脓毒性休克患者全血铜（Cu）、锌（Zn）水平及Cu/Zn比值与脓毒症诱导的左心室收缩功能障碍（SILVSD）的相关性：一项单中心前瞻性观察研究
The Correlation Between Whole Blood Copper (Cu), Zinc (Zn) Levels and Cu/Zn Ratio and Sepsis-Induced Left Ventricular Systolic Dysfunction (SILVSD) in Patients with Septic Shock: A Single-Center Prospective Observational Study.
作者信息
Meng Jian-Biao, Hu Ma-Hong, Zhang Ming, Hu Gong-Pai, Zhang Wei, Hu Shen-Jiang
机构信息
Department of Cardiology, The First Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, Zhejiang Province, 310003, People's Republic of China.
Intensive Care Unit, Tongde Hospital of Zhejiang Province, Hangzhou, Zhejiang Province, 310012, People's Republic of China.
出版信息
Int J Gen Med. 2021 Oct 27;14:7219-7234. doi: 10.2147/IJGM.S335348. eCollection 2021.
PURPOSE
This study aimed to explore relationships between whole blood copper (Cu), zinc (Zn) and Cu/Zn ratio and cardiac dysfunction in patients with septic shock.
SUBJECTS AND METHODS
Between April 2018 and March 2020, septic shock patients with sepsis-induced left ventricular systolic dysfunction (SILVSD, left ventricular ejection fraction, LVEF<50%) and with no sepsis-induced myocardial dysfunction (non-SIMD, septic shock alone and LVEF>50%) and controls were prospectively enrolled. Whole blood Cu and Zn levels were measured using flame atomic absorption spectrophotometry.
RESULTS
Eighty-six patients with septic shock including both 41 SILVSD and 45 non-SIMD and 25 controls were studied. Whole blood Cu levels and Cu/Zn ratio were significantly higher and Zn levels were lower in SILVSD compared with non-SIMD and controls (Cu, =0.009, <0.001; Zn, =0.029, <0.001; Cu/Zn ratio, =0.003, <0.001). Both increased whole blood Cu and Cu/Zn ratio and reduced Zn were associated with lower LVEF (all <0.001) and higher amino-terminal pro-B-type natriuretic peptide (NT-proBNP) (Cu, =0.002; Zn, <0.001; Cu/Zn ratio, <0.001) and had predictive values for SILVSD (Cu, AUC=0.666, =0.005; Zn, AUC=0.625, =0.039; Cu/Zn ratio, AUC=0.674, =0.029). Whole blood Cu levels and Cu/Zn ratio were increased but Zn levels were reduced in non-survivors compared with survivors (Cu, <0.001; Zn, <0.001; Cu/Zn ratio, <0.001). Whole blood Cu and Zn displayed the value of predicting 28-day mortality (Cu, AUC = 0.802, <0.001; Zn, AUC=0.869, <0.001; Cu/Zn ratio, AUC=0.902, <0.001).
CONCLUSION
Findings of the study suggest that whole blood Cu levels and Cu/Zn ratio are increased in SILVSD patients and positively correlated with cardiac dysfunction, while whole blood Zn levels are reduced and negatively associated with cardiac dysfunction. Moreover, both whole blood Cu, Zn and Cu/Zn ratio might distinguish between SILVSD and non-SIMD in septic shock patients and predict 28-day mortality.
TRIAL REGISTRATION
Registered at http://www.chictr.org.cn/ChiCTR1800015709.
目的
本研究旨在探讨脓毒性休克患者全血铜（Cu）、锌（Zn）及铜/锌比值与心脏功能障碍之间的关系。
受试者与方法
在2018年4月至2020年3月期间，前瞻性纳入了脓毒性休克患者，这些患者包括脓毒症诱导的左心室收缩功能障碍（SILVSD，左心室射血分数，LVEF<50%）且无脓毒症诱导的心肌功能障碍（非SIMD，仅脓毒性休克且LVEF>50%）以及对照组。采用火焰原子吸收分光光度法测定全血铜和锌水平。
结果
研究了86例脓毒性休克患者，包括41例SILVSD患者、45例非SIMD患者和25例对照组。与非SIMD组和对照组相比，SILVSD组全血铜水平和铜/锌比值显著升高，锌水平降低（铜，P = 0.009，P<0.001；锌，P = 0.029，P<0.001；铜/锌比值，P = 0.003，P<0.001）。全血铜和铜/锌比值升高以及锌降低均与较低的LVEF相关（均P<0.001）和较高的氨基末端B型利钠肽原（NT-proBNP）相关（铜，P = 0.002；锌，P<0.001；铜/锌比值，P<0.001），并且对SILVSD具有预测价值（铜，AUC = 0.666，P = 0.005；锌，AUC = 0.625，P = 0.039；铜/锌比值，AUC = 0.674，P = 0.029）。与幸存者相比，非幸存者全血铜水平和铜/锌比值升高，但锌水平降低（铜，P<0.001；锌，P<0.001；铜/锌比值，P<0.001）。全血铜和锌具有预测28天死亡率的价值（铜，AUC = 0.802，P<0.001；锌，AUC = 0.869，P<0.001；铜/锌比值，AUC = 0.902，P<0.001）。
结论
该研究结果表明，SILVSD患者全血铜水平和铜/锌比值升高，与心脏功能障碍呈正相关，而全血锌水平降低，与心脏功能障碍呈负相关。此外，全血铜、锌及铜/锌比值可能有助于区分脓毒性休克患者中的SILVSD和非SIMD，并预测28天死亡率。
试验注册
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