中华急诊医学杂志
中華急診醫學雜誌
중화급진의학잡지
CHINESE JOURNAL OF EMERGENCY MEDICINE
2015年
7期
772-778
,共7页
曾勉%常敏婵%何婉媚%李斌
曾勉%常敏嬋%何婉媚%李斌
증면%상민선%하완미%리빈
脓毒症%suPAR%PCT%CRP%诊断
膿毒癥%suPAR%PCT%CRP%診斷
농독증%suPAR%PCT%CRP%진단
Sepsis%suPAR%PCT%CRP%Diagnosis
目的 探讨脓毒症患者外周血可溶性尿激酶型纤溶酶原激活物受体(suPAR)水平在脓毒症的诊断及病情评估中的价值.方法 采用前瞻性研究方法,收集2013年6月至2014年3月入住中山大学附属第一医院ICU的82例脓毒症患者,根据脓毒症患者病情严重度分脓毒症组(n=27)、严重脓毒症组(n=27)和脓毒性休克组(n=28),以29例全身炎症反应综合征(SIRS)患者和15例健康志愿者作对照,各组的性别及年龄构成差异无统计学意义.测定脓毒症各组及对照组患者血suPAR、降钙素原(PCT)和C反应蛋白(CRP)水平,记录APACHEⅡ评分及SOFA评分.采用单因素方差比较各组suPAR、PCT、CRP水平,两因素相关分析用Spearman秩相关分析.绘制受试者工作曲线(ROC)评估上述指标在脓毒症诊断中的价值.结果 SIRS组、脓毒症组、严重脓毒症组、脓毒性休克组及健康对照组血suPAR水平(ng/mL)分另为(8.25±0.79)、(11.45±1.12)、(12.99±1.28)、(15.75±1.23)、(4.65±0.30),SIRS组及脓毒症各亚组suPAR水平明显高于健康对照组(P＜0.01),病情越重,suPAP水平越高,P＜0.05.血PCT水平脓毒症组(17.66±8.42) ng/mL、严重脓毒症组(9.67±3.56) ng/mL及脓毒性休克组(29.19±10.78) ng/mL,均高于SIRS组(1.10±0.78) ng/mL (P＜0.01).各组CRP升高,但差异无统计学意义.受试者工作曲线显示,血suPAR在区分SIRS和脓毒症时的曲线下面积是0.817 (P＜0.01,95％CI:0.714～0.921),当suPAR值为9.52 ng/mL时,辨别SIRS和脓毒症的灵敏度为71.93％,特异度为95.46％;suPAR联合PCT评估时,区分SIRS和脓毒症的曲线下面积是0.927(P＜0.01,95％ CI:0.870～0.985).血suPAR分别与PCT(r=0.326)、APACHEⅡ评分(r=0.492)、SOFA评分(r=0.386)呈正相关,均P＜0.01.结论 血suPAR在脓毒症患者中明显升高,与病情严重程度相关,具有区分SIRS和脓毒症的价值,suPAR联合PCT评估时,能提高脓毒症的诊断效能.
目的 探討膿毒癥患者外週血可溶性尿激酶型纖溶酶原激活物受體(suPAR)水平在膿毒癥的診斷及病情評估中的價值.方法 採用前瞻性研究方法,收集2013年6月至2014年3月入住中山大學附屬第一醫院ICU的82例膿毒癥患者,根據膿毒癥患者病情嚴重度分膿毒癥組(n=27)、嚴重膿毒癥組(n=27)和膿毒性休剋組(n=28),以29例全身炎癥反應綜閤徵(SIRS)患者和15例健康誌願者作對照,各組的性彆及年齡構成差異無統計學意義.測定膿毒癥各組及對照組患者血suPAR、降鈣素原(PCT)和C反應蛋白(CRP)水平,記錄APACHEⅡ評分及SOFA評分.採用單因素方差比較各組suPAR、PCT、CRP水平,兩因素相關分析用Spearman秩相關分析.繪製受試者工作麯線(ROC)評估上述指標在膿毒癥診斷中的價值.結果 SIRS組、膿毒癥組、嚴重膿毒癥組、膿毒性休剋組及健康對照組血suPAR水平(ng/mL)分另為(8.25±0.79)、(11.45±1.12)、(12.99±1.28)、(15.75±1.23)、(4.65±0.30),SIRS組及膿毒癥各亞組suPAR水平明顯高于健康對照組(P＜0.01),病情越重,suPAP水平越高,P＜0.05.血PCT水平膿毒癥組(17.66±8.42) ng/mL、嚴重膿毒癥組(9.67±3.56) ng/mL及膿毒性休剋組(29.19±10.78) ng/mL,均高于SIRS組(1.10±0.78) ng/mL (P＜0.01).各組CRP升高,但差異無統計學意義.受試者工作麯線顯示,血suPAR在區分SIRS和膿毒癥時的麯線下麵積是0.817 (P＜0.01,95％CI:0.714～0.921),噹suPAR值為9.52 ng/mL時,辨彆SIRS和膿毒癥的靈敏度為71.93％,特異度為95.46％;suPAR聯閤PCT評估時,區分SIRS和膿毒癥的麯線下麵積是0.927(P＜0.01,95％ CI:0.870～0.985).血suPAR分彆與PCT(r=0.326)、APACHEⅡ評分(r=0.492)、SOFA評分(r=0.386)呈正相關,均P＜0.01.結論 血suPAR在膿毒癥患者中明顯升高,與病情嚴重程度相關,具有區分SIRS和膿毒癥的價值,suPAR聯閤PCT評估時,能提高膿毒癥的診斷效能.
