MCP-1和mHLA-DR检测对脓毒症患者病情危重程度及预后评估的临床意义  

Clinical significance of the MCP-1 and the monocyte human leukocyte antigen-DR in patients with sepsis

作　　者：许志平[1] 马红玲[2] 陈双峰[3] 吴铁军[1] Xu Zhiping;Ma Hongling;Chen Shuangfeng;Wu Tiejun(Departmen of Intensive Care Unit,Liaocheng People′s Hospital,Liaocheng 252000,China;Department of Neurology,Liaocheng People′s Hospital,Liaocheng 252000,China;Central Laboratory,Liaocheng People′s Hospital,Liaocheng 252000,China)

机构地区：[1]山东省聊城市人民医院重症医学科,252000 [2]山东省聊城市人民医院神经内科,252000 [3]山东省聊城市人民医院中心实验室,252000

出　　处：《中华重症医学电子杂志》2019年第3期225-229,共5页Chinese Journal Of Critical Care & Intensive Care Medicine(Electronic Edition)

基　　金：山东省科学技术发展计划项目(2012YD18024)

摘　　要：目的探讨单核细胞趋化蛋白1(MCP-1)表达量和单核细胞人类白细胞抗原-DR(mHLA-DR)表达率对脓毒症患者病情危重程度及预后的临床意义.方法选取2014年12月至2016年2月在聊城市人民医院重症医学科就诊的脓毒症患者104例,根据预后分为生存组(63例)和死亡组(41例),所有患者发病后12h内采集静脉血,收集评估脏器功能的指标,并进行序贯器官衰竭估计(SOFA)评分和急性生理与慢性健康状况评分系统Ⅱ(APACHEⅡ)评分,应用酶联免疫吸附测定法(ELISA)检测血清MCP-1的表达量,流式细胞仪检测外周血mHLA-DR的表达率,比较2组患者之间各项指标的差异,并分析其对病情危重程度及临床预后的评估价值及相关性.结果入组的脓毒症患者,死亡组血清MCP-1表达量较生存组明显升高[(187.65±60.73)pg/mlvs(90.83±31.58)pg/ml,t=-10.65,P<0.01],外周血mHLA-DR表达率较生存组明显降低[(29.41±8.78)%vs(54.70±12.21)%,t=11.47,P<0.05],SOFA评分较生存组明显升高[(11.76±3.92)分vs(9.17±4.39)分,t=-3.28,P<0.01],APACHEⅡ评分明显高于生存组[(25.76±6.27)分vs(18.83±4.65)分,t=-6.47,P<0.05].血清MCP-1表达量评估脓毒症患者预后的受试者工作特征(ROC)曲线下面积(AUC)为0.950[95%可信区间(CI)=0.911~0.989,P<0.001],根据ROC曲线确定MCP-1评估脓毒症患者死亡的最佳阈值为115.48pg/ml时,其诊断敏感度为90.2%,特异度为87.3%.mHLA-DR表达率的ROC的AUC为0.952(95%CI=0.915~0.990,P<0.001),根据ROC曲线确定mHLA-DR评估脓毒症患者生存的最佳阈值为39.3%时,其诊断敏感度为88.9%,特异度为87.8%.SOFA评分的ROC的AUC为0.690(95%CI=0.591~0.790,P<0.002),根据ROC曲线确定SOFA评分评估脓毒症患者死亡的最佳阈值为8.5分时,其诊断敏感度为80.5%,特异度为57.1%.APACHEⅡ评分的ROC的AUC为0.805(95%CI=0.711~0.898,P<0.001),根据ROC曲线确定APACHEⅡ评分评估脓毒症患者死亡的最佳阈值为22.5分时,其诊断敏感度为75.6%,特异度为76.2%.所有入组Objective To investigate the clinical value of t MCP-1 and monocyte human leukocyte antigen-DR (mHLA-DR) in severity and the prognosis of sepsis patients. Method 104 patients with sepsis were selected. Patients were classified into two groups (survival group (63 cases) and non-survival group (41 cases). Venous blood was collected in all patients within 12 hours after admission, and sequentialorgan failure assessment (SOFA) score and acute physiology and chronic health evaluation Ⅱ(APACHE Ⅱ) score were documented. Serum MCP-1 was detected by ELISA method and peripheral blood mHLA-DR by flow cytometer. We compared the differences between the two groups, and drew the receiver-operating characteristic curve (ROC) to investigate the clinical value of different indicators for the prognosis of sepsis patients. And we further analyzed the relationship between the MCP-1 and the mHLA-DR. Result For all the enrolled sepsis patients, the expression of serum MCP-1 in non-survival group was significantly higher than in survival group [(187.65±60.73) pg/ml vs (90.83±31.58) pg/ml, t=-10.65, P < 0.01]. The level of the mHLA-DR in survival group was higher than non-survival group [(54.70±12.21)% vs (29.41±8.78)% t=11.47, P < 0.05]. The SOFA score in non-survival group was higher than in survival group [(11.76±3.92) vs (9.17±4.39), t=-3.28, P < 0.01]. The APACHE Ⅱ score in non-survival group was significantly higher than in survival group [(25.76±6.27) vs (18.83±4.65), t=-6.47, P < 0.05]. The MCP-1 death area under the curve (AUC) was 0.950 (P < 0.001, 95%CI: 0.911-0.989), and the cut-off point was 115.48pg/ml, the sensitivity was 90.2%, the specificity was 87.3%. The mHLA-DR survival area under the curve (AUC) was 0.952 (P < 0.001, 95%CI: 0.915-0.990), and the cut-off point was 39.3%, the sensitivity was 88.9%, the specificity was 87.8%. The SOFA score death area under the curve (AUC) was 0.690 (P < 0.002, 95%CI: 0.591-0, 790), and the cut-off point was 8.5 points, the sensitivity was 80.5%, the specificity was 57.1%

关 键 词：单核细胞趋化蛋白1 单核细胞人类白细胞抗原-DR 脓毒症 序贯器官衰竭估计评分 急性生理与慢性健康状况评分系统Ⅱ 

分 类 号：R459.7[医药卫生—急诊医学]