血清CRISPLD2水平对脓毒症患者的诊断及预后评估价值  

Value of serum CRISPLD2 levels for the diagnosis and prognosis evaluation of sepsis patients

作　　者：王来[1] 杨秀芬[2] 张书利[1] 朱孟莎 

机构地区：[1]河北医科大学第一医院重症医学科,河北石家庄050031 [2]河北省儿童医院重症医学科,河北石家庄050031

出　　处：《中华危重病急救医学》2017年第8期694-699,共6页Chinese Critical Care Medicine

基　　金：河北省医学科学研究重点课题计划项目（20170479）

摘　　要：目的 探讨血清半胱氨酸富集分泌蛋白含LCCL结构域2（CRISPLD2）水平对脓毒症的诊断及预后预测价值.方法 回顾性分析2014年12月至2016年12月入住河北医科大学第一医院重症加强治疗病房（ICU）成人脓毒症患者的临床资料,根据其病情严重程度分为脓毒症组、严重脓毒症组、脓毒性休克组;同时以100例健康体检者作为健康对照组.收集研究对象入院24 h内血清CRISPLD2、降钙素原（PCT）、C-反应蛋白（CRP）、急性生理学与慢性健康状况评分系统Ⅱ（APACHEⅡ）和序贯器官衰竭评分（SOFA）,以及28 d预后;分析脓毒症患者CRISPLD2与PCT、CRP、APACHEⅡ和SOFA评分的相关性;用受试者工作特征曲线（ROC）评估CRISPLD2对脓毒症诊断及预后的预测价值.结果 共入选115例脓毒症患者,其中脓毒症52例,严重脓毒症48例,脓毒性休克15例;28 d死亡29例,病死率为25.2%.脓毒症患者CRISPLD2水平与健康对照组差异无统计学意义（mg/L：204.1±74.5比211.3±12.0,P〉0.05）;但脓毒性休克组CRISPLD2水平明显低于脓毒症组和严重脓毒症组（mg/L：139.0±55.0比240.2±89.6、233.0±8.9,均P〈0.05）.脓毒症患者PCT、CRP、APACHEⅡ评分、SOFA评分均明显高于健康对照组,且随病情程度加重呈递增趋势.脓毒症死亡者CRISPLD2水平与存活者相比差异无统计学意义,PCT、CRP水平则明显升高.脓毒症患者血清CRISPLD2水平与PCT、CRP、APACHEⅡ评分、SOFA评分均呈负相关（r值分别为-0.089、-0.431、-0.115、-0.201,均P〈0.05）.ROC曲线分析显示,CRISPLD2、PCT、CRP诊断脓毒症的ROC曲线下面积（AUC）和95%可信区间（95%CI）分别为0.907（0.871-0.944）、0.922（0.886-0.958）、0.916（0.878-0.954）,均P=0.000;当CRISPLD2截断值〉216.0 mg/L时诊断脓毒症的敏感度为96.7%,特异度为92.6%,介于PCT与CPR之间.CRISPLD2评估预后的AUC明显低于PCT〔0.617（0.507-0.727）比0.786（0.668-0.903）,P〈0.01〕;当CRISPLD2截断Objective To investigate the value of cysteine-rich secretory protein LCCL domain-containing 2 （CRISPLD2） in diagnosis and prognosis in patients with sepsis.Methods Clinical data of patients admitted to intensive care unit （ICU） of the First Hospital of Hebei Medical University from December 2014 to December 2016 were retrospectively analyzed. According to the severity of sepsis, the patients were divided into three groups： sepsis patients, severe sepsis patients and septic shock patients, and 100 healthy persons were enrolled as control group. Levels of serum CRISPLD2, procalcitonin （PCT） and C-reactive protein （CRP）, acute physiology and chronic health evaluation Ⅱ （APACHEⅡ） score, sequential organ failure assessment （SOFA） score, and 28-day prognosis were recorded. Analysis of the correlation between CRISPLD2 and PCT, CRP, APACHEⅡscore, SOFA score was done. The receiver operating characteristic （ROC） curve was plotted for the CRISPLD2 value for the diagnosis and prognosis in patients with sepsis.Results A total of 115 patients with sepsis were enrolled in this study, including 52 sepsis, 48 severe sepsis, and 15 septic shock; 29 patients died after 28 days, 28-days mortality rate was 25.2%. There was no significant difference in CRISPLD2 between sepsis and healthy control group （mg/L： 204.1±74.5 vs. 211.3±12.0, P 〉 0.05）; the level of CRISPLD2 in septic shock group was significantly lower than that in sepsis group and severe sepsis group （mg/L： 139.0±55.0 vs. 240.2±89.6, 233.0±8.9, bothP 〈 0.05）. The level of PCT, CRP and APACHE Ⅱ score, SOFA score in sepsis patients were significantly higher than those in healthy control group, and increased with the severity of sepsis. There was no statistically significant difference in CRISPLD2 level between the dead and the survival of sepsis, and the levels of PCT and CRP in death group were significantly higher. The levels of CRISPLD2 were significantly negative correlated with the levels of PCT, CRP, APACHE Ⅱ

关 键 词：脓毒症 半胱氨酸富集分泌蛋白含LCCL结构域2 C-反应蛋白 降钙素原 诊断 预后 

分 类 号：R459.7[医药卫生—急诊医学]