血栓标志物联合炎症指标评估肿瘤并发脓毒性休克的效能  

Thrombus markers combined with indicators of inflammation to analyze tumor complicated with sepsis shock

作　　者：赖媛媛 何振业 王宇婷 丘享享 蔡信坚 林嘉欣 寒冰 吴宗勇 齐军 LAI Yuanyuan;HE Zhenye;WANG Yuting;QIU Xiangxiang;CAI Xinjian;LIN Jiaxin;HAN Bing;WU Zongyong;QI Jun(Department of Clinical Laboratory,National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital,Chinese Academy of Medical Sciences Shenzhen Center,Shenzhen,Guangdong 518116,China;Department of Gynecology,Union Shenzhen Hospital,Huazhong University of Science and Technology,Shenzhen,Guangdong 518000,China)

机构地区：[1]国家癌症中心/国家肿瘤临床医学研究中心/中国医学科学院北京协和医学院肿瘤医院深圳医院检验科,广东深圳518116 [2]深圳市华中科技大学协和深圳医院妇科,广东深圳518000

出　　处：《检验医学与临床》2024年第4期467-470,共4页Laboratory Medicine and Clinic

基　　金：广东省深圳市医疗卫生三名工程项目(SZSM201812062)。

摘　　要：目的探讨血栓标志物[包括凝血酶-抗凝血酶复合物(TAT)、纤溶酶-α2纤溶酶抑制剂复合物(PIC)、血栓调节蛋白(TM)与组织型纤溶酶原激活剂-抑制物复合物(t-PAI.C)]及相关炎症指标[包括白细胞介素-6(IL-6)、降钙素原(PCT)与白细胞计数(WBC)]诊断肿瘤并发脓毒性休克的价值。方法选取2022年1月至2023年6月在国家癌症中心/国家肿瘤临床医学研究中心/中国医学科学院北京协和医学院肿瘤医院深圳医院就诊的74例肿瘤并发脓毒症患者为研究对象,按照脓毒症3.0诊断标准将74例患者分为脓毒症组54例和脓毒性休克组20例。比较两组血栓标志物及炎症指标水平。采用多因素Logistic回归分析肿瘤并发脓毒性休克的危险因素;采用受试者工作特征(ROC)曲线分析各项指标对肿瘤并发脓毒性休克的诊断价值。结果脓毒症组TM、t-PAI.C、PCT水平明显低于脓毒性休克组,差异有统计学意义(P<0.05)。将TM、t-PAI.C与PCT纳入多因素Logistic回归分析,结果显示,仅t-PAIC水平升高为肿瘤并发脓毒性休克的独立危险因素(OR=1.19,95%CI 1.08~1.30,P<0.05),患者t-PAIC水平每增加1 ng/mL,肿瘤并发脓毒性休克的风险增加至1.19倍。TM、t-PAI.C、PCT及3项指标联合检测诊断肿瘤并发脓毒性休克的曲线下面积分别为0.64、0.88、0.77与0.90,其诊断肿瘤并发脓毒性休克的灵敏度分别为70.0%、85.2%、86.6%与88.9%,特异度分别为60.0%、84.0%、56.0%与84.0%。结论TM、t-PAI.C、PCT联合检测诊断脓毒性休克的效能优于单一指标,能更准确地诊断肿瘤患者发生脓毒性休克,从而协助临床进行干预治疗。Objective To investigate thrombus markers[including thrombin-antithrombin complex(TAT),plasmin-α2-plasmin inhibitor complex(PIC),thrombomodulin(TM)and tissue plasminogen activator-inhibitor complex(t-PAI.C)]and indicators of inflammation[including interleukin-6(IL-6),procalcitonin(PCT)and white blood cell count(WBC)]in diagnosing tumor complicated with sepsis shock.Methods A total of 74 cancer patients with sepsis who were admitted to National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital,Chinese Academy of Medical Sciences Shenzhen Center from January 2022 to June 2023 were selected as the research objects.According to the diagnostic criteria of sepsis 3.0,the 74 patients were divided into sepsis group(54 cases)and septic shock group(20 cases).The levels of thrombus markers and inflammatory indicators were compared between the two groups.Multivariate Logistic regression was used to analyze the risk factors of tumor complicated with septic shock.The receiver operating characteristic(ROC)curve was used to analyze the diagnostic value of each index for tumor complicated with septic shock.Results The levels of TM,t-PAI.C and PCT in sepsis group were significantly lower than those in septic shock group(P<0.05).Multivariate Logistic regression analysis showed that only the increase of t-PAI.C level was an independent risk factor for tumor complicated with septic shock(OR=1.19,95%CI 1.08-1.30,P<0.05).When the level of t-PAIC increased by 1 ng/mL,the risk of tumor complicated with septic shock increased to 1.19 times.The sensitivity of TM,t-PAI.C,PCT and their combination in the diagnosis of septic shock in cancer patients were 70.0%,85.2%,86.6% and 88.9%,and the area under curve of these indicators were 0.64,0.88,0.77 and 0.90 respectively,the specificities were 60.0%,84.0%,56.0% and 84.0% respectively.Conclusion The predictive effect of combined detection of TM,t-PAI.C and PCT in the diagnosis of septic shock is better than that of single index,which can more accurately diagnosis for sept

关 键 词：肿瘤 脓毒症 血栓标志物 炎症指标 组织型纤溶酶原激活剂-抑制物复合物 

分 类 号：R446.1[医药卫生—诊断学]