可溶性尿激酶型纤溶酶原激活物受体在脓毒症的诊断价值  

The value of soluble urokinase plasminogen activator receptor in diagnosis and severity assessment of sepsis

作　　者：曾勉[1] 常敏婵[1] 何婉媚[1] 李斌[1] 

机构地区：[1]中山大学附属第一医院MICU,广州510080

出　　处：《中华急诊医学杂志》2015年第7期772-778,共7页Chinese Journal of Emergency Medicine

摘　　要：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）分别为（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9．52ng／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 = 23 ） 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 lI （APACHE I1 ） and sequential organ failure assessment （SOFA） score were performed. Comparison of group differences for continuous variables was done by one- way 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 〈

关 键 词：脓毒症 SUPAR PCT CRP 诊断 

分 类 号：R459.7[医药卫生—急诊医学]