血清CXCL-12对感染性休克患者预后的评估价值  

The Value of the Level of Serum CXCL-12 in Prognostic Evaluation of Patients with Septic Shock

作　　者：巫亚颖[1] 孟浩[2] 杨林军[2] 

机构地区：[1]上海中医药大学附属岳阳中西医结合医院急诊科,上海200072 [2]汉中市中心医院急诊科,陕西汉中723000

出　　处：《贵州医科大学学报》2017年第8期974-978,共5页Journal of Guizhou Medical University

摘　　要：目的:观察感染性休克患者中趋化因子血清CXCL-12水平变化及评估患者预后的临床价值。方法:82例感染性休克患者分为无功能障碍组(无多器官功能障碍,n=58)和功能障碍组(有多器官功能障碍综合征,n=24),同期健康体检者50例作为对照组,采用酶联免疫吸附法(ELISA)检测感染性休克组入ICU时和对照组体检时的血清CXCL-12水平;感染性休克患者入ICU时进行APACHEⅡ评分,比较两组患者病死率,比较存活患者和死亡患者血清CXCL-12水平和APACHEⅡ评分;采用Spearman法分析患者血清CXCL-12水平与APACHEⅡ的相关性,采用多变量Logistic回归分析感染性休克死亡的危险因素,采用工作特征曲线(ROC)分析血清CXCL-12评估感染性休克患者预后的临床价值。结果:感染性休克无功能障碍组和功能障碍组患者血清CXCL-12水平均高于对照组(P<0.05),功能障碍组高于无功能障碍组(P<0.05),无功能障碍组患者APACHEⅡ评分和病死率均明显低于功能障碍组(P<0.05);感染性休克患者血清CXCL-12水平与APACHEⅡ评分呈明显正相关(r=0.751,P<0.01),存活患者的CXCL-12水平和APACHEⅡ评分明显低于死亡患者(P<0.01);多变量Logistic回归分析结果表明CXCL-12水平和APACHEⅡ评分是感染性休克预后差的独立危险因素(P<0.05),ROC曲线下面积为0.913(P<0.001,95%CI=0.880~0.963),敏感度为0.832,特异度为0.811,约登指数0.643。结论:血清CXCL-12水平与感染性休克患者的发病进程密切相关,可评估病情的严重程度及预后。Objective： To observe the level of serum CXCL-12 in patients with septic shock,and assess the clinical value of prognostic evaluation. Methods： 82 cases of patients with septic shock were randomly divided into the no dysfunction group（ no multi-organ functional disturbance,58 cases） and dysfunction group（ multiple organ dysfunction syndrome,24 cases）. And then,50 cases with healthy physical examination at the same period were collected as control group. Enzyme linked immunosorbent assay（ ELISA） was used to detect the serum CXCL-12 levels of the septic shock group when they entered the ICU room and the control group during physical examination. APACHE Ⅱ score was performed in patients with septic shock who were admitted to the ICU therapeutic room. The mortality rate was compared between the two groups. The serum level of CXCL-12 and APACHE Ⅱ in survival patients and dead patients were compared. Spearman method was used to analyze the correlation between serum CXCL-12 level and APACHE Ⅱ. The risk factors for the prognosis of septic shock were analyzed by multiple logistic regression analysis. The clinical value of CXCL-12 in assessing the prognosis of patients with septic shock was evaluated by using the work characteristic curve（ ROC） analysis.Results： Serum CXCL-12 levels of no dysfunction group and dysfunction group were higher than the control group（ P〈0. 05）,and the dysfunction group was higher than no dysfunction group（ P〈0. 05）; the APACHE Ⅱ score and fatality rate of no dysfunction group were significantly lower than that in the dysfunction group（ P〈0. 05）; there was a significant positive correlation of serum CXCL-12 level in patients with septic shock and APACHE score（ r = 0. 751,P〈0. 01）; the CXCL-12 level and APACHE score of survival patients were significantly lower than dead patients（ P〈0. 01）; multivariate Logistic regression analysis showed that the CXCL-12 level and the APACHE Ⅱ score were independent prognostic factors in septic shock�

关 键 词：趋化因子 CXCL-12 感染性休克 多器官功能障碍综合征 ROC曲线 

分 类 号：R459.7[医药卫生—急诊医学]