血清1-磷酸鞘氨醇水平动态变化对脓毒性休克短期预后的预测价值  

Dynamic Changes of Serum Level of Serum Sphingosine-1 in Patients with Septic Shock and Its Short-term Prognostic Value

作　　者：李建[1] 李文哲 王鑫[1] 李晓鹏[1] 于湘友[1] LI Jian;LI Wenzhe;WANG Xin;LI Xiaopeng;YU Xiangyou(Department of Critical Medicine, the First Affiliated Hospital of Xinjiang Medical University, Urumchi 830011, China)

机构地区：[1]新疆医科大学第一附属医院重症医学科,新疆乌鲁木齐830011

出　　处：《标记免疫分析与临床》2020年第5期794-798,共5页Labeled Immunoassays and Clinical Medicine

基　　金：新疆维吾尔自治区高校科研计划项目(编号:XJEDU2018I011).

摘　　要：目的探讨脓毒性休克患者血清1-磷酸鞘氨醇(S1P)水平动态变化及判断预后结局临床价值。方法选择我院155例脓毒症患者,按有无脓毒性休克分为:观察组,75例,存在脓毒性休克;对照组,80例,无脓毒性休克。在入院即刻、治疗第1、5、7、14天分别测定并比较两组血清S1P、降钙素原(PCT)、白介素(IL)-6、肿瘤坏死因子(TNF)-α及白细胞计数(WBC)水平;采用Pearson分析血清S1P与PCT、IL-6、TNF-α及WBC间相关性。随访1年,记录并比较两组患者生存率。应用多元Logistic回归分析上述指标与生存率相关性。ROC曲线分析血清S1P水平评估预后临床价值。结果对照组血清S1P、PCT、IL-6、TNF-α及WBC无变化(P>0.05),而观察组PCT、IL-6、TNF-α及WBC随治疗时间逐渐降低(P<0.05),但血清S1P逐渐增加(P<0.05);与对照组相比,观察组治疗后各时间点血清S1P降低,血清PCT、IL-6、TNF-α及WBC升高(P<0.05);观察组与对照组血清S1P、PCT、IL-6、TNF-α及WBC变化趋势有差异有统计学意义(P<0.05)。Pearson相关分析脓毒性休克患者血清S1P与血清PCT、IL-6、TNF-α呈负相关(P<0.05),与WBC无相关性(P>0.05)。随访1年观察组生存率低于对照组(P<0.05)。多元Logistic回归分析血清S1P为预后保护性因素(P=0.027),血清PCT为危险因素(P=0.036)。ROC曲线显示血清S1P截断值620.5nmol/L,评估预后不良发生AUC为0.828,灵敏度89.2%,特异性83.6%。结论血清S1P在脓毒性休克患者治疗中逐渐增加,能较好预测患者预后。Objective To investigate the dynamic changes of serum levels of 1-sphingosine(S1P)in patients with septic shock and to determine the clinical value of short-term prognosis outcomes.Methods 155 patients with sepsis from our hospital were enrolled in the current study.According to the presence or absence of septic shock,these patients were divided into the observation group with 75 patients who suffered from septic shock and the control group with 80 patients without septic shock.Serum S1P,procalcitonin(PCT),interleukin(IL)-6,tumor necrosis factor(TNF)-α,and white blood cell count(WBC)were measured and compared on admission and 1,5,7,and 14 days of treatment.Pearson method was used to analyze the correlation between serum S1P and PCT,IL-6,TNF-αand WBC.After 1 year of follow-up,the survival rates of the two groups were recorded and compared.Multivariate logistic regression was used to analyze the correlation between the above indicators and survival rate.The ROC curve was drawn to evaluate the value of serum S1P level in prognosis.Results There were no changes in serum S1P,PCT,IL-6,TNF-αand WBC in the control group(P>0.05),while the PCT,IL-6,TNF-αand WBC in the observation group gradually decreased during the treatment time(P<0.05),but Serum S1P increased gradually(P<0.05).Compared with the control group,serum S1P was lower at each time point after the treatment,while serum PCT,IL-6,TNF-αand WBC were higher(P<0.05).Compared with the observation group,there were differences for serum S1P,PCT,IL-6,TNF-αand WBC in the control group(P<0.05).Pearson correlation analysis of serum S1P in patients with septic shock was negatively correlated with serum PCT,IL-6,and TNF-α(P<0.05),but not with WBC(P>0.05).The survival rate of the observation group was lower than that of the control group at 1-year follow-up(P<0.05).Multivariate logistic regression analysis of serum S1P was a prognostic protective factor(P=0.027),and serum PCT was a risk factor(P=0.036).The ROC curve showed a cutoff value of serum S1P of 620.5 nmol/L,and

关 键 词：脓毒性休克 1-磷酸鞘氨醇 预后 

分 类 号：R631.4[医药卫生—外科学]