摘要
目的探讨脓毒症休克患者血清人源性激肽释放酶结合蛋白(Kal)、血管内皮钙黏蛋白(VE-cad)的变化及与预后的关系。方法前瞻性选取2016年3月—2018年3月杭州市丁桥医院重症医学科收治的脓毒症休克患者252例,根据纳入和排除标准排除74例,最终纳入研究的脓毒症休克患者为178例。根据患者28 d预后分为存活组120例和死亡组58例。比较两组患者的临床指标及入住重症监护病房(ICU)第1天、第3天、第5天血清Kal和VE-cad水平变化,记录患者急性生理学与慢性健康状况评分系统Ⅱ(APACHEⅡ)评分和序贯性器官功能衰竭评估(SOFA)评分。采用Pearson相关分析血清Kal、VE-cad与APACHEⅡ评分和SOFA评分的相关性。采用受试者工作特征(ROC)曲线评估血清Kal、VE-cad单独及联合检测对脓毒症休克患者预后的价值。采用二元Logistic回归分析脓毒症休克死亡的影响因素。结果死亡组的氧合指数和血清白蛋白(ALB)水平低于存活组(P<0.05),机械通气时间、ICU住院时间长于存活组(P<0.05),血清C反应蛋白(CRP)、降钙素原(PCT)水平、血管外肺水指数(EVLWI)、APACHEⅡ评分和SOFA评分高于存活组(P<0.05)。两组入住ICU第1天、第3天、第5天血清Kal、VE-cad水平比较,不同时间点的血清Kal、VE-cad有差异(P<0.05),两组血清Kal、VEcad有差异(P<0.05),两组血清Kal、VE-cad变化趋势有差异(P<0.05)。血清Kal水平与APACHEⅡ评分和SOFA评分呈负相关(r=-0.397和-0.466,P<0.05);血清VE-cad与APACHEⅡ评分和SOFA评分呈正相关(r=0.173和0.192,P<0.05)。入院24 h内血清Kal、VE-cad及两者联合检测的曲线下面积(AUC)分别为0.687(95%CI:0.604,0.770)、0.859(95%CI:0.805,0.912)、0.890(95%CI:0.845,0.936),血清Kal检测预测脓毒症休克患者死亡的敏感性为81.0%(95%CI:0.772,0.854),特异性为50.0%(95%CI:0.474,0.531);VE-cad检测预测脓毒症休克患者死亡的敏感性为69.0%(95%CI:0.649,0.726),特异性为86.7%(95%CI:0.822,0.914);血�
Objective To investigate the changes of serum human kallikrein-binding protein(Kallistatin,Kal)and vascular endothelial cadherin(VE-cad)in patients with septic shock and their relationship with prognosis.Methods A total of 252 patients with septic shock admitted to the Department of Critical Care Medicine,Hangzhou Hospital of Traditional Chinese Medicine,from March 2016 to March 2018,were prospective selected.74 patients were excluded according to pre-specified exclusion criteria,and there were 178 patients with septic shock who were eventually included in the study.According to the 28-day prognosis,they were divided into survival group(120 cases)and death group(58 cases).The changes of serum Kal and VE-cad levels on the 1,3 and 5 days of ICU were observed.The acute physiology and chronic health status scoring system Ⅱ(APACHE Ⅱ)score and sequential organ failure assessment(SOFA)score of sepsis patients were recorded.Pearson correlation analysis was used to analyze the correlation of serum Kal and VE-cad with APACHE Ⅱ score and SOFA score.Evaluation of prognostic value of serum Kal and VE-cad in patients with septic shock was performed with the receiver operating characteristic curve(ROC).Binary logistic regression was used to analyze the influence factors for septic shock death.Results The oxygenation index and serum albumin(ALB)levels in the death group of patients with septic shock were lower than those in the survival group(P<0.05).Mechanical ventilation time,ICU hospitalization days were longer than those in the survival group(P<0.05),the levels of serum C-reactive protein(CRP),procalcitonin(PCT),extravascular lung water index(EVLWI),APACHE Ⅱ score,and SOFA score were higher than those in the survival group(P<0.05).The serum Kal and VE-cad levels of the death group and the survival group were different at different time points(P<0.05);the serum Kal and VE-cad levels of the death group and the survival group were different(P<0.05);the change trend of serum Kal and VE-cad levels of the death group and t
作者
吴微华
俞振飞
程抗
安鹏
张伟
陈雲
叶肖琳
Wei-huaWu;Zhen-fei Yu;Kang Chen;Peng An;Wei Zhang;Yun Chen;Xiao-lin Ye(Department of Critical Care Medicine,Hangzhou Dingqiao Hospital,Hangzhou,Zhejiang 310021,China;Department of Critical Care Medicine,The Second Affiliated Hospital of Zhejiang University of Traditional Chinese Medicine,Hangzhou,Zhejiang 310005,China)
出处
《中国现代医学杂志》
CAS
北大核心
2021年第17期78-84,共7页
China Journal of Modern Medicine
基金
2018年浙江省医药卫生科技计划项目(No:2018YK0901)。
