血清血管内皮钙黏蛋白水平与脓毒性休克患者预后的关系  

Relationship between serum vascular endothelial cadherin level and prognosis of patients with septic shock

作　　者：李真玉[1] 宗晓龙[2] 胡轶鹏[1] 王斌[1] 陈兵[1] Li Zhenyu;Zong Xiaolong;Hu Yipeng;Wang Bin;Chen Bing(Intensive Care Unit,the Second Hospital of Tianjin Medical University,Tianjin 300211,China;Department of Laboratory,the Second Hospital of Tianjin Medical University,Tianjin 300211,China)

机构地区：[1]天津医科大学第二医院ICU,天津300211 [2]天津医科大学第二医院检验科,天津300211

出　　处：《中华急诊医学杂志》2018年第12期1370-1375,共6页Chinese Journal of Emergency Medicine

基　　金：天津芾卫生计生行业高层次人才选拔培养工程“青年医学新锐”人才项目;天津市卫生和计划生育委员会科技基金(2014KZ103)。

摘　　要：目的 通过监测血清血管内皮钙黏蛋白(vascular endothelial cadherin,VE-Cad)水平变化,以探讨其与脓毒性休克患者疾病严重程度及预后的关系.方法 采用前瞻性研究方法,2016年1月年至2017年12月收集脓毒性休克患者44例,同期选择25例健康查体者作为对照组;根据28 d预后将脓毒性休克组分为生存组24例和死亡组20例.入院第1、3、7天晨时取血,动态观察血清VE-Cad、血管内皮生长因子(vascular endothelial growth factor,VEGF)、肿瘤坏死因子-α(TNF-α)和白介素-6(IL-6)水平变化,同时评定APACHEⅡ评分和SOFA评分.结果 入院第1天脓毒性休克组血清VE-Cad高于对照组[(3.02±0.18)ng/mL vs.(0.26±0.05)ng/mL,t=3.275,P=0.002],和VEGF、TNF-α 和IL-6正相关(r分别为0.826、0.723和0.870,均P<0.01).死亡组的氧合指数(PaO2/FiO2)和血清白蛋白(ALB)低于生存组(P<0.05),死亡组的血管外肺水指数(extravascular lung water index,EVLWI)、乳酸、机械通气时间、7 d液体平衡量、APACHEⅡ评分和SOFA评分均高于生存组(P<0.05).死亡组1、3、7 d的血清VE-Cad和VEGF水平均高于生存组(均P<0.01).血清VE-Cad与APACHEⅡ评分和SOFA评分均正相关(r分别为0.774、0.723和0.870,均P<0.01).第1天VE-Cad预测脓毒症休克死亡的ROC曲线下面积为0.723(95%CI:0.568~0.878),当其截断值为3.100 ng/mL时,其预测脓毒症患者死亡的灵敏度为60%,特异度为70.83%.结论 脓毒性休克患者血清VE-Cad水平升高,其水平与疾病危重程度相关.Objective To investigate the prognostic significance of serum VE-cadherin in patients with septic shock. Methods A prospective observation study was performed between January 2016 and December 2017, forty-eight septic shock patients from intensive care unit (ICU) were enrolled, and 25 healthy volunteers served as the controls. Meanwhile, patients in the septic shock group were divided into two subgroups of the survival and death groups according to the 28-day mortality. The dynamic value changes of serum VE-cadherin (VE-Cad), vascular endothelial growth factor (VEGF), interleukin-6 (IL-6) and tumor necrosis factor-α (TNF-α) were monitored on the 1st, 3rd and 7th day after admission. Results The serum VE-Cad level of the septic group was significantly higher than that of the control group on the 1st day (3.02±0.18 ng/mL vs. 0.26±0.05 ng/mL, t=3.275, P=0.002). There was a positive correlation between VE-Cad level and VEGF, TNF-α and IL-6 (r=0.826, 0.723, and 0.870, respectively; P<0.01). The PaO2/FiO2 and serum albumin (ALB) level of the death group were lower than that of the survival group, and extravascular lung water index (EVLWI), serum lactate, mechanical ventilation time, 7 day fluid balance, APACHE Ⅱ and SOFA levels of the death group were higher than those of the survival group. The serum VE-Cad levels of the death group were higher than those of the survival group on the 1st, 3rd and 7th day. The serum VE-Cad levels were positively correlated with APACHE Ⅱ and SOFA. The area under the ROC curve of VE-Cad predicting septic shock death on day 1 was 0.723 (95%CI 0.568-0.878). The sensitivity and specificity of VE-Cad with cut-off of 3.1 ng/mL in predicting septic shock death were 60% and 70.83%, respectively. Conclusions Serum VE-Cad is positively correlated with disease severity and could predict a poor outcome in septic shock patients.

关 键 词：脓毒性休克 血管内皮钙黏蛋白 血管内皮生长因子 肿瘤坏死因子-Α 预后 

分 类 号：R459.7[医药卫生—急诊医学]