脓毒症相关性脑病的诊断与影响因素分析  

Diagnosis and analysis of influencing factors of sepsis-associated encephalopathy

作　　者：俞典 吴问涛 敖永凤 田雪艳 谢永鹏 李小民[1,2] Yu Dian;Wu Wentao;Ao Yongfeng;Tian Xueyan;Xie Yongpeng;Li Xiaomin(Lianyungang Clinical College,Nanjing Medical University,Lianyungang 222000,Jiangsu,China;Department of Emergency and Critical Care Medicine,Lianyungang First People's Hospital,Lianyungang 222000,Jiangsu,China;School of Clinical Medicine,Guizhou Medical University,Guiyang 550025,Guizhou,China)

机构地区：[1]南京医科大学连云港临床医学院,江苏连云港222000 [2]连云港市第一人民医院急诊重症医学科,江苏连云港222000 [3]贵州医科大学临床医学院,贵州贵阳550025

出　　处：《中国中西医结合急救杂志》2023年第4期424-430,共7页Chinese Journal of Integrated Traditional and Western Medicine in Intensive and Critical Care

基　　金：江苏省研究生实践创新项目(SJCX22-0679);江苏省科技厅社会发展面上项目(BE2020670);江苏省医药卫生面上项目(H2019109)。

摘　　要：目的分析影响脓毒症相关性脑病(SAE)的危险因素及各危险因素对患者发生SAE的预测价值。方法收集2021年1月至2022年9月连云港市第一人民医院重症监护病房(ICU)和急诊ICU(EICU)收治的114例脓毒症患者作为研究对象。按患者是否发生SAE分为SAE组(49例)和非SAE组(65例)。收集患者性别、年龄、既往史等基本信息,以及血清细胞因子水平、格拉斯哥昏迷评分(GCS)、序贯器官衰竭评分(SOFA)、急性生理学与慢性健康状况评分Ⅱ(APACHEⅡ),比较是否发生SAE两组上述指标的差异。采用单因素和多因素分析影响SAE发生的危险因素;采用双变量相关性分析炎症细胞因子白细胞介素(IL-6、IL-10)、肝素结合蛋白(HBP)水平与3种重症评分的相关性;绘制受试者工作特征曲线(ROC曲线),分析各危险因素对发生SAE的预测价值。结果与非SAE组比较,SAE组年龄更大(岁:67.55±10.57比58.94±15.061,P<0.05),患有高血压、糖尿病的比例和SOFA评分、APACHEⅡ评分、抗凝血酶Ⅲ(ATⅢ)、血清炎症因子及HBP水平均更高〔高血压:34.69%(17/49)比16.92%(11/65),糖尿病:42.86%(21/49)比21.54%(14/65),SOFA评分(分):12.76±3.02比6.75±3.98,APACHEⅡ评分(分):26.82±8.75比15.13±7.25,ATⅢ(ng/L):45.96±45.63比9.07±7.13,白细胞介素(IL-2、IL-6、IL-10,ng/L):2.56(0.35,8.20)比0.51(0.27,3.40),14565.51(655.10,24891.80)比226.90(37.70,1004.48),780.80(47.24,3203.00)比319.43(4.70,40.20),α-干扰素(IFN-α,ng/L):20.20(8.18,36.90)比11.03(4.72,23.15),γ-干扰素(IFN-γ,ng/L):80.45(34.06,206.39)比38.39(17.49,84.85),HBP(μg/L):245.76±86.43比143.26±98.96,均P<0.05〕,GCS评分和血清胆碱酯酶水平明显降低〔GCS评分(分):6.73±3.18比14.48±2.13,胆碱酯酶(μg/L):3.6±1.2比4.8±1.4,均P<0.05〕,且SAE组IL-6>5000 ng/L、IL-10>1000 ng/L及HBP>300μg/L的患者比例均较非SAE组明显增多(均P<0.05)。多因素Logistic回归分析显示,患者高龄、既往有糖尿病史和IL-6升高(>5000 ng/L)、IL-10升Objective To analyze the risk factors affecting sepsis-associated encephalopathy(SAE)and the predictive value of each risk factor for the occurrence of SAE in patients.Methods A total of 114 septic patients admitted to the intensive care unit(ICU)and emergency ICU(EICU)of the First People's Hospital of Lianyungang from January 2021 to September 2022 were collected as study subjects.The patients were divided into SAE group(49 cases)and non-SAE group(65 cases)according to whether they had SAE or not.Clinical data such as patients'gender,age,history and other basic information,serum cytokine levels,Glasgow coma score(GCS),sequential organ failure assessment(SOFA),and acute physiology and chronic health evaluationⅡ(APACHEⅡ)were collected,and univariate and multifactorial analyses were used to analyze the risk factors affecting the occurrence of SAE.Bivariate correlation was used to analyze the correlation between the levels of inflammatory cytokines interleukin(IL-6,IL-10),heparinbinding protein(HBP)levels and the 3 critical illness scores,and receiver operator characteristic curves(ROC curves)were plotted to analyze the predictive value of each risk factor for the occurrence of SAE.Results Compared with the non-SAE group,the SAE group was older(years:67.55±10.57 vs.58.94±15.061,P<0.05),had a higher percentage of hypertension,diabetes mellitus and SOFA score,APACHEⅡscore,antithrombinⅢ(ATⅢ),serum inflammatory factors and HBP levels[hypertension:34.69%(17/49)vs.16.92%(11/65),diabetes mellitus:42.86%(21/49)vs.21.54%(14/65),SOFA score:12.76±3.02 vs.6.75±3.98,APACHEⅡscore:26.82±8.75 vs.15.13±7.25,ATⅢ(ng/L):45.96±45.63 vs.9.07±7.13,interleukins(IL-2,IL-6,IL-10,ng/L):2.56(0.35,8.20)vs.0.51(0.27,3.40),14565.51(655.10,24891.80)vs.226.90(37.70,1004.48),780.80(47.24,3203.00)vs.319.43(4.70,40.20),α-interferon(INF-α,ng/L):20.20(8.18,36.90)vs.11.03(4.72,23.15),γ-interferon(IFN-γ,ng/L):80.45(34.06,206.39)vs.38.39(17.49,84.85),HBP(μg/L):245.76±86.43 vs.143.26±98.96,all P<0.05],and GCS score and serum cho

关 键 词：炎症因子风暴 白细胞介素-6 脓毒症相关性脑病 肝素结合蛋白 

分 类 号：R631[医药卫生—外科学]