목적 탐토농독증환자외주혈가용성뇨격매형섬용매원격활물수체(suPAR)수평재농독증적진단급병정평고중적개치.방법 채용전첨성연구방법,수집2013년6월지2014년3월입주중산대학부속제일의원ICU적82례농독증환자,근거농독증환자병정엄중도분농독증조(n=27)、엄중농독증조(n=27)화농독성휴극조(n=28),이29례전신염증반응종합정(SIRS)환자화15례건강지원자작대조,각조적성별급년령구성차이무통계학의의.측정농독증각조급대조조환자혈suPAR、강개소원(PCT)화C반응단백(CRP)수평,기록APACHEⅡ평분급SOFA평분.채용단인소방차비교각조suPAR、PCT、CRP수평,량인소상관분석용Spearman질상관분석.회제수시자공작곡선(ROC)평고상술지표재농독증진단중적개치.결과 SIRS조、농독증조、엄중농독증조、농독성휴극조급건강대조조혈suPAR수평(ng/mL)분령위(8.25±0.79)、(11.45±1.12)、(12.99±1.28)、(15.75±1.23)、(4.65±0.30),SIRS조급농독증각아조suPAR수평명현고우건강대조조(P＜0.01),병정월중,suPAP수평월고,P＜0.05.혈PCT수평농독증조(17.66±8.42) ng/mL、엄중농독증조(9.67±3.56) ng/mL급농독성휴극조(29.19±10.78) ng/mL,균고우SIRS조(1.10±0.78) ng/mL (P＜0.01).각조CRP승고,단차이무통계학의의.수시자공작곡선현시,혈suPAR재구분SIRS화농독증시적곡선하면적시0.817 (P＜0.01,95％CI:0.714～0.921),당suPAR치위9.52 ng/mL시,변별SIRS화농독증적령민도위71.93％,특이도위95.46％;suPAR연합PCT평고시,구분SIRS화농독증적곡선하면적시0.927(P＜0.01,95％ CI:0.870～0.985).혈suPAR분별여PCT(r=0.326)、APACHEⅡ평분(r=0.492)、SOFA평분(r=0.386)정정상관,균P＜0.01.결론 혈suPAR재농독증환자중명현승고,여병정엄중정도상관,구유구분SIRS화농독증적개치,suPAR연합PCT평고시,능제고농독증적진단효능.
Objective To determine the diagnostic and assessment value of soluble urokinase plasminogen activator receptor (suPAR) level in septic patients.Methods Totally 82 septic patients in the Department of Intensive Care Unit of The First Affiliated Hospital,Sun Yat-Sen University were prospectively analyzed from June 2013 to March 2014.Another 29 patients with systemic inflammatory response syndrome (SIRS) and 15 healthy subjects served as controls.Septic patients were divided into sepsis group (n =27),severe sepsis group (n =27) and septic shock group (n =28) according to the severity,and there was no significant difference in age and sex among these groups.Measurement of plasma suPAR,serum procalcitonin (PCT) and C-reactive protein (CRP) levels,and calculation of acute physiology and chronic health evaluation Ⅱ (APACHE Ⅱ) and sequential organ failure assessment (SOFA) score were performed.Comparison of group differences for continuous variables was done by oneway ANOVA or nonparametric Kruskal-Wallis test.Spearman rank correlation analysis was applied to establish the relation between variables.Receiver operating characteristics (ROC) curve was created and area under curve (AUC) was calculated to determine the diagnostic value of these variables in sepsis.Results The levels of plasma suPAR in SIRS group,sepsis group,severe sepsis group,septic shock group,and healthy control group were (8.22±0.61),(11.45±1.12),(12.99±1.28),(15.75± 1.23) and (4.65 ±0.30) ng/mL,respectively.Plasma suPAR levels in SIRS group and sepsis group were higher than that in healthy control group (P ＜ 0.01),and elevated plasma suPAR was accompanied by increased severity of sepsis (P ＜ 0.05).PCT levels of sepsis group (17.66 ± 8.42) ng/mL,severe sepsis group (9.67 ±3.56) ng/mL and septic shock group (29.19 ± 10.78) ng/mL were greater than that in SIRS group (1.10 ± 0.78) ng/mL,P ＜ 0.01.CRP levels elevated in all groups,but there were no significant differences among them.When suPAR and CRP were applied to distinguishing sepsis from SIRS,the AUC values from suPAR and combination of suPAR and PCT were 0.817 (P ＜ 0.01,95 ％ CI:0.714-0.921) and 0.927 (P＜0.01,95％ CI:0.870-0.985),respectively.Using9.52 ng/mL suPAR as the best cut-off to distinguish sepsis from SIRS,there were 71.93％ sensitivity and 95.46％ specificity.The levels of plasma suPAR positively correlated with PCT levels (r =0.326),APACHE Ⅱ score (r =0.492) and SOFA score (r =0.386),P ＜ 0.01.Conclusions Plasma suPAR levels significantly elevated in septic patients and correlated with the severity of sepsis.Sepsis and SIRS may be discerned by plasma suPAR levels.Joint use of suPAR and PCT could greatly increase the specificity of diagnosis of sepsis.
