血清PCSK9与脓毒症病情程度及预后的关系  

Correlation of serum PCSK9 with severity of sepsis and prognosis

作　　者：舒远路 邓紫薇[2] 邓晔 严妍 周建亮[4] 王晋[5] 段振兴[4] 江涛 赵向[7] 仇成凤[1,2] SHU Yuan-lu;DENG Zi-wei;DENG Ye;YAN Yan;ZHOU Jian-liang;WANG Jin;DUAN Zhen-xing;JIANG Tao;ZHAO Xiang;QIU Cheng-feng(The First People's Hospital of Huaihua,Huaihua,Hunan 418000,China;不详)

机构地区：[1]怀化市第一人民医院循证医学与临床研究中心,湖南怀化418000 [2]怀化市第一人民医院临床药学研究室,湖南怀化418000 [3]湖南医药学院,湖南怀化418000 [4]怀化市第一人民医院重症医学科,湖南怀化418000 [5]怀化市第一人民医院感染科,湖南怀化418000 [6]怀化市第一人民医院急诊科,湖南怀化418000 [7]怀化市第一人民医院全科医学,湖南怀化418000

出　　处：《中华医院感染学杂志》2023年第19期2881-2885,共5页Chinese Journal of Nosocomiology

基　　金：国家自然科学基金资助项目(82160075);湖南省自然科学基金资助项目(2021JJ30534,2020JJ4072,2019JJ40230);湖南省卫生健康委员会科技基金资助项目(B2019034、B2019035、202113011165);怀化市科技计划基金资助项目(2021R3114、2021R3117、2021R3115);吉首大学校级科研基金资助项目(Jdzd21041)。

摘　　要：目的探讨脓毒症患者血清前蛋白转化酶枯草溶菌素9(PCSK9)浓度与脓毒症病情程度及预后的关系.方法选取2020年3月-2021年9月于怀化市第一人民医院新确诊的203例脓毒症患者,测定入院时血清PC-SK9浓度;以序贯器官衰竭(SOFA)评分表示病情程度,以死亡或随访28天为终点事件;采用多重线性回归模型分析PCSK9与病情程度的关系,X-tile软件分析PCSK9预测脓毒症预后的最佳临界值,Cox回归模型分析PC-SK9与脓毒症预后的关系.结果血清PCSK9中位数为381.60(223.50,655.80)ng/ml;随访28天,死亡56例(27.59%).存活患者血清PCSK9低于死亡患者(P<0.05);多重线性回归模型显示:PCSK9与SOFA评分无显著性关联(P=0.375);X-tile软件分析显示,PCSK9预测脓毒症患者28天死亡风险的最佳临界值为416.50 ng/ml(P<0.05);COX风险比例模型显示:与低PCSK9组(≤416.50 ng/ml)相比,高PCSK9组(>416.50 ng/ml)患者的28天死亡风险增加2.47倍(95%CI:1.37~4.46).结论入院时脓毒症患者高血清PCSK9浓度与病情程度无关,但可增加28天死亡风险.OBJECTIVE To investigate the associations between proprotein convertase subtilisin/kexin type 9(PCSK9)and the extent and prognosis of sepsis in septic patients.METHODS Totally 203 newly diagnosed sepsis patients in the First People's Hospital of Huaihua from Mar.2020 to Sep.2021 were selected,and the serum PCSK9 concentration at admission were determined.The degree of disease was expressed by sequential organ failure(SOFA)scores,with death or follow-up of 28 days as the endpoint event.Multiple linear regression model was used to analyze the relationship between PCSK9 and the degree of disease,X-tile software was used to analyze the optimum thresholds of PCSK9 to predict the prognosis of sepsis,and Cox regression model was used to analyze the relationship between PCSK9 and the prognosis of sepsis.RESULTS The median of serum PCSK9 was 381.60(223.50,655.80)ng/ml in septic patients.56(27.59%)patients died at 28 days of follow-up.Serum PCSK9 was lower in surviving patients than in dead patients(P<0.05).Multiple linear regression analysis indicated that the PCSK9 was not associated with SOFA score(P=0.375).X-tile software analysis showed that the optimal cutoff of PCSK9 to predict the risk of death at 28 days in sepsis patients was 416.50 ng/ml(P<0.05).Cox risk proportional model showed that patients in the high PCSK9 group(>416.50 ng/ml)had a 2.47-fold(95%CI:1.37-4.46)increased risk of death at 28-day compared to the low PCSK9 group(≤416.50 ng/ml).CONCLUSION High serum PCSK9 concentration in patients with sepsis on admission were not associated with the extent of the disease,but increased the risk of death at 28-day.

关 键 词：脓毒症 脓毒症休克 前蛋白转化酶枯草溶菌素9 死亡风险 28天病死率 病情程度 预后 

分 类 号：R459.7[医药卫生—急诊医学]