摘要
目的:分析透明质酸和多配体蛋白聚糖对脓毒症预后的评估价值。方法:选取120名脓毒症、严重脓毒症和脓毒性休克患者,和30名健康志愿者。在ICU入院的1、3、5、7 d测量血清透明质酸和多配体蛋白聚糖水平。计算急性生理与慢性健康状况评分(APACHEⅡ)和序贯器官衰竭评分(SOFA)。结果:3组脓毒症患者的年龄和性别差异无明显统计学意义。APACHEⅡ评分3组之间均有显著性差异(均P <0. 01)。3组患者的病死率有显著性差异(均P <0. 01),脓毒性休克患者的病死率37. 6%,在90 d的观察期有38名患者死亡。3组脓毒症患者的透明质酸和多配体蛋白聚糖水平均显著高于对照组(P <0. 01)。在所有时间点,与脓毒症患者组相比,严重脓毒症和脓毒症性休克患者的2种标志物水平都较高。存活组患者和非存活组的透明质酸和多配体蛋白聚糖均有显著差异(P <0. 01)。在存活组中,透明质酸和多配体蛋白聚糖的中值水平在随访期显著降低(P <0. 01)。ROC分别用透明质酸和多配体蛋白聚糖的截断值438ng/mL和878ng/mL来预测死亡率。透明质酸的特异性和阴性预测值分别为91%和91%;多配体蛋白聚糖的特异性和阴性预测值分别为92%和83%。2个标志物与APACHEⅡ评分和SOFA评分均显著相关。结论:透明质酸和多配体聚糖是预测脓毒症预后的重要标志物。
Objective： To analyze the predictive value of hyaluronan and syndecan in evaluating the prognosis of sepsis patients. Methods： 120 patients with sepsis,severe sepsis and septic shock,and 30 healthy volunteers were included. Serum concentrations of hyaluronan and syndecan were measured at 1 st,3 rd,5 th,and 7 th day of ICU admission. The scores of acute physiology and chronic health evaluation scoring system（ APACHEⅡ）,and sequential organ failure assessment（ SOFA） were calculated. Results： There were no significant differences in age and gender among the three groups of sepsis.There were significant differences in APACHEⅡ scores（ P 〈0. 01） and mortality（ P 〈0. 01） among the three groups of sepsis. The mortality rate in septic shock group was 37. 6%,and 38 patients died during 90-day observation period. Hyaluronan and syndecan levels were significantly higher in all categories of sepsis than those in the control group（ P 〈0. 01）.Hyaluronan and syndecan levels were always increased in severe sepsis and septic shock groups as compared with sepsis group. Hyaluronan and syndecan levels showed significant differences（ P 〈0. 01） between survivors and non-survivors.However,median levels of hyaluronan and syndecan decreased significantly（ P 〈0. 01） during the follow-up period in the survivor group. ROC was used to predict the mortality with cut-off values of 438 ng/mL and 878 ng/mL for hyaluronan and syndecan,respectively. The specific and negative predictive values of hyaluronan were 91% and 91%,respectively; and the specific and negative predictive values of syndecan were 92% and 83%,respectively. Two markers were significantly associated with APACHEⅡ and SOFA scores. Conclusions： Hyaluronan and syndecan are important biological markers for predicting the prognosis of sepsis.
作者
陈利红
张蕾
郭利涛
刘昱
李娜
CHENG Li-hong;ZHANG Lei;GUO Li-tao;L;Li Na(The First Affiliated Hospital of Xi＇an Jiao Tong University,Xi＇an 710061,China)
出处
《内科急危重症杂志》
2018年第5期406-409,共4页
Journal of Critical Care In Internal Medicine
