血浆晚期糖基化终末产物和可溶性糖基化终末产物受体水平与脓毒症患者病情严重程度及预后的相关性  

Correlation between plasma levels of advanced glycation end products and soluble receptor for advanced glycation end products with severity and prognosis in patients with sepsis

作　　者：任娜 刘名胜 周森[1] 邢柏[1] REN Na;LIU Mingsheng;ZHOU Sen;XING Bo(Department of Intensive Care Unit,the Second Affiliated Hospital of Hainan Medical University,Haikou 570311,China)

机构地区：[1]海南医学院第二附属医院重症医学科,海口570311

出　　处：《实用医学杂志》2021年第21期2764-2769,共6页The Journal of Practical Medicine

基　　金：海南省自然科学资金资助项目(编号:819MS128)。

摘　　要：目的探讨脓毒症患者的晚期糖基化终末产物(AGEs)、可溶性糖基化终末产物受体(sRAGE)与脓毒症相关器官衰竭估计(SOFA)评分的相关性及影响脓毒症患者预后的危险因素。方法选择2020年1月至2021年5月海南医学院第二附属医院重症监护病房收治的180例脓毒症患者作为研究对象,根据28 d预后将患者分为存活组(n=144)和死亡组(n=36)。收集脓毒症患者的临床资料,计算入院后24 h内的SOFA评分、查尔森合并症指数(CCI)评分,检测血清降钙素原(PCT)、C-反应蛋白(CRP)、乳酸(Lac)水平以及血浆AGEs、sRAGE水平。比较两组的PCT、CRP、SOFA评分和血浆AGEs、sRAGE水平。比较不同SOFA评分组28 d病死率以及血浆AGEs、sRAGE水平。采用Spearman相关分析探讨血浆AGEs、sRAGE水平与SOFA评分的关系。采用多因素logistic回归分析脓毒症患者28 d预后的影响因素。采用受试者工作特征(ROC)曲线评价血浆AGEs、sRAGE、SOFA评分及其联合对脓毒症患者28 d预后的预测价值。结果与存活组相比较,死亡组年龄、糖尿病发生率更高,CCI评分、SOFA评分、血清PCT和Lac水平以及血浆AGEs和sRAGE水平显著升高(P <0.05)。随着SOFA评分升高,28 d病死率以及血浆AGEs和s RAGE水平显著升高(P <0.05)。血浆AGEs和sRAGE水平与SOFA评分呈正相关(rs=0.293、0.309,P <0.05)。CCI评分、SOFA评分、AGEs和sRAGE为脓毒症患者28 d死亡的危险因素(P <0.05)。SOFA评分、AGEs、sRAGE预测脓毒症患者28 d死亡的Cut-off值分别为8分、28.21μg/mL、2 465.32 pg/mL,三者联合预测脓毒症患者28 d死亡的AUC明显大于单独预测(Z=2.245,P=0.025;Z=2.717,P=0.007;Z=2.485,P=0.013)。结论血浆AGEs和sRAGE水平能更好地反映脓毒症患者的病情严重程度以及预后情况,血浆AGEs和sRAGE水平结合SOFA评分能有效预测脓毒症患者28d预后。Objective To investigate the correlation with advanced glycation end products(AGEs)and soluble receptor for advanced glycation end products(sRAGE)with sepsis-related organ failure assessment(SOFA)in patients with sepsis as well as the risk factors that affect the prognosis of patients with sepsis. Methods From January 2020 to May 2021,A total of 180 patients with sepsis admitted to the Intensive Care Unit of the Second Affiliated Hospital of Hainan Medical University were selected as the research objects,and the patients were divided into survival groups(n = 144)and death group(n = 36)according to the 28-day prognosis. The clinical data were collected,and the SOFA score,Charlson comorbidity index(CCI)were calculated within 24 hours after admission.Serum levels of procalcitonin(PCT),C-reactive protein(CRP),lactic acid(Lac),and plasma levels of AGEs and sRAGE were measured. The PCT,CRP,SOFA scores,and plasma AGEs and sRAGE levels of the two groups were compared. The 28-day mortality,and plasma AGEs and sRAGE levels in different SOFA score evaluation groups were compared. Spearman correlation analysis was used to explore the correlationship between plasma levels AGEs and sRAGE with SOFA score. Multivariate logistic regression was used to analyze the influencing factors of 28-day prognosis in patients with sepsis. The receiver operating characteristic(ROC)curve was used to evaluate the predictive value of plasma AGEs,sRAGE,SOFA scores and their combination on the 28-day prognosis of patients with sepsis. Results Compared with the survival group,the age and incidence of diabetes was higher in the death group.The CCI score,SOFA score,serum levels of PCT and Lac,and plasma levels of AGEs and sRAGE were significantly increased(P < 0.05). With the increase of SOFA score,the 28-day mortality and plasma levels of AGEs and sRAGE increased significantly(P < 0.05). Plasma levels of AGEs and sRAGE were significantly positively correlated with SOFA score(rs= 0.293,0.309,P < 0.05). CCI score,SOFA scores,AGEs and sRAGE were the ri

关 键 词：脓毒症 晚期糖基化终末产物 可溶性糖基化终末产物受体 SOFA评分 预测价值 

分 类 号：R446.1[医药卫生—诊断学]