血清肝素结合蛋白与抗凝血酶Ⅲ和Toll样受体4水平预测重症感染患者生存状况的临床价值  

Clinical value of serum heparin-binding protein,antithrombin III and Toll-like receptor 4 in prediction of survival status of patients with severe infection

作　　者：花云[1] 张婷婷[1] 葛红兵 王林华[1] 杨青青 许惠芬[1] HUA Yun;ZHANG Ting-ting;GE Hong-bing;WANG Lin-hua;YANG Qing-qing;XU Hui-fen(Affiliated Hospital of Nantong University,Nantong,Jiangsu226001,China;不详)

机构地区：[1]南通大学附属医院重症医学科,江苏南通226001 [2]南通市中医院重症医学科,江苏南通226000

出　　处：《中华医院感染学杂志》2022年第18期2734-2737,共4页Chinese Journal of Nosocomiology

基　　金：江苏省中医药局科技项目(LZ13238)。

摘　　要：目的 研究治疗后72 h血清肝素结合蛋白、抗凝血酶Ⅲ和Toll样受体4水平对重症感染患者生存状况的预测。方法 选取2019年12月-2021年1月南通大学附属医院ICU收治的240例重症感染患者,根据28 d生存情况,分成生存组201例和死亡组39例。单因素及多因素Logistic回归分析重症感染患者死亡的影响因素,受试者工作特征曲线(ROC)评估治疗后72 h血清肝素结合蛋白、抗凝血酶Ⅲ和Toll样受体4水平对患者预后的预测价值。结果 生存组患者APACHEⅡ评分低于死亡组(P<0.05),脓毒症、代谢性疾病、机械通气及输血患者比例低于死亡组(P<0.05);多因素Logistic回归分析显示,输血、机械通气、代谢性疾病和脓毒症是重症感染患者死亡的影响因素(P<0.05);治疗后72 h生存组患者血清肝素结合蛋白和Toll样受体4水平低于死亡组,血清抗凝血酶Ⅲ高于死亡组(P<0.05)。ROC曲线结果可知,在最佳临界点时,三指标联合检测对重症感染预后的灵敏度为94.87%,特异度为95.02%。结论 血清肝素结合蛋白、抗凝血酶Ⅲ和Toll样受体4在重症感染患者中动态异常表达,联合检测预测重症感染患者死亡的临床价值较高。OBJECTIVE To forecast the clinical value of serum heparin-binding protein,antithrombin III and Toll-like receptor 4 after treatment for 72 hours in prediction of survival status of patients with severe infection.METHODS A total of 240 ICU patients with severe infection who were treated in the Affiliated Hospital of Nantong University from Dec 2019 to Jan 2021 were enrolled in the study and were divided into the survival group with 201 cases and the death group with 39 cases according to 28-day survival status.Univariate analysis and multivariate logistic regression analysis were performed for the influencing factors for death of the patients with severe infection,and the values of serum heparin-binding protein,antithrombin III and Toll-like receptor 4 after treatment for 72 hours in prediction of prognosis were evaluated by receiver operating characteristic(ROC) curve.RESULTS The APACHE II score of the survival group was significantly lower than that of the death group(P<0.05).The percentages of patients with sepsis,metabolic disease,mechanical ventilation and blood transfusion were significantly lower in the survival group than in the death group(P<0.05).Multivariate logistic regression analysis showed that the blood transfusion,mechanical ventilation,metabolic disease and sepsis were the influencing factors for death of the patients with severe infection(P<0.05).The levels of serum heparin-binding protein and Toll-like receptor 4 of the survival group were significantly lower than those of the death group after treatment for 72 hours,while the serum antithrombin level of the survival group was significantly higher than that of the death group(P<0.05).ROC curve analysis indicated that the sensitivity of the joint detection of the three indexes was 94.87% in prediction of prognosis of the patients with severe infection at the optimal critical point,with the specificity 95.02%.CONCLUSION The patients with severe infection show dynamic abnormal expression of serum heparin-binding protein,antithrombin III and Toll-l

关 键 词：重症感染 肝素结合蛋白 抗凝血酶Ⅲ TOLL样受体4 预后 预测 

分 类 号：R446.1[医药卫生—诊断学]