摘要
目的探讨线粒体相关蛋白延胡索酰乙酰乙酸酯水解酶结构域含蛋白1(FAHD1)和生长分化因子15(GDF-15)在脓毒症诊断中的价值。方法从一项基于脓毒症的早期预警及规范化诊疗体系建立的"脓毒症全过程预警及诊治管理数据库"中,收集2014年5月至2015年10月浙江医院、浙江大学医学院附属第二医院、中山大学附属第一医院、四川大学华西医院、宁波市第一医院纳入的疑似感染的成人患者。分析脓毒症和非脓毒症患者基础生命体征信息及确诊时主要血常规指标、肝肾功能指标、血气指标、急性生理学与慢性健康状况评分Ⅱ(APACHEⅡ)和序贯器官衰竭评分(SOFA)等。利用保存的血清样本,用电化学发光法检测降钙素原(PCT)水平,用免疫比浊法检测C-反应蛋白(CRP)水平,用酶联免疫吸附试验(ELISA)检测FAHD1和GDF-15水平。采用单因素和多因素Logistic回归分析脓毒症诊断中的危险因素,并应用受试者工作特征曲线(ROC曲线)分析各指标对脓毒症的诊断效能。结果共入选132例患者,其中脓毒症76例,非脓毒症56例。与非脓毒症组相比,脓毒症组心率加快(次/min:116.4±17.8比97.4±19.1),平均动脉压(MAP)、血小板计数(PLT)、动脉血氧分压(PaO_(2))显著降低〔MAP(mmHg,1 mmHg=0.133 kPa):65.8±9.7比74.7±10.3,PLT(×109/L):120(69,204)比163(117,239),PaO_(2)(mmHg):83.0(66.6,108.0)比108.0(84.4,130.0),均P<0.05〕,直接胆红素(DBil)、血肌酐(SCr)、血乳酸(Lac)、APACHEⅡ评分和SOFA评分均显著升高〔DBil(μmol/L):13.00(5.55,55.31)比6.20(2.20,21.90),SCr(μmol/L):118.00(70.00,191.73)比77.20(59.65,110.86),Lac(mmol/L):2.90(1.50,4.10)比1.90(1.20,2.80),APACHEⅡ(分):20.0(16.0,25.0)比16.0(10.0,21.0),SOFA(分):12.0(8.0,16.0)比8.0(5.0,13.0),均P<0.05〕。此外,脓毒症组血清FAHD1、GDF-15、PCT、CRP水平均显著高于非脓毒症组〔FAHD1(μg/L):3.96(2.25,5.92)比2.47(1.03,3.54),GDF-15(μg/L):8.46(4.37,19.68)比4.32(1.74,10.39),PCT(μg/L):3
Objective To investigate the diagnostic value of mitochondrial associated protein fumarylacetoacetate domain containing protein 1(FAHD1)and growth differentiation factor-15(GDF-15)in sepsis.Methods Based on the database of the whole process of sepsis early warning,diagnosis and treatment management,which was established on the study of sepsis early warning and standardized diagnosis and treatment system,adult patients with suspected infection admitted to the department of critical care medicine of Zhejiang Hospital,Second Affiliated Hospital of Zhejiang University,the First Affiliated Hospital of Sun Yat-Sen University,West China Hospital of Sichuan University,Ningbo First Hospital from May 2014 to October 2015 were enrolled.The basic vital signs,and the main blood routine results,liver and kidney function,blood gas,acute physiology and chronic health evaluationⅡ(APACHEⅡ)and sequential organ failure assessment(SOFA)score at the time of diagnosis of patients with or without sepsis were analyzed.The preserved serum samples were taken,the levels of procalcitonin(PCT),C-reactive protein(CRP)were detected by electrochemiluminescence method,immunoturbidimetry respectively,and FAHD1 and GDF-15 were detected by enzyme linked immunosorbent assay(ELISA).Univariate and multivariate Logistic regression were used to analyze the risk factors for sepsis diagnose.The indexes'diagnostic efficacy in sepsis were analyzed by receiver operating characteristics curve(ROC curve).Results A total of 132 patients were enrolled,including 76 cases of sepsis and 56 cases of non-sepsis.Compared with the non-sepsis group,the heart rate in the sepsis group was increased(bpm:116.4±17.8 vs.97.4±19.1),while the mean arterial pressure(MAP),platelet count(PLT),arterial partial pressure of oxygen(PaO_(2))were significantly decreased[MAP(mmHg,1 mmHg=0.133 kPa):65.8±9.7 vs.74.7±10.3,PLT(×109/L):120(69,204)vs.163(117,239),PaO_(2)(mmHg):83.0(66.6,108.0)vs.108.0(84.4,130.0),all P<0.05],direct bilirubin(DBil),serum creatinine(SCr),lactic acid(Lac)
作者
李萌
任蓉蓉
陈上仲
陈琛
严静
Li Meng;Ren Rongrong;Chen Shangzhong;Chen Chen;Yan Jing(Department of Clinical Laboratory,Zhejiang Hospital,Hangzhou 310013,Zhejiang,China;Department of Critical Care Medicine,Zhejiang Hospital,Hangzhou 310013,Zhejiang,China)
出处
《中华危重病急救医学》
CAS
CSCD
北大核心
2021年第2期180-185,共6页
Chinese Critical Care Medicine
基金
浙江省自然科学基金(LY16H200002)。
