肝素结合蛋白对呼吸道病毒感染的诊断及预后评估价值  

The value of heparin-binding protein in the diagnosis and prognosis of respiratory viral infections

作　　者：郭磊[1] 张铮[1] 沈华[1] 秦海东[1] 孙才智[1] 魏晶晶 Guo Lei;Zhang Zheng;Shen Hua;Qin Haidong;Sun Caizhi;Wei Jingjing(Department of Emergency Medicine,Nanjing Hospital Affiliated to 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,210006

出　　处：《中华急诊医学杂志》2021年第12期1465-1469,共5页Chinese Journal of Emergency Medicine

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

摘　　要：目的探究肝素结合蛋白(Heparin-binding protein,HBP)对呼吸道病毒感染患者的诊断及预后评估价值。方法选取2018年11月至2020年11月南京医科大学附属南京医院急诊科收治的经病原学检查明确诊断为呼吸道病毒感染的患者为病毒感染组,及同期收治的非感染患者为非病毒感染组。收集患者的一般临床资料,并记录患者入院24 h内外周血白细胞计数(white blood cell count,WBC)、中性粒细胞与淋巴细胞比值(meutrophil-to-lymphocyte ratio,NLR)、C-反应蛋白(C-reactive protein,CRP)、降钙素原(procalcitonin,PCT)、HBP。比较两组患者各项指标的差异,绘制受试者工作特征(ROC)曲线,评估各指标对呼吸道病毒感染患者的诊断价值。记录病毒感染组患者入院24 h内SOFA评分和APACHEⅡ评分以及ICU滞留时间、抗病毒疗程、呼吸机及血管活性药物使用时间与总住院时间占比等预后指标,通过对HBP与上述指标进行Spearman相关性分析,判断HBP对呼吸道病毒感染患者的预后评估价值。结果共纳入病毒感染组106例,非病毒感染组107例,两组患者的性别、年龄以及身体质量指数比较,差异均无统计学意义(P>0.05)。与非病毒感染组相比,病毒感染组患者的血清CRP、HBP水平均明显升高(P<0.05),而WBC及NLR水平则显著降低,差异有统计学意义(P<0.05),两组间PCT水平差异无统计学意义(P>0.05)。HBP对呼吸道病毒感染的诊断效能最佳,其ROC曲线下面积为0.895,最佳截断值为13.625μg/L,敏感度为92.50%,特异度为76.60%。相关性分析表明,病毒感染组患者入院24 h内血清HBP水平与SOFA评分及APACHEⅡ评分均呈正相关(r=0.756,P<0.05;r=0.747,P<0.05);ICU滞留时间、抗病毒疗程、呼吸机及血管活性药物使用时间与总住院时间占比等指标也均与HBP水平呈正相关(r=0.873、0.748、0.830、0.794,均P<0.05)。结论HBP可作为呼吸道病毒感染患者良好的诊断指标,对其预后具有较好的评估价�Objectives To explore the value of heparin-binding protein(HBP)in the diagnosis and prognosis of patients with respiratory viral infections.Methods The patients who were admitted to Emergency Department of Nanjing Hospital Affiliated to Nanjing Medical University from November 2018 to November 2020 were selected as the viral infection group,and the non-infected patients admitted in the same period as the non-viral infection group.Data of all patients'general clinical information,peripheral white blood cell count(WBC),neutrophil-to-lymphocyte ratio(NLR),C-reactive protein(CRP),procalcitonin(PCT),and HBP in 24 h were collected.The differences in various indicators were compared between the two groups of patients,the receiver operating characteristic(ROC)curves were drawn,and the diagnostic value of each indicator for patients with respiratory virus infection were evaluated.The prognostic indicators such as sequential organ failure assessment(SOFA)score,the acute physiology and chronic health evaluationⅡ(APACHEⅡ)score within 24 h were recorded,and duration of ICU stay,antiviral treatment,ventilator and vasoactive agents to total length of hospital stay of patients in the viral infection group were calculated.The Spearman correlation analysis of HBP and the above indicators was performed to determine the prognostic value of HBP in patients with respiratory virus infections.Results A total of 106 patients were included in the viral infection group,and 107 in the non-viral infection group.There were no significant differences in sex,age,and body mass index(BMI)between the two groups of patients(P>0.05).Compared with the non-viral infection group,the serum CRP and HBP of the viral infection group were significantly higher(P<0.05),while the WBC and NLR levels were significantly lower(P<0.05).There was no statistical difference in PCT between the two groups(P>0.05).HBP had the best diagnosis efficiency for respiratory viral infections,the areas under the ROC was 0.895,the optimal cut-off point was 13.625μg/L,the sens

关 键 词：呼吸道病毒感染 肝素结合蛋白 C-反应蛋白 降钙素原 预后 

分 类 号：R56[医药卫生—呼吸系统]