前蛋白转化酶枯草溶菌素9对革兰阴性菌脓毒症预后的评估价值  

The evaluation value of proprotein convertase subtilisin 9 on the prognosis of gram-negative bacteria sepsis

作　　者：祝青 郭琪 吴颖[1,2] 贺军宇 邹国英 吴意[3] ZHU Qing;GUO Qi;WU Ying;HE Junyu;ZOU Guoying;WU Yi(Section of Laboratory Medicine,School of Clinical Medicine,Hunan University of Traditional Chinese Medicine,Changsha,Hunan 410208,China;Department of Clinical Laboratory,Hunan Brain Hospital,Changsha,Hunan 410007,China;Department of Clinical Laboratory,Hunan Provincial People′s Hospital,Changsha,Hunan 410005,China)

机构地区：[1]湖南中医药大学临床医学院检验教研室,湖南长沙410208 [2]湖南省脑科医院检验科,湖南长沙410007 [3]湖南省人民医院检验科,湖南长沙410005

出　　处：《国际检验医学杂志》2021年第8期907-911,共5页International Journal of Laboratory Medicine

基　　金：湖南省自然科学基金项目(2018JJ6102)。

摘　　要：目的探讨前蛋白转化酶枯草溶菌素9(PCSK9)对革兰阴性菌(G^(-))脓毒症患者病情严重程度和预后的评估价值。方法选取湖南省脑科医院收治的90例G^(-)脓毒症患者(G^(-)脓毒症组)、40例单纯全身炎症反应综合征(SIRS)患者(单纯SIRS组)、38例革兰阳性菌(G^(+))脓毒症患者(G^(+)脓毒症组)和40例体检健康人员(健康对照组)为研究对象。采用ELISA法检测所有研究对象血清中PCSK9水平,同时检测载脂蛋白M(apoM)、降钙素原(PCT)、白细胞介素-6(IL-6)、乳酸(LAC)、C反应蛋白(CRP)水平。采用单因素与多因素Logistic回归分析G^(-)脓毒症预后的危险因素;采用受试者工作特征曲线(ROC曲线)分析各指标预测G^(-)脓毒症预后的效能。结果与健康对照组比较,单纯SIRS组、G^(+)脓毒症组、G^(-)脓毒症组血清LAC、PCSK9水平明显升高,但apoM水平明显降低(P<0.05);与单纯SIRS组和G^(+)脓毒症组比较,G^(-)脓毒症组血清PCSK9、LAC水平明显升高(P<0.05);G^(-)脓毒症组血清apoM水平明显低于单纯SIRS组(P<0.05)。随着G^(-)脓毒症病情的加重,PCSK9水平呈增高趋势,但apoM水平呈降低趋势(P<0.05);单因素分析显示,预后不良组血清中PSCK9、PCT、LAC、CRP及急性生理与慢性健康状况评分(APACHEⅡ评分)高于预后良好组(P<0.05),而血清apoM水平低于预后良好组(P<0.05);多因素Logistic回归分析显示,PCSK9、apoM、APACHEⅡ评分是G^(-)脓毒症预后的独立影响因素(P<0.05);进一步采用ROC曲线分析结果显示,apoM和PCSK9预测G^(-)脓毒症预后不良的曲线下面积(AUC)分别为0.8178和0.7940,低于APACHEⅡ评分的0.8771。但PCSK9的特异度(94.44%)高于APACHEⅡ评分(90.74%),apoM的灵敏度(86.49%)高于APACHEⅡ评分(78.38%)。结论血清PCSK9、apoM与APACHEⅡ评分是G^(-)脓毒症预后的独立影响因素,可用于G^(-)脓毒症病情的判断和预后的评估。Objective To explore the value of proprotein convertase subtilisin 9(PCSK9)for the severity and prognosis of patients with gram-negative(G^(-))sepsis.Methods Ninety patients with G^(-)sepsis(G^(-)sepsis group),40 patients with simple systemic inflammatory response syndrome(simple SIRS group),38 patients with gram-positive(G^(+))sepsis(G^(+)sepsis group)and 40 healthy physical examiners(healthy control group)of Hunan Brain Hospital were enrolled as the subjects.ELISA method was used to detect the level of PCSK9 in the serum of all subjects,and apolipoprotein M(apoM),procalcitonin(PCT),interleukin-6(IL-6),lactic acid(LAC),C-reactive protein(CRP)levels were also detected.Single factor and multivariate Logistic regression were used to analyze the risk factors for the prognosis of G^(-)sepsis.Receiver operating characteristic curve(ROC curve)was used to analyze the efficacy of each index in predicting the prognosis of G^(-)sepsis.Results Compared with the healthy control group,the serum LAC and PCSK9 levels of the simple SIRS group,the G^(+)sepsis group,and the G^(-)sepsis group were significantly increased(P<0.05),but the apoM level was significantly reduced(P<0.05).Compared with the simple SIRS group and G^(+)sepsis group,the serum PCSK9 and LAC levels in the G^(-)sepsis group were significantly increased(P<0.05).The serum apoM level in the G^(-)sepsis group was significantly lower than that of simple SIRS group(P<0.05).With the worsening of G^(-)sepsis,the level of PCSK9 showed an increasing trend,but the level of apoM showed a decreasing trend(P<0.05).Univariate analysis showed that serum PSCK9,PCT,LAC,CRP and acute physiology and chronic health status score(APACHEⅡscore)in the poor prognosis group was significantly higher than the good prognosis group(P<0.05),while the serum apoM level was significantly lower than the good prognosis group(P<0.05).Multivariate Logistic regression analysis showed that the PCSK9,apoM and APACHEⅡscores were independent influenced factors for the prognosis of G^(-)sepsis(P<0.05).R

关 键 词：前蛋白转化酶枯草溶菌素9 脓毒症 预后 革兰阴性菌 

分 类 号：R446.1[医药卫生—诊断学]