肝素结合蛋白对脓毒症的预测价值  

Predictive value of heparin binding protein for sepsis

作　　者：张重威 祝益民[1] 曹彦[1] 樊麦英[1] 周玉成[1] 李想[1] 曹才文[1] 韩小彤[1] Zhang Zhongwei;Zhu Yimin;Cao Yan;Fan Maiying;Zhou Yucheng;Li Xiang;Cao Caiwen;Han Xiaotong(Hunan Provincial Institute of Emergency Medicine,Department of Emergency Medicine,Hunan Provincial People's Hospital,the First Affiliated Hospital of Hunan Normal University,Changsha 410005,Hunan,China)

机构地区：[1]湖南省人民医院(湖南师范大学附属第一医院)急诊医学科,湖南省急救医学研究所,长沙410005

出　　处：《中华危重病急救医学》2021年第6期654-658,共5页Chinese Critical Care Medicine

基　　金：湖南省卫生健康委科研计划课题项目(B2019066)。

摘　　要：目的探讨肝素结合蛋白(HBP)对脓毒症的预测价值。方法选择2019年6月至2020年12月在湖南省人民医院急诊科就诊的188例患者作为研究对象。根据脓毒症3.0标准将患者分为非脓毒症组(87例)和脓毒症组(101例)。记录患者性别、年龄、白细胞计数(WBC)、C-反应蛋白(CRP)、降钙素原(PCT)、HBP、序贯器官衰竭评分(SOFA)、快速SOFA评分(qSOFA)、改良早期预警评分(MEWS)以及患者近期用药史等资料,比较两组上述指标的差异。采用Logistic回归分析脓毒症发生的危险因素。采用Spearman相关性分析法分析HBP、PCT、CRP与SOFA评分的相关性,评估HBP、PCT和CRP对脓毒症器官衰竭严重程度的预测价值;并绘制受试者工作特征曲线(ROC曲线),评估HBP、PCT和CRP对脓毒症的预测价值。结果与非脓毒症组比较,脓毒症组HBP、PCT、CRP、WBC、SOFA评分、qSOFA评分、MEWS均明显升高〔HBP(μg/L):55.46(24.57,78.49)比5.90(5.90,9.01),PCT(μg/L):6.83(1.75,30.64)比0.23(0.12,0.75),CRP(mg/L):67.35(26.23,123.23)比4.45(2.62,47.22),WBC(×10^(9)/L):11.84(7.18,16.06)比6.58(5.47,8.99),SOFA评分(分):6(4,8)比0(0,0),qSOFA评分(分):2(1,3)比0(0,1),MEWS(分):4(3,6)比1(0,2)〕,住院时间明显延长〔d:10(4,17)比0(0,7)〕,病死率明显升高〔29.7%(30/101)比4.6%(4/87)〕,差异均有统计学意义(均P<0.05)。相关性分析显示:HBP、PCT、CRP与SOFA评分均呈明显正相关(r值分别为0.60、0.33和0.38,均P<0.01),其中以HBP相关性最强、CRP次之、PCT最弱。Logistic回归分析显示:HBP、PCT和CRP均是影响脓毒症的独立危险因素〔优势比(OR)分别为1.015、1.094、1.067,95%可信区间(95%CI)为1.007-1.022、1.041-1.150、1.043-1.093,均P<0.01〕。ROC曲线分析显示:HBP、PCT和CRP对脓毒症均有一定的预测价值〔ROC曲线下面积(AUC)分别为0.92、0.87、0.80,95%CI分别为0.88-0.97、0.82-0.92、0.74-0.87,均P<0.01〕,其中以HBP的诊断效能更高;当HBP临界值≥15.11μg/L时,其敏感度和特异�Objective To investigate the predictive value of heparin binding protein(HBP)for sepsis.Methods From June 2019 to December 2020,188 patients admitted to the department of emergency of Hunan Provincial People's Hospital were enrolled.The patients were divided into non-sepsis group(87 patients)and sepsis group(101 patients)according to Sepsis-3 criteria.Gender,age,white blood cell count(WBC),C-reactive protein(CRP),procalcitonin(PCT),HBP,sequential organ failure assessment(SOFA)score,quick SOFA(qSOFA)score,modified early warning score(MEWS)and patients'recent medication history were recorded,the differences in the above indicators between the two groups were compared.The risk factors of sepsis were analyzed by Logistic regression.Spearman correlation analysis was used to analyze the correlation between HBP,PCT,CRP and SOFA score to evaluate the predictive value of HBP,PCT and CRP for the severity of septic organ failure.Receiver operating characteristic curve(ROC curve)were drawn to evaluate the diagnostic value of HBP,PCT and CRP for sepsis.Results Compared with the non-sepsis group,the sepsis group had significantly higher levels of HBP,PCT,CRP,WBC,SOFA score,qSOFA score,and MEWS[HBP(μg/L):55.46(24.57,78.49)vs.5.90(5.90,9.01),PCT(μg/L):6.83(1.75,30.64)vs.0.23(0.12,0.75),CRP(mg/L):67.35(26.23,123.23)vs.4.45(2.62,47.22),WBC(×10^(9)/L):11.84(7.18,16.06)vs.6.58(5.47,8.99),SOFA score:6(4,8)vs.0(0,0),qSOFA score:2(1,3)vs.0(0,1),MEWS:4(3,6)vs.1(0,2)],the length of hospital stay was significantly prolonged[days:10(4,17)vs.0(0,7)],and the mortality was significantly increased[29.7%(30/101)vs.4.6%(4/87)],with statistical significance(all P<0.05).Correlation analysis showed that HBP,PCT and CRP were significantly positively correlated with SOFA score(r values were 0.60,0.33,and 0.38,respectively,all P<0.01),among which HBP had the strongest correlation,CRP was the second,and PCT was the weakest.Logistic regression analysis showed that HBP,PCT and CRP levels were independent risk factors for sepsis[odds ratio(OR)were 1.01

关 键 词：肝素结合蛋白 序贯器官衰竭评分 脓毒症 生物标志物 

分 类 号：R459.7[医药卫生—急诊医学]