血清Cys-C、TBiL、MR-proADM、AGEs水平均高于应答组（P＜0.05）,且与左心室射血分数（LVEF）呈负相关（P＜0.05）,与左室舒张末期内径（LVEDD）和左室收缩末期内径（LVESD）呈正相关（P＜0.05）。多因素Logistic回归分析结果显示缺血性心肌病、血清Cys-C、TBiL、MR-proADM、AGEs是老年CHF患者CRT治疗无应答的危险因素（P＜0.05）,LVEF是保护因素（P＜0.05）。结论：CRT治疗无应答老年CHF患者血清Cys-C、TBiL、MR-proADM、AGEs水平升高,且与心功能下降有关。血清Cys-C、TBiL、MR-proADM、AGEs是CRT治疗无应答的危险因素,可为CRT治疗效果评估提供一定的参考。     

Biomarker dynamics in cardiac surgery: a prospective observational study on MR-proADM,MR-proANP,hs-CRP and sP-selectin plasma levels in the perioperative period

Abstract

Background: For many biomarkers in cardiac surgery, there is a lack of knowledge regarding the normal dynamics of plasma levels during the perioperative course. The aim of this study was to investigate the perioperative dynamics of MR-proADM, MR-proANP, hs-CRP and sP-selectin in cardiac surgery.

Method: A prospective observational pilot study with 20 patients scheduled for open cardiac surgery procedures with cardiopulmonary bypass (CPB). Plasma samples were taken for each patient and biomarker during the pre-, per- and postoperative period until Day 6 postoperatively.

Results: MR-proADM increased significantly from 0.62 [IQR; 0.54–0.93]?nmol/L preoperatively to 1.20 [1.04–1.80]?nmol/L postoperative Day 1. MR-proANP increased significantly from 125 [77–152]?pmol/L preoperatively to 198 [168–307]?pmol/L on weaning from CPB. hs-CRP increased significantly from 2.5?mg/L [0.4–12] preoperatively to peak at 208?mg/L [186–239] postoperative Day 3. The preoperative level of sP-selectin at 23.0 [21.3–26.3]?ng/mL initially fell at weaning from CPB, followed by a significant peak of 25.5 [22.7–27.7]?ng/mL 8?h postoperatively.

Conclusions: The findings in this study may help to understand the physiology of the biomarkers analysed and their response to cardiac surgical trauma including CPB. Furthermore, these findings will guide us in further research on the clinical usefulness of these biomarkers.     

Significant decrease in plasma midregional proadrenomedullin level in patients with end-stage renal disease after living kidney transplantation

Impaired renal function has been suggested to significantly impact plasma midregional proADM (MR-proADM) level. The aim of this study was to assess whether improvement of renal function after living kidney transplantation has an impact on plasma MR-proADM-like immunoreactive substance (IS) level. Eleven patients with end-stage renal disease (ESRD) who were scheduled to undergo the first living kidney allograft transplantation were enrolled. Plasma MR-proADM-IS levels were measured before and 3, 7, 10, 14, 21, 30, 60 and 90 days after kidney transplantation. Plasma MR-proADM-IS level decreased significantly from day 3 after kidney transplantation compared to before kidney transplantation. A significant negative correlation was observed between creatinine clearance and plasma MR-proADM-IS level from before to 90 days after kidney transplantation (r_s = −0.70, p < 0.0001). These results suggest that recovery of kidney function after kidney transplantation may lead to decrease in plasma MR-proADM level in patients with ESRD, and that plasma MR-proADM level may depend largely on renal function.