脓毒症患者血清可溶性血栓调节蛋白与预后的相关性
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摘要
目的探讨血清可溶性血栓调节蛋白(sTM)对脓毒症患者的预后评估作用。方法选择2015年1月至2016年1月在我院住院的121例脓毒症作为观察组,同期来我院进行健康查体者120例作为对照组。收集两组一般临床资料,分析血清sTM水平与APACHEⅡ、SOFA的相关性,采用受试者工作曲线分析血清sTM水平对脓毒症患者预后价值。结果观察组一般临床资料与对照组比较差异均无统计学意义(均P> 0.05)。sTM、APACHEⅡ、SOFA、28 d病死率均随病情加重呈递增趋势(均P <0.01)。脓毒症患者sTM、APACHEⅡ、SOFA之间均有良好的正相关性(r=0.712,0,653,均P <0.05)。ROC曲线分析结果显示sTM+APACHEⅡ评分的AUC、灵敏度和特异度显著高于sTM(P <0.05)。结论 sTM联合APAcHEⅡ评分更好地评估脓毒症患者预后。
Objective To investigate the clinical significance of serum soluble thrombomodulin(sTM)in evaluating the prognosis of patients with sepsis. Methods A total of 121 cases of sepsis admitted to the emergency department of our hospital were selected as observation group from January 2015 to January 2016. In the same period,120 healthy cases having physical examination in our hospital were included as the control group. Clinical data of the two groups were collected. Association of serum sTM levels with APACHE Ⅱ and SOFA was analyzed.The prognostic value of serum sTM levels in patients with sepsis was analyzed by receiver operating curve(ROC).Results There were no significant differences in general clinical data between the observation group and the control group(all P > 0.05). The sTM level of the observation group was significantly higher than that of the control group(P < 0.05);sTM,APACHE II,SOFA,and 28 d mortality increased with the severity of the disease(both P < 0.01).There was significantly positive correlation between sTM,APACHE II and SOFA in patients with sepsis(r = 0.712,0,653,both P < 0.05). ROC curve analysis showed that AUC,sensitivity and specificity of sTM were higher than those of APACHE II score and the difference was statistically significant(P < 0.05),but AUC,sensitivity and specificity of sTM + APACHE II score were significantly higher than those of sTM(P < 0.05).Conclusion TM combined with APACHE II score is a better tool for assessing the prognosis of patients with sepsis.
Objective To investigate the clinical significance of serum soluble thrombomodulin(sTM)in evaluating the prognosis of patients with sepsis. Methods A total of 121 cases of sepsis admitted to the emergency department of our hospital were selected as observation group from January 2015 to January 2016. In the same period,120 healthy cases having physical examination in our hospital were included as the control group. Clinical data of the two groups were collected. Association of serum sTM levels with APACHE Ⅱ and SOFA was analyzed.The prognostic value of serum sTM levels in patients with sepsis was analyzed by receiver operating curve(ROC).Results There were no significant differences in general clinical data between the observation group and the control group(all P > 0.05). The sTM level of the observation group was significantly higher than that of the control group(P < 0.05);sTM,APACHE II,SOFA,and 28 d mortality increased with the severity of the disease(both P < 0.01).There was significantly positive correlation between sTM,APACHE II and SOFA in patients with sepsis(r = 0.712,0,653,both P < 0.05). ROC curve analysis showed that AUC,sensitivity and specificity of sTM were higher than those of APACHE II score and the difference was statistically significant(P < 0.05),but AUC,sensitivity and specificity of sTM + APACHE II score were significantly higher than those of sTM(P < 0.05).Conclusion TM combined with APACHE II score is a better tool for assessing the prognosis of patients with sepsis.
引文
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[6]郭峻氚,刘琪,肖东.溶性血栓调节蛋白在脓毒症急性肾损伤预测价值的研究[J].中国急救医学,2018,38(7):590-595.
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[10]COLETTA C,MóDIS K,OLáH G,et al.Endothelial dysfunction is a potential contributor to multiple organ failure and mortality in aged mice subjected to septic shock:preclinical studies in a murine model of cecal ligation and puncture[J].Crit Care,2014,18(5):511.
[11]LEE W L,SLUTSKY A S.Sepsis and endothelial permeability[J].N Engl J Med,2010,363(7):689-691.
[12]罗运山,刘易林,邓霞梅,等.PCT、s TREM-1结合APACHEⅡ评分对脓毒症诊断和预后的价值[J].实用医学杂志,2017,33(4):586-590.
[13]CEUNYNCK K D,PETERS C G,JAIN A,et al.PAR1 agonists stimulate APC-like endothelial cytoprotection and confer resistance to thromboinflammatory injury[J].Proc Natl Acad Sci US A,2018,115(5):201718600.
[2]SAKURAI K,MIYASHITA T,OKAZAKI M,et al.Role for Neutrophil Extracellular Traps(NETs)and platelet aggregation in early sepsis-induced hepatic dysfunction[J].Vivo,2017,31(6):1051-1058.
[3]MCDONALD B,DAVIS R P,KIM S J,et al.Platelets and neutrophil extracellular traps collaborate to promote intravascular coagulation during sepsis in mice[J].Blood,2017,129(10):1357-1367.
[4]贺能英,郭振辉,刘朝炜.急性时相蛋白与慢性健康状况评估Ⅱ评分对老年脓毒症患者预后的研究[J].重庆医学,2018,47(1):93-95.
[5]柴云飞,雷黎明,李鹏,等.血管内皮细胞损伤与脓毒症休克的相关性[J].实用医学杂志,2017,33(15):2529-2532.
[6]郭峻氚,刘琪,肖东.溶性血栓调节蛋白在脓毒症急性肾损伤预测价值的研究[J].中国急救医学,2018,38(7):590-595.
[7]SCHERAG A,SCHONEWECK F,KESSELMEIER M,et al.Genetic factors of the disease course after sepsis:a genomewide study for 28 day mortality[J].E Bio Medicine,2016,12:239-246.
[8]SINGER M,DEUTSCHANM C S,SEYMOUR C W,et al.The third international consensus definitions for sepsis and septic shock(Sepsis-3)[J].JAMA,2016,315(8):801-810.
[9]WEI F,LIU S,LUO L,et al.Anti-inflammatory mechanism of ulinastatin:Inhibiting the hyperpermeability of vascularendothelial cells induced by TNF-αvia the Rho A/ROCK signal pathway[J].Int Immunopharmacol,2017,46(3):220-227.
[10]COLETTA C,MóDIS K,OLáH G,et al.Endothelial dysfunction is a potential contributor to multiple organ failure and mortality in aged mice subjected to septic shock:preclinical studies in a murine model of cecal ligation and puncture[J].Crit Care,2014,18(5):511.
[11]LEE W L,SLUTSKY A S.Sepsis and endothelial permeability[J].N Engl J Med,2010,363(7):689-691.
[12]罗运山,刘易林,邓霞梅,等.PCT、s TREM-1结合APACHEⅡ评分对脓毒症诊断和预后的价值[J].实用医学杂志,2017,33(4):586-590.
[13]CEUNYNCK K D,PETERS C G,JAIN A,et al.PAR1 agonists stimulate APC-like endothelial cytoprotection and confer resistance to thromboinflammatory injury[J].Proc Natl Acad Sci US A,2018,115(5):201718600.
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