脓毒性休克患者血清Kal、VE-Cad水平变化及其预后预测效能  

Changes in levels of serum Kal and VE-Cad in patients with septic shock and their prognostic value

作　　者：李超[1] 王军辉[1] 赵麦良[1] LI Chao;WANG Junhui;ZHAO Mailiang(Xingtai People's Hospital,Xingtai 054031,China)

机构地区：[1]邢台市人民医院,河北邢台054031

出　　处：《山东医药》2021年第3期32-36,共5页Shandong Medical Journal

基　　金：河北省重点研发计划自筹项目(172777210)。

摘　　要：目的观察血清人源性激肽释放酶结合蛋白(Kal)、血管内皮钙黏蛋白(VE-Cad)水平变化,并评估二者对脓毒性休克(SS)患者预后的预测价值。方法201例SS患者(观察组)根据28 d预后情况分为死亡组、存活组,另选取同时期200例体检健康者为对照组,比较观察组与对照组之间血清VE-Cad、Kal水平和全身性感染相关性器官功能衰竭系统(SOFA)评分、急性生理和慢性健康评估系统(APACHEⅡ)评分,死亡组与存活组患者入院后第1、3、5天检测血清Kal、VE-Cad,并比较。采用Pearson相关分析上述各指标的相关性。采用Logistic回归分析SS患者死亡危险因素。ROC评估血清VE-Cad、Kal水平预判SS患者预后的价值。结果观察组血清VE-Cad水平和SOFA、APACHEⅡ评分高于对照组,Kal水平低于对照组(P均<0.05);死亡组与存活组各时间血清VE-Cad、Kal水平对比,P均<0.05;死亡组第1、3、5天血清VE-Cad水平高于存活组,血清Kal水平低于存活组(P均<0.05);死亡组SOFA评分、APACHEⅡ评分高于存活组(P均<0.05)。入院1 d死亡组血清VE-Cad水平与SOFA、APACHEⅡ评分呈正相关(P均<0.05),血清Kal水平与SOFA、APACHEⅡ评分呈负相关(P均<0.05)。血清VE-Cad(OR=1.382,95%CI=1.045~1.786)为SS患者死亡危险因素,血清Kal(OR=0.429,95%CI=0.187~0.968)为SS患者死亡保护因素(P<0.05)。入院1 d血清VE-Cad联合Kal检测判断SS预后的AUC大于VE-Cad、Kal单独检测(P均<0.05),准确率、灵敏度、特异性也高于VE-Cad、Kal单独检测(P均<0.05)。结论SS患者血清Kal水平降低,VE-Cad水平升高,二者为患者死亡独立影响因素,联合检测血清Kal及VE-Cad对SS预后的预测性能高于各指标的单独检测。Objective To observe the changes of serum kallikrein binding protein(Kal)and vascular endothelial cadherin(VE-Cad)levels and to evaluate their predictive value for the prognosis of septic shock(SS).Methods Totally 201 patients with SS(observation group)were divided into the death group and survival group according to the 28-day prog⁃nosis;another 200 healthy people who took physical examination in the same period were selected as the control group.The levels of serum VE-Cad and Kal,sepsis-related organ failure assessment(SOFA)score,and acute physiology and chronic health evaluation(APACHE)Ⅱscore in each group were compared between the observation group and the control group.On the 1st,3rd and 5th days,the serum Kal and VE-Cad levels were compared between the death group and surviv⁃al group.The correlation between the above indexes was analyzed by Pearson correlation.The risk factors for death of SS patients were analyzed by Logistic Regression analysis.The predictive value of serum VE-Cad and Kal levels for prognosis of patients with SS were analyzed by ROC.Results The levels of serum VE-Cad,SOFA,and APACHEⅡscores in the observation group were higher than those in the control group,while the level of Kal in the observation group was lower than in the control group(all P<0.05).On the 1st,3rd and 5th days,the serum VE-Cad levels of the death group were higher than those of the survival group,and the serum Kal level was lower than that of the survival group(all P<0.05),and SOFA and APACHEⅡscores of the death group were higher than those of the survival group(both P<0.05).Serum VE-Cad level was positively correlated with SOFA and APACHEⅡscores in the death group on the 1st day after admis⁃sion(both P<0.05),while serum Kal level was negatively correlated with SOFA and ApacheⅡscores(both P<0.05).Multivariate stepwise logistic regression analysis showed that VE-Cad(OR=1.382,95%CI=1.045-1.786)was a risk fac⁃tor for death of SS patients,and Kal(OR=0.429,95%CI=0.187-0.968)was a protective factor for SS pa

关 键 词：血管内皮钙黏蛋白 人源性激肽释放酶结合蛋白 脓毒性休克 影响因素 

分 类 号：R459.7[医药卫生—急诊医学]