摘要
目的观察脓毒症并发ICU获得性衰弱(ICU-acquired weakness,ICU-AW)患者血浆神经丝轻链(neurofilament light chain,NfL)水平变化,探讨血浆NfL对脓毒症患者发生ICU-AW的预测价值。方法脓毒症患者65例,ICU治疗期间每日应用英国医学研究理事会肌力评分评估肌力,根据是否发生ICU-AW分为ICU-AW组24例和非ICU-AW组41例。比较2组脓毒症休克发生率、机械通气时间、ICU治疗时间、住院总时间;2组于入ICU 24 h内行序贯器官衰竭评估(sequential organ failure assessment,SOFA)、急性生理学和慢性健康状况Ⅱ(acute physiology and chronic health evaluationⅡ,APACHEⅡ)评分,检测NfL、空腹血糖、C反应蛋白、降钙素原、血乳酸、肌酸激酶、白细胞介素-6、白细胞介素-10、肿瘤坏死因子-α水平;采用多因素logistic回归分析脓毒症患者发生ICU-AW的影响因素;绘制ROC曲线,评估血浆NfL预测脓毒症患者发生ICU-AW的效能。结果ICU-AW组脓毒症休克发生率(54.17%)、SOFA评分[10.50(7.00,13.00)分]、APACHEⅡ评分[(22.12±6.42)分]及血乳酸[2.98(2.04,3.96)mmol/L]、血浆NfL[125.28(83.32,426.21)ng/L]水平均高于非ICU-AW组[19.51%、5.00(3.00,7.00)分、(12.73±5.50)分、1.56(1.21,3.00)mmol/L、74.71(43.07,121.35)ng/L](P<0.05),机械通气时间[5.00(1.25,17.75)d]、ICU治疗时间[13.00(9.50,20.50)d]均长于非ICU-AW组[0.00(0.00,2.00)、11.00(9.00,14.75)d](U=-3.331,P=0.001;U=-2.590,P=0.010),住院总时间及空腹血糖、C反应蛋白、降钙素原、肌酸激酶、白细胞介素-6、白细胞介素-10、肿瘤坏死因子-α水平与非ICU-AW组比较差异均无统计学意义(P>0.05)。血浆NfL是脓毒症患者发生ICU-AW的影响因素(OR=1.008,95%CI:1.000~1.017,P=0.049)。血浆NfL以103.70 ng/L为最佳截断值,预测脓毒症患者发生ICU-AW的AUC为0.735(95%CI:0.611~0.837,P<0.001),灵敏度为73.17%,特异度为66.67%。结论脓毒症并发ICU-AW患者血浆NfL水平升高,血浆NfL预测脓毒症患者发生ICU-AW有一定价值。
Objective To observe the level of plasma neurofilament light chain(NfL)in septic patients with ICU-acquired weakness(ICU-AW),and to investigate its value to the prediction of ICU-AW in septic patients.Methods Sixty-five patients with sepsis were evaluated daily with the Medical Research Council muscle strength score in ICU,and were divided into 24 patients with ICU-AW(ICU-AW group)and 41 patients with no ICU-AW(no-ICU-AW group).The plasma NfL level was detected in two groups by ELISA technique within 24 h after admission to ICU.The incidence of septic shock,duration of mechanical ventilation,length of ICU stay,and length of total hospital stay were compared between two groups.Sequential organ failure assessment(SOFA)within 24 h after admission to ICU and acute physiology and chronic health evaluationⅡ(APACHEⅡ)score were assessed,and the levels of fasting plasma glucose,C-reactive protein,procalcitonin,lactate,creatine kinase,interleukin-6,interleukin-10 and tumor necrosis factor-αwere detected in two groups.Multivariate logistic regression was done to analyze the influencing factors of ICU-AW in septic patients.The ROC curve was plotted to evaluate the efficiency of plasma NfL on predicting ICU-AW in septic patients.Results The incidence of septic shock,SOFA score,APACHEⅡscore,blood lactic acid level and plasma NfL level were higher in ICU-AW group[54.16%,10.50(7.00,13.00),22.12±6.42,2.98(2.04,3.96)mmol/L,125.28(83.32,426.21)ng/L]than those in no-ICU-AW group[19.51%,5.00(3.00,7.00),12.73±5.50,1.56(1.21,3.00)mmol/L,74.71(43.07,121.35)ng/L](P<0.05),the mechanical ventilation time and length of ICU stay were longer in ICU-AW group[5.00(1.25,17.75)d,13(9.50,20.50)d]than those in no-ICU-AW group[0.00(0.00,2.00)d,11.00(9.00,14.75)d](U=-3.331,P=0.001;U=-2.590,P=0.010),and there were no significant differences in the length of total hospital stay,and the levels of fasting plasma glucose,C-reactive protein,procalcitonin,creatine kinase,interleukin-6,interleukin-10and tumor necrosis factor-αbetween two groups(P>0
作者
赵霞飞
丁明月
邵换璋
秦秉玉
ZHAO Xia-fei;DING Ming-yue;SHAO Huan-zhang;QIN Bing-yu(Department of Intensive Care Unit,Zhengzhou University People's Hospital,Henan Provincial People's Hospital,Zhengzhou,Henan 450003,China)
出处
《中华实用诊断与治疗杂志》
2023年第3期304-307,共4页
Journal of Chinese Practical Diagnosis and Therapy
基金
河南省自然科学基金面上项目(202300410458)。
