血管内皮-钙黏蛋白在脓毒症患者病情严重程度评估中的价值  

Value of vascular endothelial-cadherin in evaluating the severity of patients with sepsis

作　　者：连洁[1] 谈朦 陈隆望[1] 赵光举[1] 洪广亮[1] 卢中秋[1] Lian Jie;Tan Meng;Chen Longwang;Zhao Guangju;Hong Guangliang;Lu Zhongqiu(Department of Emergency,the First Affiliated Hospital of Wenzhou Medical University,Wenzhou Key Laboratory of Emergency and Disaster Medicine,Wenzhou 325000,Zhejiang,China;Department of Infection,Taizhou Enze Medical Center,Taizhou 317000,Zhejiang,China)

机构地区：[1]温州医科大学附属第一医院急诊科,温州市急危重病与救援医学重点实验室,浙江温州325000 [2]台州恩泽医疗中心感染科,浙江台州317000

出　　处：《中华危重病急救医学》2022年第8期808-813,共6页Chinese Critical Care Medicine

基　　金：浙江省"十三五"中医药重点专科(2019-1);浙江省重点研发计划项目(2021C03072)。

摘　　要：目的探讨血管内皮-钙黏蛋白(VE-cad)在脓毒症患者病情严重程度中的评估价值。方法采用前瞻性研究,选择2015年6月1日至2017年11月1日温州医科大学附属第一医院急诊病区收治的85例脓毒症患者,记录患者的性别、年龄、既往史、首发感染部位、受累器官数量、实验室指标、急性生理学与慢性健康状况评分Ⅱ(APACHEⅡ)、简化急性生理学评分Ⅱ(SAPSⅡ)、序贯器官衰竭评分(SOFA)、总住院时间、急诊重症监护病房(EICU)住院时间及入院28 d和住院期间生存情况,检测患者入院24 h内血浆VE-cad水平。根据患者病情进展分为脓毒症组和脓毒性休克组;根据患者是否伴有多器官功能障碍综合征(MODS)分为MODS组和非MODS组。分析并比较各组患者及不同28 d预后患者上述指标的差异。绘制受试者工作特征曲线(ROC曲线),评估VE-cad对脓毒症患者病情严重程度的评估价值。结果共纳入85例患者,以呼吸道感染为主;其中38例为脓毒症,47例为脓毒性休克;39例发生MODS,46例未发生MODS;患者入院28 d内存活64例,死亡21例。与脓毒症组相比,脓毒性休克组患者受累器官数量多〔个:3(2,4)比1(0,2)〕,APACHEⅡ评分〔分:13(10,21)比7(5,12)〕、SAPSⅡ评分〔分:35(31,55)比7(5,12)〕、SOFA评分〔分:7.0(5.0,10.0)比3.0(0,5.0)〕、血乳酸〔Lac(mmol/L):3.5(2.4,6.2)比1.9(1.2,2.2)〕、C-反应蛋白〔CRP(mg/L):90.0(58.1,90.0)比50.5(38.0,90.0)〕、VE-cad水平〔mg/L:1.427(1.141,2.150)比1.195(0.901,1.688)〕均明显升高,而血小板计数〔PLT(×10^(9)/L):113.4±67.2比202.5±10^(9).5〕、血红蛋白(Hb)水平(g/L:106.3±36.3比118.6±18.0)均明显降低(均P<0.05)。与非MODS组相比,MODS组患者APACHEⅡ评分〔分:14(10,22)比8(6,13)〕、SAPSⅡ评分〔分:36(32,56)比29(24,35)〕、SOFA评分(分:7.9±3.9比4.0±3.8)、住院病死率〔53.8%(21/39)比0%(0/46)〕、Lac〔mmol/L:3.1(2.3,6.3)比2.1(1.4,4.6)〕和VE-cad水平〔mg/L:1.427(1.156,1.937)比1.195(Objective To explore the value of vascular endothelial-cadherin(VE-cad)in evaluating the severity of sepsis.Methods A prospective study was conducted to select 85 patients with sepsis treated in the emergency ward of the First Affiliated Hospital of Wenzhou Medical University from June 1,2015 to November 1,2017.The gender,age,medical history,first infection site,number of affected organs,laboratory indexes,acute physiology and chronic health evaluationⅡ(APACHEⅡ),simplified acute physiology scoreⅡ(SAPSⅡ),sequential organ failure assessment(SOFA)and the total length of stay,emergency intensive care unit(EICU)length of stay,28-day at admission and survival during hospitalization were measured,and the VE-cad level within 24 hours at admission was measured.The patients were divided into sepsis group and septic shock group according to the progress of the disease.The patients were divided into multiple organ dysfunction syndrome(MODS)group and non MODS group according to whether they were accompanied by MODS.The differences of the above indexes in patients with different disease progression,MODS and different prognosis were analyzed and compared.The receiver operator characteristic curve(ROC curve)was drawn to evaluate the value of VE-cad in evaluating the severity of sepsis.Results A total of 85 patients were included,mainly respiratory tract infection.Among them,38 cases were sepsis and 47 cases were septic shock,39 cases had MODS,46 cases had no MODS,64 cases survived and 21 cases died within 28 days after admission.Compared with sepsis group,the number of affected organs in septic shock group was greater[3(2,4)vs.1(0,2)],APACHEⅡscore[13(10,21)vs.7(5,12)],SAPSⅡscore[35(31,55)vs.7(5,12)],SOFA score[7.0(5.0,10.0)vs.3.0(0,5.0)],blood lactic acid[Lac(mmol/L):3.5(2.4,6.2)vs.1.9(1.2,2.2)],C-reactive protein[CRP(mg/L):90.0(58.1,90.0)vs.50.5(38.0,90.0)]and VE-cad levels[mg/L:1.427(1.141,2.150)vs.1.195(0.901,1.688)]were significantly increased,while platelet count[PLT(×10^(9)/L):113.4±67.2 vs.202.5±10^(9).5]an

关 键 词：脓毒症 脓毒性休克 血管内皮-钙黏蛋白 血管内皮损伤 

分 类 号：R459.7[医药卫生—急诊医学]