肝素结合蛋白评估老年感染性疾病病情及预后的应用价值  

Application value of heparin-binding protein in evaluating the condition and prognosis of elderly patients with infectious diseases

作　　者：沈华[1] 冯倩茹 张铮[1] 孙才智[1] 郭磊[1] 秦海东[1] SHEN Hua;FENG Qian-ru;ZHANG Zheng;SUN Cai-zhi;GUO Lei;QIN Hai-dong(Department of Emergency, Nanjing First Hospital, Nanjing Medical University, Nanjing 210006, China)

机构地区：[1]南京医科大学附属南京医院(南京市第一医院)急诊科,江苏省南京市210006

出　　处：《实用老年医学》2021年第11期1131-1135,共5页Practical Geriatrics

基　　金：睿E(睿意)急诊医学研究专项基金资助项目(R2019016);南京市卫生科技发展项目(YKK20114)。

摘　　要：目的探讨肝素结合蛋白(heparine-binding protein,HBP)评估老年感染性疾病病情及预后的价值。方法选取我院急诊科2018年8月至2020年12月符合标准的老年病人168例,根据是否存在感染及器官功能衰竭分为脓毒症组(A组)81例、轻度感染组(B组)48例、非感染组(C组)39例。收集病人入院24 h内的HBP、降钙素原(PCT)、CRP、WBC水平及最高体温,并进行序贯器官衰竭评分(SOFA)。建立ROC曲线评价各指标对病人预后的预测意义并计算约登指数确定最佳截断值。结果A组病人HBP、PCT、CRP水平升高,与B、C组相比,差异有统计学意义(P<0.05);B组病人HBP、CRP和WBC水平高于C组病人,差异有统计学意义(P<0.05);B组病人PCT水平与C组相比,差异无统计学意义(P>0.05)。A组病人24 h最高体温显著高于B、C组,差异有统计学意义(P<0.001)。在对所有入选病人进行死亡风险预测时,HBP、PCT、CRP的AUC分别为0.802、0.777、0.711;在对脓毒症组死亡风险进行预测时,HBP、PCT的AUC分别为0.724、0.648。结论HBP可作为评估老年感染性疾病病情及预后的有效生物标记物。Objective To investigate the value of heparin binding protein(HBP)in assessing the condition and prognosis of elderly patients with infectious diseases.Methods From August 2018 to December 2020,168 elderly patients in the Emergency Department of our hospital were selected.According to the presence of infection and organ failure,they were divided into in the sepsis group(group A,n=81),the mild infection group(group B,n=48)and the non-infection group(group C,n=39).The levels of HBP,procalcitonin(PCT),C-reaction protein(CRP),white blood cell count(WBC)and the highest body temperature were collected within 24 h after admission,and sequential organ failure score was assessed.Receiver operating characteristic(ROC)curve was established to evaluate the prognostic significance of each index,and Youden index was calculated to determine the best cut-off value.Results The levels of HBP,PCT and CRP in group A were significantly higher than those in group B and group C(P<0.05).The levels of HBP,CRP and WBC in group B were higher than those in group C(P<0.05).There was no significant difference in the level of PCT between group B and group C(P>0.05).The highest 24 h body temperature in group A was significantly higher than that in group B and group C(P<0.001).In predicting the risk of death of all selected patients,the areas under the ROC curve(AUC)of HBP,PCT and CRP were 0.802,0.777 and 0.711,respectively.In predicting the risk of death in sepsis patients,the AUC of HBP and PCT were 0.724 and 0.648,respectively.Conclusions HBP can be used as an effective biomarker to evaluate the condition and prognosis of infectious diseases in the elderly.

关 键 词：肝素结合蛋白 老年人 感染性疾病 脓毒症 序贯器官衰竭评分 预后 

分 类 号：R446[医药卫生—诊断学]