肺炎继发脓毒症患者血清sFasL和s-Met水平及预后评估价值  

The prognostic value of serum sFasL and s-Met levels in patients with sepsis secondary to pneumonia

作　　者：余秉昌 赖震宇 赵展庆 谢小芳 蔡秋燕 YU Bingchang;LAI Zhenyu;ZHAO Zhanqing;XIE Xiaofang;CAI Qiuyan(Department of Critical Care Medicine,Hainan West Central Hospital,Haikou 571700,China)

机构地区：[1]海南西部中心医院重症医学科,571700

出　　处：《天津医药》2023年第9期983-988,共6页Tianjin Medical Journal

摘　　要：目的探讨肺炎继发脓毒症患者的血清可溶性Fas配体(sFasL)和可溶性间质表皮转化因子(s-Met)的临床预后价值。方法纳入150例肺炎继发脓毒症患者并根据其入院28 d生存情况分为存活组(96例)和死亡组(54例),另纳入70例肺炎患者为肺炎组,60例体检健康者为对照组。酶联免疫吸附试验检测血清sFasL和s-Met水平。Spearman秩相关分析肺炎继发脓毒症患者sFasL、s-Met水平与序贯器官衰竭评分(SOFA)、快速序贯器官衰竭评分(q-SOFA)的相关性。多因素Logistic回归分析影响肺炎继发脓毒症患者死亡的危险因素。受试者工作特征曲线分析各指标对肺炎继发脓毒症患者死亡的诊断价值。结果对照组、肺炎组入院即刻及肺炎继发脓毒症组入院时sFasL和s-Met水平依次升高(P<0.05)。与存活组相比,死亡组0、24、48、72及120 h血清sFasL和s-Met水平均较高(均P<0.05)。肺炎继发脓毒症患者血清sFasL、s-Met及PCT与SOFA、q-SOFA呈正相关性(均P<0.01)。较高水平血清PCT、sFasL、s-Met和q-SOFA是影响肺炎继发脓毒症患者死亡的独立危险因素。血清PCT、sFasL、s-Met和q-SOFA联合检测对肺炎继发脓毒症患者死亡预测的曲线下面积(AUC)为0.872(95%CI:0.838~0.909),高于血清PCT、sFasL、s-Met和q-SOFA单项指标检测0.778(95%CI:0.739~0.817)、0.795(95%CI:0.761~0.829)、0.712(95%CI:0.672~0.753)、0.815(95%CI:0.774~0.857),Z分别为6.450、4.305、5.117、2.384(均P<0.05)。结论肺炎继发脓毒症患者血清sFasL和s-Met是评估肺炎继发脓毒症预后的血清标志物。Objective To investigate the prognostic value of serum soluble Fas ligand(sFasL)and soluble interstitial epidermal transforming factor(s-Met)in patients with pneumonia and sepsis.Methods A total of 150 patients with pneumonia secondary sepsis were were divided into the survival group(96 cases)and the death group(54 cases)according to the prognosis of 28 days after admission.Seventy patients with pneumonia were selected as the pneumonia group,and 60 healthy people were selected as the control group.Serum sFasL and s-Met levels were detected by ELISA in all subjects.Spearman rank correlation analysis was used for correlation analysis of sFasL,s-Met levels and SOFA,q-SOFA scores in patients with pneumonia secondary sepsis.Multivariate Logistic regression analysis was used to analyze factors influencing the death of patients with pneumonia secondary sepsis.The diagnostic value of each index in death of patients with pneumonia secondary sepsis was analyzed by receiver characteristic operating curve.Results Levels of sFasL and s-Met increased sequentially immediately after admission in the control group,the pneumonia group and the pneumonia combined with sepsis group(P<0.05).Compared with the survival group,serum sFasL and s-Met levels were higher at 0,24,48,72 and 120 h in the death group(P<0.05).Serum PCT,sFasL,s-Met and q-SOFA score were independent risk factors for death of patients with pneumonia secondary sepsis.The area under the curve of the combined detection of serum PCT,sFasL,s-Met,and q-SOFA scores for predicting mortality in patients with pneumonia secondary sepsis was 0.872(0.838-0.909),which was higher than the single indicator detection of serum PCT,sFasL,s-Met,and q-SOFA scores of 0.778(0.739-0.817),0.795(0.761-0.829),0.712(0.672-0.753)and 0.815(0.774-0.857)(Z=6.450,4.305,5.117,2.384,all P<0.05).Conclusion The serum sFasL and s-Met levels in patients with pneumonia secondary sepsis are serum biomarkers for evaluating the prognosis of pneumonia secondary sepsis patients.

关 键 词：脓毒症 肺炎 预后 可溶性FAS配体 可溶性间质表皮转化因子 序贯器官衰竭评分 

分 类 号：R563.1[医药卫生—呼吸系统]