3-脱氧葡萄糖醛酮对PICS的诊断价值及其与脓毒症病情和预后的相关性  

The value of 3-deoxyglucosone in the diagnosis of PICS and its relationship with sepsis and prognosis

作　　者：曹志龙 韩旭东[1] 黄晓英[1] 张素燕[1] 田李均[1] 林金锋[1] 徐俊贤[1] 袁晓宇[2] CAO Zhilong;HAN Xudong;HUANG Xiaoying;ZHANG Suyan;TIAN Lijun;LIN Jinfeng;XU Junxian;YUAN Xiaoyu(Department of Intensive Care Unit,the Third People′s Hospital of Nantong City,Jiangsu Province,Nantong 226006;Department of Emergency Medicine,the Affiliated Hospital of Nantong University)

机构地区：[1]江苏省南通市第三人民医院重症医学科,南通226006 [2]南通大学附属医院急诊医学科

出　　处：《南通大学学报（医学版）》2020年第3期226-230,共5页Journal of Nantong University(Medical sciences)

基　　金：南通市卫计委青年科研基金项目(WKZL2018061);南通市级社会民生科技项目(MS12018048)。

摘　　要：目的:探讨3-脱氧葡萄糖醛酮(3-deoxyglucosone,3-DG)在持续炎症、免疫抑制和分解代谢综合征(persistent inflammation,immunosuppression,and catabolism syndrome,PICS)诊断及其与脓毒症病情和预后判断中的价值。方法:采用观察性队列研究方法,选择2017年1月1日—2019年12月31日收住南通市第三人民医院重症医学科的脓毒症患者240例作为研究对象,按照是否合并PICS分为PICS组和非PICS组,检测两组患者血浆中3-DG的水平,对比两组患者临床检验指标,分析PICS的影响因素及3-DG预测PICS的价值,评估3-DG与脓毒症患者病情严重程度以及临床预后价值。结果:PICS组淋巴细胞计数、血清白蛋白、格拉斯哥昏迷评分(Glasgow coma scale,GCS)低于非PICS组,而PICS组在血浆3-DG、C-反应蛋白、急性生理与慢性健康Ⅱ(acute physiology and chronic health evaluationⅡ,APACHEⅡ)评分、序贯器官衰竭(sequential organ failure assessment,SOFA)评分高于非PICS组(P<0.05)。多项Logistic回归分析结果显示,淋巴细胞计数、血浆3-DG、C-反应蛋白、APACHEⅡ评分、SOFA评分是PICS的影响因素(P<0.05)。3-DG预测脓毒症致PICS的ROC曲线下结果为0.720,敏感度为81.3%,特异度为56.6%。相关性分析显示3-DG与APACHEⅡ评分(r=0.237,P=0.004)、SOFA评分(r=0.308,P<0.001)、GCS评分(r=0.125,P=0.041)具有相关性。生存分析显示3-DG不同表达水平与脓毒症患者预后具有相关性(P<0.05)。结论:淋巴细胞计数、血浆3-DG、C-反应蛋白、APACHEⅡ评分、SOFA评分是PICS的影响因素,3-DG预测PICS具有较高价值。3-DG表达水平与脓毒症患者的病情及预后具有相关性。Objective:To investigate the diagnosis of 3-deoxyglucosone(3-DG)in persistent inflammation,immunosuppression,and catabolism syndrome(PICS)and its relationship with sepsis and prognosis value.Methods:An observational cohort study was used,and we selected 240 patients with sepsis who were diagnosed and treated in the Department of Intensive Medicine of the Third People’s Hospital of Nantong from January 1,2017 to December 31,2019.They were divided into PICS group and non-PICS group according to whether combining PICS.The levels of 3-DG in the plasma of the 2 groups of patients were compared.The clinical test indicators of the 2 groups of patients were compared.The influencing factors of PICS and the value of 3-DG to predict PICS were evaluated.Evaluated the severity and clinical prognosis of 3-DG and sepsis patients.Results:The lymphocyte count,serum albumin,and Glasgow coma scale(GCS)of the PICS group were lower than those in the non-PICS group,while the plasma 3-DG,C-reactive protein,acute physiology and chronic health evaluationⅡ(APACHEⅡ),and sequential organ failure assessment(SOFA)scores of the PICS group were higher than those in the non-PICS group(P<0.05).Multiple Logistic regression analysis results showed that lymphocyte count,plasma 3-DG,C-reactive protein,APACHEⅡscore,and SOFA score were influencing factors of PICS(P<0.05).Under the ROC curve of 3-DG for predicting sepsis-induced PICS,the result was 0.720,the sensitivity was 81.3%,and the specificity was 56.6%.Correlation analysis showed that 3-DG was correlated with APACHEⅡscore(r=0.237,P=0.004),SOFA score(r=0.308,P<0.001),and GCS score(r=0.125,P=0.041)(P<0.05).Survival analysis showed that different expression levels of 3-DG were correlated with the prognosis of patients with sepsis(P<0.05).Conclusion:Lymphocyte count,plasma 3-DG,C-reactive protein,APACHEⅡscore,and SOFA score are the influencing factors of PICS,and 3-DG has high value in predicting PICS.The correlation between 3-DG expression level and condition and prognosis in patients wi

关 键 词：脓毒症 3-脱氧葡萄糖醛酮 持续炎症、免疫抑制和分解代谢综合征 

分 类 号：R459.7[医药卫生—急诊医学]