抗菌肽LL-37在急诊脓毒症患者早期诊断中的临床意义  

Clinical significance of antibacterial peptide LL-37 in early diagnosis of patients with sepsis in emergency department

作　　者：刘安平[1] 周杨 叶鹏[1] 张小军[1] 罗应华 喻安永[1] 汪松[1] Liu Anping;Zhou Yang;Ye Peng;Zhang Xiaojun;Luo Yinghua;Yu Anyong;Wang Song(Department of Emergency,Affiliated Hospital of Zunyi Medical College,Zunyi 563003,Guizhou,China)

机构地区：[1]遵义医学院附属医院急诊科,563003

出　　处：《中华危重病急救医学》2019年第9期1083-1086,共4页Chinese Critical Care Medicine

基　　金：贵州省科技计划项目(2017-7094);遵义医学院附属医院硕士科研启动基金(2015-23)。

摘　　要：目的探讨抗菌肽LL-37在急诊脓毒症患者早期诊断中的临床意义。方法选择2017年12月至2018年3月遵义医学院附属医院急诊抢救室诊断为脓毒症的40例患者作为脓毒症组;选择同期本院体检中心20例健康志愿者作为健康对照组。脓毒症组于确诊后即刻、健康对照组于体检时取外周血,采用酶联免疫吸附试验(ELISA)检测抗菌肽LL-37表达,同时检测血清降钙素原(PCT)、C-反应蛋白(CRP)水平。比较两组抗菌肽LL-37、PCT、CRP水平的差异;采用Pearson相关法分析抗菌肽LL-37与PCT、CRP的相关性;绘制受试者工作特征曲线(ROC),分析各项指标单独或联合检测对脓毒症的早期诊断价值。结果脓毒症患者外周血抗菌肽LL-37、PCT、CRP水平均明显高于健康对照组〔LL-37(μg/L):1.34±0.69比0.10±0.06,PCT(μg/L):46.67±39.51比0.03±0.02,CRP(mg/L):129.68±49.83比3.16±2.85〕,差异均有统计学意义(均P<0.05)。Pearson相关分析显示,脓毒症患者抗菌肽LL-37的表达与PCT、CRP水平均呈显著正相关(r1=0.835、r2=0.932,均P<0.01)。ROC曲线分析显示,LL-37、PCT、CRP早期诊断脓毒症的ROC曲线下面积(AUC)分别为0.885、0.963、0.983,且三者联合诊断的AUC高达0.994,说明三者联合诊断脓毒症的价值大于单独诊断;当三者联合预测概率为0.92时,敏感度为97.5%,特异度为95.0%。结论抗菌肽LL-37在脓毒症患者早期诊断中有一定的临床应用价值,与PCT、CRP联合检测可作为早期脓毒症患者的常规监测指标。Objective To discuss the clinical significance of antibacterial peptide LL-37 in the early diagnosis of patients with sepsis in emergency department.Methods Forty patients diagnosed with sepsis in the emergency department of the Affiliated Hospital of Zunyi Medical College from December 2017 to March 2018 were enrolled as sepsis group.Twenty healthy volunteers were enrolled contemporaneously in our hospital at medical center as healthy control group.Peripheral blood was collected immediately after diagnosis in sepsis group or during physical examination in healthy control group.The expression of antibacterial peptide LL-37 was determined by enzyme-linked immunosorbent assay(ELISA).Meanwhile,serum procalcitonin(PCT)and C-reactive protein(CRP)levels were determined.The differences in antibacterial peptide LL-37,PCT and CRP levels between the two groups were compared.Pearson correlation method was used to analyze the correlation between antibacterial peptide LL-37,PCT and CRP.Receiver operating characteristic(ROC)curve was drawn,and the early individually or jointly diagnostic value of each detected index for sepsis was analyzed.Results The levels of antimicrobial peptide LL-37,PCT and CRP in peripheral blood of sepsis group were significantly higher than those of healthy control group[LL-37(μg/L):1.34±0.69 vs.0.10±0.06,PCT(μg/L):46.67±39.51 vs.0.03±0.02,CRP(mg/L):129.68±49.83 vs.3.16±2.85],with statistically significant differences(all P<0.05).Pearson correlation analysis showed that the expression of antimicrobial peptide LL-37 was positively correlated with PCT and CRP levels(r1=0.835,r2=0.932,both P<0.01).ROC curve analysis showed that the area under ROC curve(AUC)of LL-37,PCT and CRP for early diagnosis of sepsis was 0.885,0.963 and 0.983,respectively,and the AUC of combined diagnosis of the three parameters was as high as 0.994,indicating that the value of combined diagnosis of sepsis was greater than that of single diagnosis;when the combined prediction probability of the three parameters was 0.92,the

关 键 词：脓毒症 抗菌肽LL-37 降钙素原 C-反应蛋白 早期诊断 

分 类 号：Q78[生物学—分子生物学]