CD63联合抗凝血酶-Ⅲ对脓毒症患者继发MODS的预测价值  

Predictive value of CD63 combined with AT-Ⅲin MODS patient secondary to sepsis

作　　者：莫伟斌 欧阳婉爱 范少峰 梁英杰[3] Mo Wei-bin;Ouyang Wan-ai;Fan Shao-feng;Liang Ying-jie(Department of Infectious Disease,the Eighth Affiliated Hospital of Guangzhou Medical University,Guangzhou 510000,China)

机构地区：[1]广州医科大学附属市八医院传染科,广东广州510000 [2]广州医科大学附属市八医院门诊,广东广州510000 [3]广州市第一人民医院骨及脊柱外科重症监护室,广东广州510000

出　　处：《中国急救医学》2022年第5期431-435,共5页Chinese Journal of Critical Care Medicine

摘　　要：目的通过研究脓毒症继发多器官功能障碍综合征(MODS)患者CD63与抗凝血酶-Ⅲ(AT-Ⅲ)表达水平的变化,探讨其对病情转归的预测价值。方法本研究选取从2018年2月至2021年2月广州医科大学附属市八医院重症医学科(ICU)收治的60例脓毒症患者,根据7 d内是否继发MODS分为MODS组(30例)和非MODS组(30例);分别于入院24 h内和第3天抽取血标本,用流式细胞仪检测患者CD63阳性表达率和平均荧光强度;检测患者入院后同时间段血常规、AT-Ⅲ、降钙素原(PCT)、C-反应蛋白(CRP)、血乳酸(Lac)、D-二聚体、活化部分凝血活酶时间(APTT)、凝血酶原时间(PT),以及序贯器官衰竭评分(SOFA)、急性生理学与慢性健康状况评估系统Ⅱ(APACHEⅡ)评分等。研究观察指标数据之间的相关性采用Pearson分析,对差异有统计学意义的变量进行二元Logistic回归分析,以确定脓毒症患者继发MODS的独立危险因素。采用受试者工作特征(ROC)曲线分析CD63联合AT-Ⅲ对脓毒症患者继发MODS的预测价值。结果MODS组的CD63阳性率较非MODS组明显增高[(9.35±0.93)%vs.(5.12±1.17)%,P<0.01],而AT-Ⅲ活性则明显降低(70.05±4.51 vs.89.16±6.80,P<0.01)。二元Logistic回归分析显示:CD63阳性率[优势比(OR)=1.304,P<0.01]、AT-Ⅲ活性(OR=0.964,P<0.01)和PCT(OR=1.024,P<0.05)是影响脓毒症患者继发MODS的独立危险因素。通过分析ROC曲线发现,CD63阳性率及AT-Ⅲ活性对脓毒症继发MODS的预测价值均较高[ROC曲线下面积(AUC)分别为0.8177及0.7714]。CD63联合AT-Ⅲ对脓毒症继发MODS可能具有更好的预测能力(AUC=0.8665,敏感度为81.82%,特异度为74.26%)。结论在一定程度上早期检测CD63阳性率和AT-Ⅲ活性表达水平可以用于预测脓毒症患者继发MODS的风险。Objective To study the changes of platelet CD63 and antithrombin-Ⅲ(AT-Ⅲ)expression in the patients with multiple organ dysfunction syndrome(MODS)secondary to sepsis,and to explore their predictive value for the prognosis.Methods 60 patients with sepsis treated in the ICU Department of our hospital from February 2018 to February 2021 were divided into MODS group(30 cases)and non-MODS group(30 cases)according to whether MODS was secondary within 7 days;Blood samples were taken within 24 hours after admission and on the third day.The positive expression rate of CD63 and average fluorescence intensity were detected by flow cytometry.Blood routine,AT-Ⅲ,procalcitonin(PCT),C-reactive protein(CRP),blood lactic acid,D-dimer,activated partial thromboplastin time(APTT),prothrombin time(PT),SOFA score and APACHEⅡscore were measured at the same time after admission.Pearson analysis was used to analyze the correlation between the data,and binary Logistic regression analysis was carried out for the variables with statistically significant difference so as to determine the independent risk factors of secondary MODS in the patients with sepsis.Receiver operating characteristic curve(ROC curve)was used to analyze the predictive value of platelet CD63 combined with AT-Ⅲin the patients with secondary MODS in sepsis.Results Compared with non-MODS group,the expression level of CD63 in MODS group was significantly higher[(9.35±0.93)%vs.(5.12±1.17)%,P<0.01],while the activity of AT-Ⅲwas significantly lower(70.05±4.51 vs.89.16±6.80,P<0.01).Binary Logistic regression analysis showed that CD63[odds ratio(OR)=1.304,P<0.01],AT-Ⅲactivity(OR=0.964,P<0.01)and PCT(OR=1.024,P<0.05)were independent risk factors for secondary MODS in the patients with sepsis.By analyzing the ROC curve,it was found that CD63 and AT-Ⅲhad high predictive value for MODS secondary to sepsis[the area under the ROC curve(AUC)were 0.8177 and 0.7714,respectively].CD63 combined with AT-Ⅲmay had better predictive ability for MODS secondary to sepsis(AUC=

关 键 词：脓毒症 多器官功能障碍综合征(MODS) CD63 抗凝血酶-Ⅲ(AT-Ⅲ) 流式细胞术 

分 类 号：R459.7[医药卫生—急诊医学]