血浆游离DNA对脓毒症预后的预测价值  

Predictive value of plasma cell-free DNA for prognosis of sepsis

作　　者：黄天宝[1] 杨志燕[1] 陈少剑[1] 陈金图[1] Chen Jintu(Department of Emergency,the First Hospital of Quanzhou Affiliated to Fujian Medical University,Quanzhou 362000,Fujian,China)

机构地区：[1]福建医科大学附属泉州第一医院急诊中心,福建泉州362000

出　　处：《中华危重病急救医学》2018年第10期925-928,共4页Chinese Critical Care Medicine

基　　金：福建省泉州市科技计划项目（Z[2015]0079）

摘　　要：目的 探讨血浆游离DNA（cf-DNA）对脓毒症患者预后的预测价值.方法 选择2015年6月至2017年6月福建医科大学附属泉州第一医院急诊中心收治的105 例脓毒症患者为研究对象,并根据病情程度分为脓毒症组（50例）和严重脓毒症组（55例）;同时选择本院体检中心50例健康体检者作为健康对照组.比较3组间cf-DNA、降钙素原（PCT）、急性生理学与慢性健康状况评分Ⅱ（APACHEⅡ）的差异;采用Bivariate法分析cf-DNA与PCT、APACHEⅡ的相关性.采用Logistic回归分析脓毒症的独立预测因素;绘制受试者工作特征曲线（ROC）,评估cf-DNA、PCT、APACHEⅡ单独或联合对脓毒症预后的预测能力.结果 脓毒症组和严重脓毒症组PCT、APACHEⅡ及cf-DNA均明显高于健康对照组〔PCT（μg/L）：5.80（3.28,8.85）、17.53（8.40, 29.61）比0.02（0.01,0.03）,APACHEⅡ（分）：13.04±3.03、23.29±8.02比2.10±1.05,cf-DNA（μg/L）：1 438.0 （1 154.0,1 576.0）、2 595.0（2 162.0,5 198.0）比17.0（13.0,20.5）,均P＜0.05〕,且严重脓毒症组各指标较脓毒症组进一步升高（均P＜0.05）.相关性分析显示,cf-DNA与PCT 〔r＝0.675,95%可信区间（95%CI）＝0.575-0.766, P＜0.001〕、APACHEⅡ（r＝0.911,95%CI＝0.874-0.939,P＜0.001）均呈显著正相关.ROC曲线分析显示, PCT、APACHEⅡ、cf-DNA、PCT＋APACHEⅡ、cf-DNA＋PCT、cf-DNA＋APACHEⅡ、cf-DNA＋PCT＋APACHEⅡ预测脓毒症患者预后的ROC曲线下面积（AUC）分别为0.898、0.905、0.961、0.941、0.974、0.976、0.982.脓毒症预后的预测能力显示,PCT、APACHEⅡ、cf-DNA单独预测时,cf-DNA的AUC最大（0.961）,敏感度为100%,特异度为81.43% ;cf-DNA与PCT或APACHEⅡ联合预测可进一步增加AUC,且cf-DNA＋PCT＋APACHEⅡ三者联合预测的AUC达最大（0.982）,敏感度为94.29%,特异度为98.57%.结论 cf-DNA、PCT、APACHEⅡ对脓毒症患者的预后均具有一定的预测价值,单独预测时cf-DNA的价值最高,但cf-DNA、PCObjective To explore the predictive value of plasma cell-free DNA （cf-DNA） for prognosis in patients with sepsis. Methods 105 patients with sepsis admitted to department of emergency of the First Hospital of Quanzhou Affiliated to Fujian Medical University from June 2015 to June 2017 were enrolled. Patients were divided into sepsis group （n = 50） and severe sepsis group （n = 55）. At the same time, 50 cases of physical examination center in our hospital were randomly selected as the healthy control group. The differences of cf-DNA, procalcitonin （PCT） and acute physiology and chronic health evaluation Ⅱ（APACHEⅡ） score among the three groups were compared. The correlation between cf-DNA and PCT or APACHEⅡ were analyzed by Bivarite method. Logistic regression was used to analyze the independent predictors of sepsis. The receiver operating characteristic curve （ROC） was made to evaluate cf-DNA, PCT, APACHEⅡ alone or combined ability to predict the prognosis of sepsis. Results The PCT, APACHE Ⅱ and cf-DNA in the sepsis group and severe sepsis group were significantly higher than those in the healthy control group [PCT （μg/L）：5.80 （3.28, 8.85）, 17.53 （8.40, 29.61） vs. 0.02 （0.01, 0.03）; APACHEⅡ： 13.04±3.03, 23.29±8.02 vs. 2.10±1.05;cf-DNA （μg/L）： 1 438.0 （1 154.0, 1 576.0）, 2 595.0 （2 162.0, 5 198.0） vs. 17.0 （13.0, 20.5）; all P﹤0.05], and the indicators in the severe sepsis group were further higher than the sepsis group （all P 〈 0.05）. Correlation analysis showed that cf-DNA was significantly positive correlated with PCT [r = 0.675, 95% confidence interval （95%CI） = 0.575-0.766, P 〈 0.001] and APACHEⅡ （r = 0.911, 95%CI = 0.874-0.939, P 〈 0.001）. ROC curve analysis showed that the areas under ROC curve （AUC） of PCT, APACHEⅡ, cf-DNA, PCT＋APACHEⅡ, cf-DNA＋PCT, cf-DNA＋APACHEⅡ, cf-DNA＋PCT＋APACHEⅡ to predict the prognosis of sepsis patients were 0.898, 0.905, 0.961, 0.941, 0.974, 0.976 and 0.982, respec

关 键 词：脓毒症 血浆游离DNA 急性生理学号陧性健康状况评分Ⅱ 降钙素原 预后 

分 类 号：R459.7[医药卫生—急诊医学]