脓毒症相关心肌损伤患者血清BMAL1、sCR1水平与心肌损伤的相关性及对预后的评估价值OA

Objective To investigate the correlation between serum basic helix-loop-helix ARNT like 1(BMAL1)and soluble complement receptor 1(sCR1)levels and myocardial injury in patients with sepsis-related myocardial injury(SRMI)and their prognostic value.Methods A total of 155 patients with SRMI admitted to the Department of Emergency Medicine,General Hospital of Eastern Theater Commander from January 2023 to June 2025 were selected as the SRMI group,and 155 patients with simple sepsis admitted in the same period were selected as the simple sepsis group at a 1:1 ratio.Serum levels of BMAL1,sCR1 and myocardial injury markers[creatine kinase isoenzyme(CK-MB),cardiac troponin I(cTnI),myo-globin(Mb),brain natriuretic peptide(BNP)]were measured.Pearson correlation analysis was used to analyze the correlation between serum BMAL1,sCR1 and myocardial injury markers in patients with SRMI.Based on 28-day outcomes,SRMI pa-tients were divided into a death subgroup and a survival subgroup.Factors influencing poor prognosis and the predictive effi-cacy of serum BMAL1 and sCR1 levels were analyzed.Results Compared with the simple sepsis group,serum BMAL1 lev-els were significantly decreased,while levels of sCR1,CK-MB,cTnI,Mb,and BNP were significantly increased in the SRMI group(t/P=16.536/<0.001,14.962/<0.001,17.631/<0.001,30.884/<0.001,20.173/<0.001,21.827/<0.001).Serum BMAL1 was negatively correlated with CK-MB,cTnI,Mb,and BNP levels in SRMI patients(r/P=-0.605/<0.001,-0.612/<0.001,-0.552/<0.001,-0.565/<0.001),while sCR1 was positively correlated with these markers(r/P=0.518/<0.001,0.618/<0.001,0.589/<0.001,0.581/<0.001).The 28-day mortality rate of the 155 SRMI patients was 40.00%(62/155).The death subgroup had sig-nificantly higher SOFA score,lactic acid,CK-MB,cTnI,Mb,BNP,and sCR1 levels,and significantly lower BMAL1 levels compared with the survival subgroup(t/P=7.124/<0.001,6.337/<0.001,4.956/<0.001,2.900/<0.001,4.522/<0.001,5.950/<0.001,7.187/<0.001,7.681/<0.001).Increased SOFA score,increased lactic acid,increased cTnI,increased BNP,and increased sCR1 were independent risk factors for death in SRMI patients,while increased BMAL1 was an independent protective factor[OR(95%CI)=1.251(1.078-1.451),4.594(2.027-10.414),1.318(1.113-1.560),1.011(1.004-1.018),1.202(1.082-1.335),0.301(0.157-0.576)].The AUCs of serum BMAL1,sCR1,and their combination for predicting poor prognosis were 0.808,0.795,and 0.904,respectively.The combined prediction showed significantly better performance than either marker alone(Z/P=3.612/<0.001,3.574/<0.001).Conclusion Decreased serum BMAL1 and increased sCR1 levels in SRMI patients are associated with aggravated myocardial injury and poor prognosis.The combination of serum BMAL1 and sCR1 levels has high predictive value for prognosis.