血浆血管内皮生长因子浓度与血小板计数比值对脓毒症预后的预测作用  

Significance of the ratio of plasma vascular endothelial growth factor level to platelet count in the prognosis of patients with sepsis

作　　者：江稳强[1] 欧阳维富[2] 陈纯波[1] 朱高峰[1] 黄林强[1] 曾红科[1] 

机构地区：[1]广东省人民医院(广东省医学科学院)急危重症医学部,广州510080 [2]广东省人民医院(广东省医学科学院)检验科,广州510080

出　　处：《中华危重病急救医学》2014年第7期484-488,共5页Chinese Critical Care Medicine

基　　金：广东省科技计划项目（2008B080703039）;国家临床重点专科建设项目（2012-649）;广东省医学科研基金项目（B2012004）

摘　　要：目的 探讨血浆血管内皮生长因子浓度与血小板计数（VEGF/PLT）比值预测脓毒症患者28 d生存情况的临床价值.方法 采用前瞻性队列研究方法,入选2009年9月至2013年3月广东省人民医院重症监护病房（ICU）脓毒症患者164例,排除年龄＜18岁、慢性疾病终末期、3d内出现≥2个器官功能障碍、急性胰腺炎而未合并感染、预测生存时间≤28 d者,最终135例患者纳入统计分析.取患者入院当天的外周静脉血,检测血常规;离心取血浆,采用酶联免疫吸附试验（ELISA）检测VEGF浓度;计算7d急性生理学与慢性健康状况评分系统Ⅱ（APACHEⅡ）评分,并随访28 d临床结局.根据28 d生存情况将患者分为存活组和死亡组,进行单因素分析;采用Spearman秩相关分析VEGF与PLT的关系;多因素logistic回归分析影响28 d死亡的独立危险因素;绘制受试者工作特征曲线（ROC曲线）,以曲线下面积（AUC）评价相关指标的预测效力.结果 与存活组（93例）比较,死亡组（42例）患者入院时VEGF（ng/L：471.73±198.34比383.49±266.54,t=-1.918,P=0.057）、PLT（× 109/L：220.40±127.60比246.42±100.72,t=1.275,P=0.204）、白细胞计数（×109/L：12.48±4.62比13.70±5.97,t=1.063,P=0.292）、平均动脉压[mrnHg（1 mmHg=0.133 kPa）：86.50±12.04比91.03±13.10,t=1.557,P=0.123]和血乳酸（mmol/L：1.79±1.30比1.50±0.60,t=-1.768,P=0.079）差异均无统计学意义,但死亡组VEGF/PLT比值和APACHEⅡ评分显著升高[VEGF/PLT比值：2.59±1.44比1.73±1.13,t=-3.756,P=0.000; APACHEⅡ评分（分）：15.50±4.50比13.28±4.61,t=-2.022,P=0.045],氧合指数（PaO2/FiO2）显著降低（kPa：32.38±11.12比37.04±10.97,t=2.278,P=0.024）.相关分析显示,VEGF与PLT呈显著正相关（r=0.271,P=0.001）.多因素logistic回归分析显示：仅VEGF/PLT比值是预测脓毒症患者28 d生存的独立危险因素[优势比（OR）为1.591,95％可信区间（95％CI）为1.164 ～ 2.175,P=0.004],其AUC为0.704±0.Objective To investigate the clinical value of the ratio of plasma vascular endothelial growth factor level to platelet count （VEGF/PLT） in predicting 28-day prognosis in patients with sepsis.Methods A prospective cohort study was conducted.From September 2009 to March 2013,164 sepsis patients in Intensive Care Unit （ICU） of Guangdong General Hospital were included for study.Patients with age younger than 18 years old,the illness already reaching final stage of chronic diseases,suffering from two or more organs dysfunction within 3 days,acute pancreatitis without infection,or less than 28 days of expected survival time were excluded.Finally,135 patients were included in the further analysis.Peripheral blood samples were collected at admission.Routine blood tests were done,and then VEGF levels in plasma were measured by enzyme linked immunosorbent assay （ELISA）.Acute physiology and chronic health evaluation Ⅱ （APACHE Ⅱ） scores were recorded every day for 7 days.Patients＇ prognosis was assessed during the following 28 days.The patients were divided into 28-day survival group and non-survival group.Comparison between two groups was done by single factor analysis.Spearman rank correlation was used to analyze the correlation between VEGF levels and PLT.Mutivariate logistic regression analysis was performed to identify the independent risk factor for 28-day prognosis.Receiver operating characteristic curve （ROC curve） was plotted,and the effect of related indexes on predicting 28-day survival was evaluated by area under ROC curve （AUC）.Results There were no significant differences in VEGF （ng/L：471.73 ± 198.34 vs.383.49 ± 266.54,t=-1.918,P=0.057）,PLT （× 109/L：220.40±127.60 vs.246.42± 100.72,t=1.275,P=0.204）,leucocyte counts （× 109/L：12.48 ±4.62 vs.13.70 ±5.97,t=1.063,P=0.292）,mean arterial pressure [mmHg （1 mmHg=0.133 kPa）：86.50 ± 12.04 vs.91.03 t 13.10,t=1.557,P=0.123] and blood lactic acid （mmol/L：1.79 ± 1.30 vs.1.50 ± 0.60,t=-1.768,P=0.079） at ad

关 键 词：血管内皮生长因子 血小板计数 脓毒症 预后 急性生理学与慢性健康状况评分Ⅱ 

分 类 号：R459.7[医药卫生—急诊医学]