炎症因子评估脓毒血症患者疾病预后的应用价值-现代医学

炎症因子评估脓毒血症患者疾病预后的应用价值

单位：1. 上海市交通大学医学院附属第九人民医院奉城分院急诊科, 上海 201411;
2. 上海市交通大学医学院附属第六人民医院医院南院呼吸内科, 上海 201499

分类号：R4004

出版年·卷·期（页码）：2019·47·第七期（778-782）

摘要：

目的：探讨多种炎症因子在脓毒血症患者疾病预后评估中的应用价值。方法：回顾性分析2014年5月至2018年4月上海两家三甲医院收治脓毒血症患者的临床资料，根据28 d后生存情况将患者分为存活组和死亡组，比较两组炎症指标的差异，应用Pearson相关分析法评估炎症因子与生存时间的相关性，应用受试者工作特征（ROC）曲线分析炎症因子对脓毒血症预后评估的效果。结果：（1）本研究共纳入137例患者，其中存活组82例，死亡组55例，存活率为59.85%，平均生存时间（15.58±4.52） d。（2）存活组中性粒细胞百分比（Neut）、血清白细胞介素（IL）-6、IL-8、肿瘤坏死因子（TNF）-ɑ、血浆降钙素原（PCT）、血清C-反应蛋白（CRP）、血清淀粉样蛋白（SAA）、脂多糖（LPS）均较死亡组低，差异均有统计学意义（P<0.05）；存活组白细胞计数（WBC）较死亡组低，但差异无统计学意义（P>0.05）。（3） Pearson相关分析结果显示，IL-6、TNF-ɑ、PCT、CRP、SAA、LPS均与生存时间呈负相关（P<0.05），WBC、Neut、IL-8与生存时间均无明显相关性（P>0.05）。多元线性回归分析显示，PCT、CRP、SAA及LPS是生存时间的影响因素（P<0.05）。（4） ROC曲线下面积（AUC）>0.7的炎症指标有IL-6（AUC=0.801）、IL-8（AUC=0.729）、TNF-ɑ（AUC=0.821）、PCT（AUC=0.913）、CRP（AUC=0.846）、SAA（AUC=0.855）、LPS（AUC=0.772），其约登指数从大到小依次为PCT（0.732 6）、SAA（0.524 7）、CRP（0.470 5）、LPS（0.400 3）、IL-6（0.298 5）、TNF-ɑ（0.293 7）、IL-8（0.141 6）。PCT、SAA、CRP及LPS 4个指标联合检测时预测脓毒血症预后的AUC（0.947）和约登指数（0.829 1）最高（P<0.05）。结论：将PCT、CRP、SAA、LPS升高作为脓毒血症患者疾病预后不良的预测因子可能较其他炎症因子更可靠。

Objective:To analyze the value of various inflammatory factors in evaluating the prognosis of patients with sepsis. Methods:The clinical data of patients with sepsis who were hospitalized in two third-class hospital ofShanghai from May 2014 to April 2018 was studied retrospectively.According to the survival status after 28 days,the patients were divided into survival group and death group.The differences of inflammation indexes were compared between the two groups.The correlation of inflammatory factors and survival time were analyzed by Pearson correlation,and the effect of inflammatory factors on prognosis vealeation to sepsis were analyzed by receiver operating characteristic (ROC) curves. Results:(1) A total of 137 patients were enrolled to this study, 82 cases (59.85%)in the survival group and 55 cases in the death group,and the average survival time was (15.58±4.52) days. (2) Neutrophil percentage (Neut), serum interleukin (IL)-6, IL-8, tumor necrosis factor (TNF)-ɑ, plasma procalcitonin (PCT), serum C-reactive protein(CRP), serum amyloid (SAA) and lipopolysaccharide (LPS) in survival group were significantly lower than those in death group(all P<0.05). The white blood cell count (WBC) in the survival group was lower than that in the death group, but the difference was not statistical (P>0.05).(3) IL-6, TNF-ɑ, PCT, CRP, SAA, LPS were negatively correlated with survival time by Pearson correlation analysis(all P<0.05), but WBC, Neut and IL-8 werenot correlated with survival time (all P>0.05). Multiple linear regression analysis showed that PCT, CRP, SAA and LPS were the main influencefactor of survival time(all P<0.05). (4)Area under the curve (AUC)was greater than 0.7 in IL-6 (AUC=0.801), IL-8 (AUC=0.729), TNF-ɑ (AUC=0.821), PCT (AUC=0.913), CRP (AUC=0.846), SAA (AUC=0.855), LPS (AUC=0.772).The Yoden index from large to small were PCT (0.732 6), SAA (0.524 7), CRP(0.470 5), LPS (0.400 3), IL-6 (0.298 5), TNF-ɑ(0.293 7), 0.141 6(IL-8). Combining PCT,SAA,CRP and LSP to predicat the prognosis sepsis, the AUC and Yoden index were the highest[AUC(0.947) and Yoden index(0.829 1)]. Conclusion:PCT, CRP, SAA and LPS may be more reliable predictors of poor prognosis in patients with sepsis than other inflammatory fosis

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