PCT联合PCSK9对脓毒症病情及预后的评估价值  

The Value of Serum PCT Combined With PCSK9 in Evaluating the Condition and Prognosis of Sepsis

作　　者：翁春发 胡建雄[1] 李冬平[1] 黄肖海 林美娟 WENG Chunfa;HU Jianxiong;LI Dongping;HUANG Xiaohai;LIN Meijuan(Department of Critical Medicine,Affiliated Hospital of Putian University,Putian Fujian 351100,China)

机构地区：[1]莆田学院附属医院重症医学科,福建莆田351100

出　　处：《中国卫生标准管理》2023年第23期118-121,共4页China Health Standard Management

摘　　要：目的探讨血清降钙素原(procalcitonin,PCT)联合前蛋白转化酶枯草溶菌素9(proprotein convertase subtilisin/kexin type 9,PCSK9)对脓毒症病情严重程度及预后的评估价值。方法选择2021年1月—2022年1月莆田学院附属医院重症医学科收治的99例脓毒症患者为脓毒症组,另选取莆田学院附属医院重症医学科同时期收治的40例全身炎症反应综合征(systemic inflammatory response syndrome,SIRS)患者为SIRS组,以及莆田学院附属医院体检中心40例健康者为对照组。抽取三组的静脉血样测定血清PCT水平,同时采用ELISA方法检测血清中PCSK9水平,比较三组指标的差异。根据不同病情严重程度将脓毒症组患者分为轻度组、中度组、重度组,比较三组指标的差异。根据不同预后将脓毒症组患者分为预后良好组和预后不良组,比较两组指标的差异。采用Logistic回归分析脓毒症患者病情存在的风险因素,利用受试者工作特征曲线(area under curve,ROC)分析患者各指标,对脓毒症预后进行评估。结果与对照组比较,SIRS组和脓毒症组PCT水平明显高(P<0.05)。与SIRS组比较,脓毒症组PCT水平呈现明显高(P<0.05)。与对照组比较,SIRS组和脓毒症组PCSK9水平均明显高(P<0.05);与SIRS组比较,脓毒症组PCSK9水平明显高(P<0.05)。脓毒症患者血清中PCT联合PCSK9的阳性率分别在不同程度组中呈现逐步升高的态势。与预后良好组对比,预后不良组PCT、PCSK9水平呈现明显升高的趋势。Logistic回归分析结果表明,PCT、PCSK9是脓毒症患者预后独立影响的因素(P<0.05)。脓毒症患者预后风险与血清PCT联合PCSK9水平呈显著性正相关(P<0.05)。PCT与PCSK9预测预后不良的曲线下面积(area under curve,AUC)为0.8288和0.7950,其中PCSK9的特异度、敏感度明显高于90.0%。结论PCT联合PCSK9与脓毒症风险评估之间具有协同性,二者联合用于脓毒症预后的评估具备提高预测的价值。Objective To evaluate the value of serum procalcitonin(PCT)combined with pro-protein converting enzyme subtilisin/kexin type 9(PCSK9)in the severity and prognosis of sepsis.Methods A total of 99 patients with sepsis admitted to department of critical medicine,Affiliated Hospital of Putian University from January 2021 to January 2022 were selected as the sepsis group,40 patients with systemic inflammatory response syndrome(SIRS)admitted to department of critical medicine,Affiliated Hospital of Putian University at the same time were selected as the SIRS group,and 40 healthy people in the physical examination center,Affiliated Hospital of Putian University were selected as the control group.The venous blood samples of the three groups were taken to determine the serum PCT level,and the serum PCSK9 level was detected by ELISA,and the differences of the three groups were observed and compared.According to the severity of the disease,patients in the sepsis group were divided into mild group,moderate group and severe group,and the differences of the three groups were observed and compared.According to different prognosis,patients in sepsis group were divided into good prognosis group and bad prognosis group,and the difference of indexes between the two groups was observed and compared.Logistic regression was used to analyze the risk factors of sepsis patients,and ROC subjects'working characteristic curve was used to analyze the patient's various indicators to evaluate the prognosis of sepsis.Results Compared with the control group,the level of PCT in SIRS group and sepsis group increased significantly(P<0.05).Compared with SIRS group,PCT level in sepsis group was significantly higher(P<0.05).Compared with the control group,the level of PCSK9 in SIRS group and sepsis group increased significantly(P<0.05).Compared with SIRS group,the level of PCSK9 in sepsis group was significantly higher(P<0.05).The positive rate of PCT and PCSK9 in the serum of patients with sepsis showed a gradual increase in different degree groups.C

关 键 词：血清降钙素原 前蛋白转化酶枯草溶菌素9 脓毒症 全身炎症反应综合征 健康者 病情 预后评估 

分 类 号：R459[医药卫生—治疗学]