内皮细胞损伤分子标志物在恶性肿瘤器官衰竭患者中 的研究  

Application of molecular markers of endothelial cell injury in patients with malignant tumor organ failure

作　　者：周坤 索冰 李艳丽 高庆峰 吴彩宇 Zhou Kun;Suo Bing;Li Yanli;Gao Qingfeng;Wu Caiyu(Beidahuang Industry Group General Hospital Department of Clinical Laboratory,Harbin 150088 HeiLongjiang China)

机构地区：[1]北大荒集团总医院检验科,黑龙江哈尔滨150088

出　　处：《肿瘤代谢与营养电子杂志》2023年第5期645-651,共7页Electronic Journal of Metabolism and Nutrition of Cancer

基　　金：黑龙江省卫生健康委科研课题(20211111000263)。

摘　　要：目的评价快速序贯器官衰竭评分(qSOFA)、可溶性血栓调节蛋白(sTM)、组织纤溶酶原激活物-抑制剂1复合物(t-PAIC)在恶性肿瘤多器官功能衰竭(MOF)患者中的应用价值。方法回顾性分析2022年1月至12月北大荒集团总医院确诊为恶性肿瘤的240例患者,其中无器官衰竭患者125例(无器官衰竭组),MOF115例患者,所有入选者均检测sTM、t-PAIC,并根据实验室检验信息系统(Laboratory Information System,LIS)中的信息计算患者qSOFA评分及SOFA评分。两组间非正态分布数据比较采用Mann-Whitney U检验,二元多因素Logistic回归分析恶性肿瘤患者发生MOF的影响因素。受试者工作特征曲线(ROC曲线)判断各指标的诊断效能,约登指数最大处作为最佳截断值。Kaplan-Meier方法绘制生存曲线,分析qSOFA、sTM、t-PAIC高水平组与低水平组生存率的差异。结果发生MOF的恶性肿瘤患者60 d死亡率,qSOFA评分,SOFA评分,sTM、t-PAIC显著高于无器官衰竭组,差异有统计学意义(P<0.001)。二元多因素Logistic回归分析结果显示sTM、t-PAIC是恶性肿瘤患者发生MOF的危险因素(OR=1.750、1.185,P<0.001、P=0.003)。ROC曲线分析结果显示,qSOFA、sTM、t-PAIC预测恶性肿瘤患者发生MOF的截断值分别为2分、27.40 kU/L、18.65μg/L,曲线下面积(AUC)分别为0.815、0.848、0.824。sTM+t-PAIC联合诊断的效率最高,AUC为0.881。将qSOFA≥2分、sTM≥27.40 kU/L,t-PAIC≥18.65μg/L的患者作为高水平组,小于截断值的作为低水平组,Kaplan-Meier曲线分析结果显示qSOFA、sTM、t-PAIC高水平组患者的总生存率较低水平组显著降低,差异有统计学意义(P=0.021、P<0.001、P<0.001)。结论发生MOF的恶性肿瘤患者,血浆sTM、t-PAIC水平显著升高,是恶性肿瘤患者发生MOF的危险因素。通过实验室无创、快速的检测对发生MOF的恶性肿瘤患者提早进行干预,改善肿瘤患者的短期预后。Objective To evaluate the application value of quick sequential organ failure score qSOFA soluble thrombomodulin sTM tissue plasminogen activator-inhibitor complex t-PAIC in patients with malignant multiple organ failure MOF.Method A retrospective analysis was performed on 240 patients diagnosed with malignant tumor in our hospital including 125 patients without organ failure and 115 patients with multiple organ failure MOF.Mann-Whitney U test was used to compare the two groups and binary Logistics regression was used to analyze the relationship between sTM t-PAIC and MOF in malignant tumor patients.The receiver operating characteristic curve ROC determines the diagnostic efficiency of each index and the maximum Youden index is taken as the best cutoff value.Survival curve was plotted by Kaplan-Meier method to analyze the difference of survival rate among different groups.Result The 60-day mortality qSOFA score SOFA score sTM t-PAIC of malignant tumor patients with MOF were significantly higher than those without organ failure group the difference was statistically significant P<0.001.Binary Logistic regression analysis showed that sTM and t-PAIC were significantly correlated with MOF in patients with malignant tumors OR=1.7501.185 P<0.001 P=0.003.ROC curve analysis results showed that the cutoff values of qSOFA sTM and t-PAIC for predicting MOF in malignant tumor patients were 227.40 kU/L and 18.65μg/L respectively and the area under curve AUC were 0.8150.848 and 0.824 respectively.The combined diagnosis efficiency of sTM+t-PAIC was the highest and the AUC was 0.881.Patients with qSOFA≥2 sTM≥27.40 kU/L t-PAIC≥18.65μg/L were taken as the high level group and those with less than cutoff value were taken as the low level group.Kaplan-Meier analysis results showed that the overall survival rate of patients with high level qSOFA sTM t-PAIC was significantly reduced.The difference was statistically significant P=0.021 P<0.001 P<0. 001 . Conclusion In malignant tumor patients with MOF plasma sTM and t-PAIC leve

关 键 词：多器官功能衰竭 可溶性血栓调节蛋白 组织纤溶酶原激活物-抑制剂1复合物 短期预后 

分 类 号：R730.5[医药卫生—肿瘤]