脓毒症患者连续性血液净化治疗前后PCT Trx-1D-Lac表达及意义  

The Expression Level and Significance of PCT Trx-1 and D-Lac in Patients with Sepsis before and after Continuous Blood Purification Treatment

作　　者：曾广志[1] 唐海莲[1] 陈海玉[1] 曾慧志 梅林[1] ZENG Guangzhi;TANG Hailian;CHEN Haiyu(Liuzhou Liutie Central Hospital,Guangxi Liuzhou 545007,China)

机构地区：[1]广西壮族自治区柳州市柳铁中心医院重症医学科,广西柳州545007

出　　处：《河北医学》2024年第1期50-55,共6页Hebei Medicine

基　　金：广西壮族自治区卫生健康委员会自筹经费科研课题项目,(编号:Z-B20231480)。

摘　　要：目的:探讨脓毒症患者连续性血液净化(CBP)治疗前后血清降钙素原(PCT)、硫氧还蛋白-1(Trx-1)、D-乳酸(D-Lac)水平变化,分析其对CBP疗效的预测价值及临床意义。方法:选取2021年1月至2022年12月本院100例脓毒症患者作为观察组,另遵循1∶1配对原则,选取100例健康体检者作为对照组。统计两组血清PCT、Trx-1、D-Lac水平。观察组接受CBP治疗,依据治疗效果分为存活亚组、死亡亚组。比较不同亚组血清PCT、Trx-1、D-Lac水平、急性生理学与慢性健康状况Ⅱ评分(APACHEⅡ)及治疗前后其变化差值。Pearson分析各血清指标水平变化差值与APACHEⅡ评分相关性。采用受试者工作特征曲线(ROC)及曲线下面积(AUC)分析各血清指标水平变化差值对疗效的预测价值。采用卡普兰-迈耶(Kaplan-Meier)分析不同血清表达者28d内生存状况。结果:观察组血清PCT、Trx-1、D-Lac水平高于对照组(P<0.05);治疗1周后,死亡亚组血清PCT、Trx-1、D-Lac水平及APACHEⅡ评分高于存活亚组,且变化差值小于存活亚组(P<0.05);各血清指标水平变化差值与APACHEⅡ评分呈正相关(P<0.05);各血清指标水平变化差值联合预测CBP疗效的AUC分别大于单一指标预测、各血清指标联合预测(P<0.05);PCT、Trx-1、D-Lac水平变化差值高表达者死亡风险分别是低表达的4.828、3.600、2.318倍,且生存率高于低表达者(P<0.05)。结论:脓毒症患者CBP治疗前后血清PCT、Trx-1、D-Lac水平变化可反映病情严重程度,且与28d内生存情况密切相关,联合检测其变化差值对CBP疗效具有一定预测价值。Objective:To investigate the changes of serum procalcitonin(PCT),thioredoxin(Trx-1)and D-lactic acid(D-Lac)levels before and after continuous blood purification(CBP)treatment in patients with sepsis,and to analyze its predictive value and clinical significance for the efficacy of CBP.Methods:A total of 100 patients with sepsis in our hospital from January 2021 to December 2022 were selected as the observation group,and 100 healthy subjects were selected as the control group according to the 1:1 pairing principle.The serum PCT,Trx-1 and D-Lac levels of the two groups were analyzed.Observation group received CBP treatment and was divided into survival subgroup and death subgroup according to treatment effect.The serum levels of PCT,Trx-1,D-Lac,acute physiology and chronic health statusⅡscore(APACHEⅡ)were compared between different subgroups and the difference before and after treatment.Pearson correlation analysis was performed to assess the correlation between the changes in serum biomarker levels and APACHE II scores.Receiver operating characteristic curve(ROC)and area under curve(AUC)were used to analyze the predictive value of the difference in the level of each serum indicator.Kaplan-Meier was used to analyze the survival status of patients with different serum expressions within 28 days.Results:The serum levels of PCT,Trx-1 and D-Lac in observation group were higher than those in control group(P<0.05).After 1 week of treatment,the levels of serum PCT,Trx-1,D-Lac and APACHEⅡscore in death subgroup were higher than those in survival subgroup,and the difference was smaller than that in survival subgroup(P<0.05).There was a positive correlation between the difference of serum indexes and APACHEⅡscore(P<0.05).The AUC of the combined prediction of CBP was greater than that of the single prediction and the combined predic-tion of the serum prediction(P<0.05).The risk of death in patients with high expression of PCT,Trx-1 and D-Lac was 4.828,3.600 and 2.318 times of that in patients with low expression,respec

关 键 词：脓毒症 连续性血液净化 降钙素原 硫氧还蛋白-1 D-乳酸 

分 类 号：R459.7[医药卫生—急诊医学]