生长分化因子15和降钙素原在脓毒症中的诊断与预后价值分析  

Analysis of the diagnostic and prognostic value of growth differentiation factor 15 and procalcitonin in sepsis

作　　者：李欢[1] 陈娟娟 胡元慧 蔡馨[1] 汤冬玲[1] 张平安[1] Li Huan;Chen Juanjuan;Hu Yuanhui;Cai Xin;Tang Dongling;Zhang Ping′an(Department of Clinical Laboratory,Renmin Hospital of Wuhan University,Wuhan 430060,China)

机构地区：[1]武汉大学人民医院检验科,武汉430060

出　　处：《中华检验医学杂志》2021年第9期827-834,共8页Chinese Journal of Laboratory Medicine

摘　　要：目的探讨生长分化因子15(GDF15)和降钙素原(PCT)在脓毒症中的诊断与预后价值。方法选取2020年7月至2021年1月在武汉大学人民医院ICU就诊的脓毒症患者137例(脓毒症组)和有炎症感染但未诊断为脓毒症的患者59例(非脓毒症组),再选取同时期健康体检者62名(对照组)。脓毒症患者根据入院28 d生存情况分为死亡组(48例)和存活组(89例)。检测所有研究对象的血清GDF15、PCT、C反应蛋白(CRP)、白介素6(IL-6)和白介素10(IL-10)水平,并动态监测脓毒症患者入院第1、3、7天各个指标的水平,利用非参数检验比较不同分组之间两个指标的差异,用Spearman相关检验分析脓毒症患者GDF15与PCT之间的相关性,绘制受试者工作特征(ROC)曲线评价2个指标对脓毒症的诊断及预后价值。结果脓毒症组、非脓毒症组和对照组的GDF15水平分别为3.22(1.39,6.31)、0.84(0.21,1.66)和0.11(0.09,0.13)μg/L,PCT水平分别为13.10(1.99,50.25)、0.24(0.13,0.68)和0.05(0.03,0.10)μg/L,CRP水平分别为115.80(26.40,184.07)、24.20(11.30,53.20)和0.50(0.50,2.76)mg/L,IL-6水平分别为68.26(21.59,255.46)、33.20(10.81,89.27)和8.82(7.33,11.23)ng/L,IL-10水平分别为11.30(5.88,25.50)、9.34(5.65,16.90)和4.94(4.31,5.31)ng/L,脓毒症组的GDF15、PCT、CRP和IL-6显著高于非脓毒症组(U值分别为67.681、86.034、44.164和38.934,P均<0.05)和对照组(U值分别为136.475、138.667、120.701和100.886,P均<0.001),脓毒症组的IL-10与非脓毒症组比较差异无统计学意义,但高于对照组(U=80.221,P<0.001)。脓毒症患者的GDF15和PCT呈正相关,Spearman相关系数为0.234(P=0.006)。死亡组和生存组的GDF15分别为5.49(3.60,8.25)μg/L和2.03(1.06,3.69)μg/L,PCT水平分别为26.45(11.23,94.25)μg/L和9.08(1.33,22.75)μg/L,死亡组的GDF15和PCT均显著高于存活组(U值分别为3 305.500和3 060.000,P均<0.001)。第1、3、7天死亡组的GDF15与PCT水平均高于存活组(P<0.05),而CRP和IL-10水平差异无统计学意义(P>0.Objective To investigate the diagnostic and prognostic value of the growth differentiation factor 15(GDF15)and the procalcitonin(PCT)in sepsis.Methods A total number of 137 patients with sepsis(considered as the sepsis group)and 59 patients with inflammatory infection but not diagnosed as sepsis(the non-sepsis group)received treatment in intensive care unit of Renming Hospital of Wuhan University were collected from July 2020 to January 2021,and 62 cases of healthy physical examination(control group)were simultaneously chosen as control.Sepsis patients were divided into two groups(death group[n=48]and survival group[n=89])according to their 28-day′s survival.The serum levels of GDF15,PCT,C-reactive protein(CRP),interleukin-6(IL-6)and interleukin-10(IL-10)were examined,and the levels of each index,was dynamically monitored on the 1st,3rd and 7th day after admission.The differences of the two indicators between different groups were compared by non-parametric test.The correlation between GDF15 and PCT was analyzed by Spearman correlation test.The receiver operating characteristic(ROC)curve was drawn to evaluate the diagnostic and prognostic value of the two indicators for sepsis.Results The levels of GDF15 in the sepsis group,non-sepsis group and control group were 3.22(1.39,6.31)μg/L,0.84(0.21,1.66)μg/L and 0.11(0.09,0.13)μg/L,respectively.The levels of PCT were 13.10(1.99,50.25)μg/L,0.24(0.13,0.68)μg/L and 0.05(0.03,0.10)μg/L,respectively.The levels of CRP were 115.80(26.40,184.07)mg/L,24.20(11.30,53.20)mg/L and 0.50(0.50,2.76)mg/L,respectively.The levels of IL-6 were 68.26(21.59,255.46)ng/L,33.20(10.81,89.27)ng/L and 8.82(7.33,11.23)ng/L,respectively.The levels of IL-10 were 11.30(5.88,25.50)ng/L,9.34(5.65,16.90)ng/L and 4.94(4.31,5.31)ng/L,respectively.The GDF15,PCT,CRP and IL-6 of the sepsis group were significantly higher than those of the non-sepsis group(The U values were 67.681,86.034,44.164 and 38.934,respectively,with P values less than 0.05)and the control group(The U values were 136.475,138.667

关 键 词：脓毒症 生长分化因子15 降钙素原 诊断 预后 

分 类 号：R459.7[医药卫生—急诊医学]