中国实验诊断学

目的 探究慢性心力衰竭(CHF)患者外周血沉默信息调节因子2相关酶3(SIRT3)/锰超氧化物歧化酶(MnSOD)信号通路因子与恶性室性心律失常(MVA)关系及预警价值。方法 回顾性收集2023年1月至2024年6月周口市中心医院收治的CHF患者作为研究对象，选取出院1年内并发MVA患者100例作为并发组，出院后1年内未并发MVA患者100例作为未并发组，另在2024年7月至2025年4月收治的CHF患者中，以上述200例CHF患者年龄、性别为参考，成功匹配性别、年龄均衡可比的86例CHF患者作为外部验证组。比较两组一般资料、外周血SIRT3、MnSOD水平，Logistic回归分析CHF患者并发MVA的影响因素，采用受试者工作特征(ROC)曲线评价并验证外周血SIRT3、MnSOD对CHF患者并发MVA的预测价值，限制性立方样条(RCS)模型分析外周血SIRT3、MnSOD水平与CHF患者并发MVA风险的剂量反应关系。结果 并发组年龄、NYHA分级、LVEF、LVEDD、应用抗心律失常药占比及外周血SIRT3、MnSOD水平与未并发组比较，差异均有统计学意义(P<0.05);Logistic回归分析结果显示，年龄、抗心律失常药、外周血SIRT3、MnSOD均为CHF患者并发MVA影响因素(P<0.05);外周血SIRT3、MnSOD预测CHF患者并发MVA的AUC值分别为0.758、0.733,当二者截断值分别为21.58 ng/L、8.27 U/ml,约登指数最大；以最佳截断值为参考，进行RCS模型显示，外周血SIRT3、MnSOD水平与CHF患者并发MVA风险均存在非线性剂量反应关系(P<0.05);SIRT3、MnSOD联合预测AUC值为0.845,明显高于二者单独预测AUC值(P<0.05);外部验证组ROC曲线显示，SIRT3、MnSOD联合预测模型CHF患者并发MVA的AUC值为0.876,与上述联合预测AUC值比较差异无统计学意义(P>0.05)。结论 CHF患者外周血SIRT3/MnSOD信号通路因子与MVA有关，联合检测有助于预警MVA发生。

Objective To investigate the relationship between the peripheral blood silent information regulator 2-related enzyme 3(SIRT3)/manganese superoxide dismutase(MnSOD) signaling pathway factors and malignant ventricular arrhythmias(MVA) in patients with chronic heart failure(CHF),as well as their early warning value.Methods A retrospective study was conducted on CHF patients admitted to Our Hospital from January 2023 to June 2024,who were selected as the research subjects.Among them, 100 patients who developed MVA within 1 year after discharge were selected as the concurrent group, and another 100 patients who did not develop MVA within 1 year after discharge were selected as the non-concurrent group.Additionally, among CHF patients admitted from July 2024 to April 2025,86 patients with balanced gender and age, comparable to the aforementioned 200 CHF patients, were successfully matched as the external validation group.The general information, peripheral blood SIRT3,and MnSOD levels were compared between the two groups.Logistic regression analysis was used to investigate the influencing factors of MVA in CHF patients.Receiver Operating Characteristic(ROC) curves were employed to evaluate and verify the predictive value of peripheral blood SIRT3 and MnSOD for MVA in CHF patients.A Restricted Cubic Spline(RCS) model was used to analyze the dose-response relationship between peripheral blood SIRT3 and MnSOD levels and the risk of MVA in CHF patients.Results Compared with the non-concurrent group, the concurrent group showed statistically significant differences in age, NYHA classification, LVEF,LVEDD,proportion of patients using antiarrhythmic drugs, and levels of peripheral blood SIRT3 and MnSOD(P<0.05).Logistic regression analysis indicated that age, antiarrhythmic drugs, peripheral blood SIRT3,and MnSOD were all factors influencing the occurrence of MVA in CHF patients(P<0.05).The AUC values for predicting MVA in CHF patients using peripheral blood SIRT3 and MnSOD were 0.758 and 0.733,respectively.When the cutoff values for both were set at 21.58 ng/L and 8.27 U/ml, the Youden's index reached its maximum.Using the optimal cutoff values as a reference, the RCS model demonstrated a nonlinear dose-response relationship between the levels of peripheral blood SIRT3 and MnSOD and the risk of MVA in CHF patients(P<0.05).The combined prediction AUC value for SIRT3 and MnSOD was 0.845,significantly higher than the individual AUC values for each marker(P<0.05).The ROC curve of the external validation group showed that the combined prediction model of SIRT3 and MnSOD had an AUC value of 0.876 for predicting MVA in CHF patients, which did not significantly differ from the aforementioned combined prediction AUC value(P>0.05).Conclusion The SIRT3/MnSOD signaling pathway factors in peripheral blood of CHF patients are associated with MVA.Combined detection can help predict the occurrence of MVA and guide clinical precision prevention and treatment.