Chen Di, Li Honglei, Huang Shitao, Huang Zhongya, Sun Yibo, Liu Liping
The First Clinical College of Lanzhou University, Lanzhou, Gansu, China.
Department of Emergency Critical Care Medicine, The First Hospital of Lanzhou University, Lanzhou, China.
Front Med (Lausanne). 2024 Aug 7;11:1429109. doi: 10.3389/fmed.2024.1429109. eCollection 2024.
Septic cardiomyopathy (SCM), a prevalent and critical condition in individuals suffering from sepsis and septic shock, remains elusive in terms of its intricate pathogenesis, thereby lacking definitive diagnostic standards. Current clinical management predominantly revolves around addressing the underlying disease and alleviating symptoms, yet mortality rates persist at elevated levels. This research endeavors to delve into the effects of low molecular weight heparin on Heparanase (HPA) levels in SCM patients, while assessing the clinical significance of HPA as a diagnostic marker in this patient population.
A comprehensive cohort of 105 patients diagnosed with SCM was recruited from the Department of Critical Care Medicine at the First Hospital of Lanzhou University, spanning the period from September 2022 to October 2023, serving as the primary research subjects for this investigation. A prospective, randomized controlled trial was undertaken, wherein 53 SCM patients were randomly allocated to a control group receiving standard therapy, while 52 patients were randomly assigned to an intervention group receiving conventional treatment augmented with low molecular weight heparin (LMWH). On the 1st, 3rd, and 7th days post-treatment, the following parameters were measured and documented: HPA levels, syndecan-1 levels, IL-6, TNF-α, CD4+/CD8+ cell ratio, anti-Xa factor, antithrombin III (AT-III) levels, left ventricular ejection fraction (LVEF), fractional shortening (FS), E/e' ratio, stroke volume (SV), cardiac performance index (CPI), global end-diastolic volume index (GEDVI), N-terminal pro-brain natriuretic peptide (NT-proBNP), cardiac troponin I (CTnI), heart-type fatty acid-binding protein (H-FABP), lactate (Lac) levels, central venous oxygen saturation (ScvO2), Sequential Organ Failure Assessment (SOFA) score, Acute Physiology and Chronic Health Evaluation II (APACHE II) score, ICU length of stay, and 28-day mortality rate.
In comparison to the control group, the LMWH group demonstrated significantly lower levels of HPA and syndecan-1 ( < 0.05), along with reduced levels of IL-6, TNF-α, E/e', NT-proBNP, CTnI, H-FABP, GEDVI, SOFA score, APACHE II score, ICU length of stay, and 28-day mortality ( < 0.05). Additionally, the LMWH group exhibited increased levels of anti-Xa factor, AT-III, CD4+/CD8+ cell, LVEF, FS, SV, and CPI ( < 0.05). ROC curve analysis indicated that HPA can be combined with NT-proBNP, CTnI and H-FABP to improve the diagnostic efficiency of SCM.
In SCM patient management, the integration of LMWH into conventional treatment significantly reduced HPA levels, mitigated syndecan-1 loss, attenuated inflammatory responses, enhanced immune function, improved microcirculation, cardiac systolic and diastolic functions, myocardial contractility, heart index, and end-diastolic volume. These interventions correlated with decreased clinical severity, ICU stays, and 28-day mortality rates in SCM patients.
脓毒症性心肌病（SCM）是脓毒症和脓毒症休克患者中常见的严重病症，其复杂的发病机制尚不清楚，因此缺乏明确的诊断标准。目前的临床管理主要围绕治疗基础疾病和缓解症状展开，但死亡率仍居高不下。本研究旨在探讨低分子量肝素对SCM患者乙酰肝素酶（HPA）水平的影响，并评估HPA作为该患者群体诊断标志物的临床意义。
从兰州大学第一医院重症医学科招募了105例确诊为SCM的患者，时间跨度为2022年9月至2023年10月，作为本研究的主要研究对象。进行了一项前瞻性随机对照试验，其中53例SCM患者被随机分配到接受标准治疗的对照组，52例患者被随机分配到接受常规治疗并加用低分子量肝素（LMWH）的干预组。在治疗后的第1天、第3天和第7天，测量并记录以下参数：HPA水平、多配体蛋白聚糖-1水平、白细胞介素-6、肿瘤坏死因子-α、CD4+/CD8+细胞比值、抗Xa因子、抗凝血酶III（AT-III）水平、左心室射血分数（LVEF）、缩短分数（FS）、E/e'比值、每搏输出量（SV）、心脏功能指数（CPI）、全心舒张末期容积指数（GEDVI）、N末端脑钠肽前体（NT-proBNP）、心肌肌钙蛋白I（CTnI）、心型脂肪酸结合蛋白（H-FABP）、乳酸（Lac）水平、中心静脉血氧饱和度（ScvO2）、序贯器官衰竭评估（SOFA）评分、急性生理与慢性健康状况评分系统II（APACHE II）评分、重症监护病房住院时间和28天死亡率。
与对照组相比，LMWH组的HPA和多配体蛋白聚糖-1水平显著降低（<0.05），白细胞介素-6、肿瘤坏死因子-α、E/e'、NT-proBNP、CTnI、H-FABP、GEDVI、SOFA评分、APACHE II评分、重症监护病房住院时间和28天死亡率也降低（<0.05）。此外，LMWH组的抗Xa因子水平、AT-III、CD4+/CD8+细胞、LVEF、FS、SV和CPI升高（<0.05）。ROC曲线分析表明，HPA可与NT-proBNP、CTnI和H-FABP联合使用，以提高SCM的诊断效率。
在SCM患者的管理中，将LMWH纳入常规治疗可显著降低HPA水平，减轻多配体蛋白聚糖-1的丢失，减轻炎症反应，增强免疫功能，并改善微循环、心脏收缩和舒张功能、心肌收缩力、心脏指数和舒张末期容积。这些干预措施与SCM患者临床严重程度降低、重症监护病房住院时间缩短和28天死亡率降低相关。
