外周血游离DNA/NETs在脓毒症诊断和预后评估中的应用价值  

Clinical value of peripheral serum cf-DNA/NETs level in diagnosis and severity assessment of sepsis patients

作　　者：孟强[1] 屈峰[1] 董伟[1] 张昊[1] MENG Qiang;QU Feng;DONG Wei;ZHANG Hao(Intensive Care Unit, The First People＇s Hospital of Jining, Jining, Shandong 272011, P. R. China)

机构地区：[1]济宁市第一人民医院重症监护科,山东济宁272011

出　　处：《中国呼吸与危重监护杂志》2018年第3期255-258,共4页Chinese Journal of Respiratory and Critical Care Medicine

摘　　要：目的探讨血浆游离DNA/中性粒细胞胞外诱捕网(cf-DNA/NETs)对脓毒症临床诊断和严重度评估的价值。方法收集脓毒症患者、非感染全身炎性反应综合征(nf-SIRS)患者入监护室时的血液标本,检测两组患者血液中cf-DNA/NETs的水平,并绘制受试者工作特征(ROC)曲线,与白细胞(WBC)、降钙素原(PCT)和白细胞介素-6(IL-6)比较,评价cf-DNA/NETs及其他感染指标鉴别脓毒症患者的能力。根据预后将脓毒症患者分为生存组和死亡组两个亚组,比较两组间感染指标是否有显著差异,并与序贯器官衰竭评分(SOFA评分)进行相关性分析。结果脓毒症组与nf-SIRS组比较,cf-DNA/NETs和PCT明显升高(均P<0.05),而WBC和IL-6在两组患者间差异无统计学意义(均P<0.05)。cf-DNA/NETs、PCT用于脓毒症诊断时的ROC曲线下面积分别为0.884和0.803,诊断脓毒症的敏感性分别为81.2%和79.2%,特异性分别为82.4%和81.0%。死亡组与生存组比较,cf-DNA/NETs和PCT水平明显升高(均P<0.05)。双变量相关分析显示cf-DNA/NETs和PCT均与SOFA评分有较好的相关性,r值分别为0.573和0.518(均P<0.01)。结论 cf-DNA/NETs和PCT均可以作为脓毒症早期的诊断指标。cf-DNA/NETs与PCT相比,在脓毒症诊断能力上有一定的优势,并且有助于对脓毒症严重程度的评估。Objective To investigate the clinical value of peripheral serum cell-free DNA/neutrophil extracellular traps（cf-DNA/NETs） level in diagnosis and severity assessment of sepsis patients. Methods Forty patients with sepsis and 40 patients with non-infectious systemic inflammatory response syndrome（nf-SIRS） were enrolled in this study. The cf-DNA/NETs level in serum of all subjects were measured. Receiver operating characteristic（ROC） curve was used to evaluate the diagnostic ability of the cf-DNA/NETs, white blood cell count（WBC）, procalcitonin（PCT） and interleukin-6（IL-6）. The sepsis patients were stratified into a survival group and a death group according to the prognosis. Sequential organ failure（SOFA） score were recorded in the sepsis patients, and the correlations between SOFA and cf-DNA/NETs,PCT, WBC, IL-6 were analyzed. Results Compared with the nf-SIRS group, cf-DNA/NETs and PCT levels were significantly higher in the sepsis group（both P〈0.05）. WBC and IL-6 showed no significant differences between the two groups（both P〈0.05）. The area under the ROC curve（AUC） of cf-DNA/NETs was 0.884 for diagnosis of sepsis, and it was higher than the AUC of PCT（0.803）. The cf-DNA/NETs showed better sensitivity（81.2% and 79.2%） and specificity（81.0% and 82.4%） than PCT. cf-DNA/NETs and PCT were significantly higher in the death group than those in the survival group. Bivariate collection analysis revealed positive correlations between SOFA score and the two biomarkers of cf-DNA/NETs and PCT（r1=0.573, r2=0.518; both P〈0.01）. Conclusions cf-DNA/NETs and PCT have certain value in early diagnosis of sepsis, and cf-DNA/NETs shows better diagnostic value in distinguishing sepsis from nf-SIRS than PCT.cf-DNA/NETs can be used as a routine monitoring index to help assess disease severity in sepsis.

关 键 词：中性粒细胞胞外诱捕网 脓毒症 降钙素原 全身炎症反应综合征 

分 类 号：R459.7[医药卫生—急诊医学]