摘要
目的观察感染性休克患者血浆中组织蛋白酶S(cat S)和血小板反应蛋白-1(TSP-1)的表达变化,并探讨其与炎症水平及与患者预后的关系。方法收集2015年1月-2018年2月在南京医科大学附属淮安第一医院病理确诊的126例感染性休克患者作为研究对象,同时期130例健康体检者作为对照组。酶联免疫吸附(ELISA)法检测血浆cat S、TSP-1、白介素-6(IL-6)、IL-10表达水平,对患者急性生理学与慢性健康状况Ⅱ(APACHEⅡ)评分,并对全部患者进行随访,分析不同预后cat S、TSP-1、IL-6、IL-10、APACHEⅡ表达水平及关系。结果感染性休克组血浆中cat S、TSP-1、IL-6、IL-6/IL-10水平均高于对照组,IL-10水平低于对照组,差异有统计学意义(P<0.05)。感染性休克死亡组血浆中cat S、TSP-1、IL-6、IL-6/IL-10、APACHEⅡ评分水平均高于生存组,IL-10水平低于生存组,差异有统计学意义(P<0.05)。感染性休克患者血浆中cat S水平与IL-6/IL-10、APACHEⅡ评分正相关,与IL-10呈负相关,差异有统计学意义(P<0.05);TSP-1水平与IL-6、IL-6/IL-10、APACHEⅡ评分呈正相关(P均<0.05)。血浆中cat S、TSP-1水平预测感染性休克患者不良预后的ROC曲线下面积分别为0.846、0.728(95%CI:0.780~0.912、0.631~0.825),截断值分别为13.60 ng/mL、32.55 ng/mL,此时其敏感性分别为85.4%、68.8%,对应特异性为70.5%、73.1%。二者联合感染性休克患者不良预后的ROC曲线下面积为0.880(95%CI:0.822~0.938),敏感性为72.9%、特异性为87.2%。结论感染性休克患者血浆中cat S、TSP-1、IL-6高表达,IL-10低表达,IL-6/IL-10水平升高,血浆中cat S、TSP-1表达水平与IL-6/IL-10、APACHEⅡ评分密切相关,对感染性休克患者不良预后具有一定预测价值。
Objective To observe the changes of cathepsin S(cat S)and thrombospondin-1(TSP-1)expressions in plasma of patients with septic shock,and explore their relationships with the level of inflammation and prognosis of patients with septic shock.Methods 126 patients with septic shock diagnosed by pathology in our hospital from January 2015 to February 2018 were collected as the study subjects,and 130 healthy people were taken as the control group.The expression levels of cat S,TSP-1,interleukin-6(IL-6)and IL-10 in plasma were detected by enzyme-linked immunosorbent assay(ELISA),acute physiology and chronic health evaluationⅡ(APACHEⅡ)were assessed;all patients were followed up;the expressions of cat S,TSP-1,IL-6,IL-10 and APACHEⅡin different prognosis were analyzed.Results The levels of cat S,TSP-1,IL-6 and IL-6/IL-10 in plasma of septic shock group were higher than those of healthy control group,and the level of IL-10 was lower than those of healthy control group(P<0.05).The levels of cat S,TSP-1,IL-6,IL-6/IL-10 and APACHEⅡin the septic shock death group were higher than those in the survival group,while the level of IL-10 was lower than those in the survival group(P<0.05).The level of cat S in plasma of septic shock patients was positively correlated with IL-6/IL-10 and APACHEⅡscore(P<0.05),and negatively correlated with IL-10(P<0.05);TSP-1 level was positively correlated with IL-6,IL-6/IL-10 and APACHEⅡscore(all P<0.05).The areas under ROC curves of cat S and TSP-1 in plasma for predicting adverse prognosis of septic shock patients were 0.846 and 0.728(95%CI:0.780~0.912,0.631~0.825),respectively;the truncation values were 13.60 ng/mL and 32.55 ng/mL,respectively;the sensitivities were85.4%and 68.8%respectively;the corresponding specificities were 70.5%and 73.1%.The area under the ROC curve of two combination for predicting adverse prognosis of septic shock patients was 0.880(95%CI:0.822~0.938);the sensitivity was 72.9%;the specificity was 87.2%.Conclusion Cat S,TSP-1 and IL-6 were highly expressed in plas
作者
顾立志
孙虹
严专
GU Li zhi;SUN Hong;YAN Zhuan(Department of Emergency Medicine,Huai’an First Hospital Affiliated to Nanjing Medical University,Nanjing,Jiangsu 223300,China)
出处
《热带医学杂志》
CAS
2019年第11期1413-1416,共4页
Journal of Tropical Medicine
