生物标志物联合检测在脓毒症相关急性肝损伤患者中的应用价值  

Clinical study of biomarker combination test in patients with sepsis-associated acute liver injury

作　　者：吴迪[1] 陈佳颖 耿立霞[2] WU Di;CHEN Jiaying;GENG Lixia(Baotou Medical College of Inner Mongolia University of Science and Technology,Baotou 014040,China;Intensive Care Unit,the First Affiliated Hospital of Baotou Medical College of Inner Mongolia University of Science and Technology)

机构地区：[1]内蒙古科技大学包头医学院,内蒙古包头014040 [2]内蒙古科技大学包头医学院第一附属医院重症医学科

出　　处：《包头医学院学报》2023年第2期12-19,共8页Journal of Baotou Medical College

基　　金：内蒙古自治区高等学校科学研究项目(NJZY13248);内蒙古自治区科技计划项目(20140151)。

摘　　要：目的:探讨生物标志物联合检测对脓毒症相关急性肝损伤患者的早期诊断和预后评估的价值。方法:收集内蒙古科技大学包头医学院第一附属医院重症医学科(ICU)2019年11月-2022年1月收治的104例脓毒症患者临床资料,按照入ICU时是否发生急性肝损伤分为脓毒症相关急性肝损伤组(n=42)和非肝损伤组(n=62),将脓毒症相关急性肝损伤患者按28 d是否存活分为存活组(n=16)和死亡组(n=26),记录104例患者入ICU 6 h内血清正五聚蛋白3(PTX-3)、C-反应蛋白(CRP)、降钙素原(PCT)、总胆红素(TBIL)、谷草转氨酶(AST)、谷丙转氨酶(ALT)、凝血酶原时间国际标准化比值(INR值)、凝血酶原时间(PT)、凝血酶原活动度(PTA)、血小板(PLT)、入ICU 24 h内急性生理与慢性健康状况评估量表II(APACHEII)评分最差值及序贯器官衰竭评估(SOFA)评分;同时记录脓毒症相关急性肝损伤患者28 d预后。PTX-3的相关性采用Spearman相关分析;绘制受试者工作特征曲线(ROC曲线),计算ROC曲线下面积(AUC),分析各指标单独检测以及联合检测对脓毒症相关急性肝损伤患者的诊断价值以及对其不良预后的预测效果。结果:脓毒症相关急性肝损伤组血清PTX-3、CRP、PCT、TBIL、AST、ALT、INR值、PT、APACHEII评分、SOFA评分高于非肝损伤组,PTA、PLT低于非肝损伤组,差异具有统计学意义(均P<0.05);Spearman相关分析显示,PTX-3与APACHEII评分及SOFA评分均呈显著正相关。ROC曲线分析显示,TBIL、INR值、PTX-3对脓毒症相关急性肝损伤的诊断效能相近,优于其他指标;三者联合检测诊断的效能更高(AUC=0.945),敏感度为85.7%,特异度为95%。死亡组患者血清PTX-3、CRP、PCT、TBIL、AST、ALT、INR值、PT、APACHEII评分、SOFA评分均高于存活组,PTA、PLT低于存活组,差异具有统计学意义(均P<0.05)。ROC曲线分析显示,PTX-3对脓毒症相关急性肝损伤患者28 d死亡的评估效能优于其他指标;PTX-3联合TBIL及IObjective:To investigate the early diagnosis and prognosis value of biomarker combination test in patients with sepsis-associated acute liver injury.Methods:The clinical data of 104 sepsis patients admitted to the Intensive Care Unit(ICU)of Baotou First Affiliated Hospital of Inner Mongolia University of Science and Technology from November 2019 to January 2022 were collected.Selected cases were divided into sepsis-associated acute liver injury group(n=42)and non-liver injury group(n=62)based on acute liver injury occurring or not when entering ICU.Patients with septic acute liver injury were divided into survival groups(n=16)and death groups(n=26)after 28 days of survival.The sera pentraxin-3(PTX-3),c-reactive protein(CRP),procalcitonin(PCT),total bilirubin(TBIL),glutamic-oxal(o)acetic transaminase(AST),glutamate pyruvate transaminase(ALT),international normalized ratio(INR value),prothrombin time(PT),prothrombin activity(PTA),platelet(PLT)of the 104 patients were recorded within 6h after entering ICU,the worst score of acute physiology and chronic health assessment scaleⅡ(APACHEⅡ)score and sequential organ failure assessment(SOFA)grade within 24 hours was recorded after entering the ICU.The 28 d prognosis of patients with sepsis-related acute liver injury was also recorded.The correlation of PTX-3 was analyzed using Spearman correlation coefficient.The receiver operating characteristic curve(ROC curve)was also drawn,and the area under the roc curve(AUC)was calculated.The diagnosis and prognosis value of individual detection and combined testing on sepsis-related acute liver injury were analyzed and evaluated.Results:The levels of serum PTX-3,CRP,PCT,TBIL,AST and ALT,INR value,PT,APACHEⅡscore and SOFA score were significantly higher in the sepsis-associated acute liver injury group than those in the non-liver injury group,PTA and PLT level were lower than that in the non-liver injury group(P<0.05).The Spearman correlation analysis result showed that a significant positive correlation between PTX-3 level an

关 键 词：脓毒症 急性肝损伤 正五聚蛋白3 总胆红素 

分 类 号：R459.7[医药卫生—急诊医学] R575[医药卫生—治疗学]