血清铁调素Hepcidin在成人重症患者脓毒症临床诊断中的价值  

Value of Hepcidin as a diagnostic biomarker of sepsis in critically ill adults

作　　者：邱泽亮[1] 沈侃[1] 舒铭 许东伟[1] 邓星奇 陈德昌 Qiu Zeliang;Shen Kan;Shu Ming;Xu Dongwei;Deng Xingqi;Chen Dechang(Department of Intensive Care Unit,Zhoupu Hospital Affiliated to Shanghai University of Medicine ＆ Health Sciences,Shanghai 201318,China;Department of Intensive Care Unit,Ruijin Hospital Shanghai Jiao Tong University School of Medicine,Shanghai 200025,China)

机构地区：[1]上海健康医学院附属周浦医院重症医学科,201318 [2]上海交通大学医学院附属瑞金医院重症医学科,200025

出　　处：《中华危重病急救医学》2018年第7期652-657,共6页Chinese Critical Care Medicine

基　　金：上海市卫生和计划生育委员会科研项目（201540420）;上海市浦东新区卫生系统学科带头人培养计划项目（PWRd2016-08）

摘　　要：目的评价血清铁调素Hepcidin对成人重症患者脓毒症的临床诊断价值。方法采用观察性研究方法，选择2016年3月至2017年11月上海健康医学院附属周浦医院重症医学科（ICU）收治的临床疑似或确诊感染的患者。根据脓毒症及脓毒性休克第3次国际共识定义（Sepsis-3）诊断标准将患者分为非脓毒症组和脓毒症组，后者再按感染严重程度分为一般脓毒症和脓毒性休克两个亚组。比较非脓毒症组与脓毒症组以及脓毒症两个亚组患者间入ICU 1 h内血清Hepcidin、白细胞介素-6（IL-6）、肿瘤坏死因子-α（TNF-α）、降钙素原（PCT）、C-反应蛋白（CRP）、白细胞计数（WBC）、中性粒细胞计数（NEUT）和动脉血乳酸（Lac）水平，记录患者入ICU 24 h内急性生理学与慢性健康状况评分Ⅱ（APACHEⅡ）和序贯器官衰竭评分（SOFA），随访记录28 d病死率。绘制受试者工作特征曲线（ROC），评价Hepcidin对脓毒症的诊断价值，并与PCT、CRP、WBC进行比较。采用Logistic回归模型分析Hepcidin与脓毒症的关系。脓毒症患者Hepcidin与各项指标之间的相关性采用Spearman相关分析。结果共纳入183例患者，其中非脓毒症组93例，脓毒症组90例；一般脓毒症48例，脓毒性休克42例。①脓毒症组患者血清Hepcidin、IL-6、TNF-α、PCT、Lac水平和APACHEⅡ、SOFA评分均较非脓毒症组明显升高。ROC曲线分析显示，血清Hepcidin和PCT诊断脓毒症的ROC曲线下面积（AUC）分别为0.865〔95%可信区间（95%CI）＝0.807～0.911〕和0.848（95%CI＝0.788～0.897），二者比较差异无统计学意义（Z＝0.443，P＝0.657）；Hepcidin的诊断效能明显优于传统指标CRP和WBC〔AUC分别为0.530（95%CI＝0.455～0.604）和0.527（95%CI＝0.452～0.601）〕，差异均有统计学意义（均P〈0.01）。当Hepcidin〉54.00 μg/L时，其诊断脓毒症的敏感度为95.56%，特异度为66.67%，阳性预测值为73.51%，�ObjectiveTo investigate the diagnostic value of Hepcidin as a sepsis biomarker in critically ill adults.MethodsAn observational study was conducted. The patients with suspected or proven infection admitted to intensive care unit （ICU） of Zhoupu Hospital Affiliated to Shanghai University of Medicine ＆ Health Sciences from March 2016 to November 2017 were enrolled. According to the third international consensus definitions for sepsis and septic shock （Sepsis-3）, the patients were divided into non-sepsis group and sepsis group, and the septic patients were subdivided into general sepsis subgroup and septic shock subgroup according to the severity of disease. The differences in serum Hepcidin, interleukin-6 （IL-6）, tumor necrosis factor-α （TNF-α）, procalcitonin （PCT）, C-reactive protein （CRP）, white blood cell （WBC）, neutrophil granulocytes （NEUT） and lactic acid （Lac） within 1 hour after ICU admission between non-sepsis and sepsis groups and among the sepsis subgroups were compared. The acute physiology and chronic health evaluation Ⅱ （APACHE Ⅱ） within 24 hours after ICU admission and sequential organ failure score （SOFA） were recorded, and the mortality rate was followed up for 28 days. Receiver operation characteristic curve （ROC） was used to evaluate and compare the diagnostic value of Hepcidin and PCT, CRP, WBC for sepsis. Logistic regression model was used to estimate the association between Hepcidin and sepsis. Spearman correlation analysis was used to analyze the correlation between Hepcidin and other parameters of sepsis patients.ResultsA total of 183 patients were enrolled, 93 in the non-sepsis group and 90 in the sepsis group （48 with general sepsis and 42 with septic shock）.① The levels of Hepcidin, IL-6, TNF-α, PCT, Lac in serum, and APACHEⅡand SOFA scores in the sepsis group were significantly higher than those in the non-sepsis group. ROC analysis showed that the area under the ROC curve （AUC） of Hepcidin and PCT for sepsis diagnosis

关 键 词：脓毒症 HEPCIDIN 降钙素原 诊断 生物学标志物 

分 类 号：R459.7[医药卫生—急诊医学]