胎盘特异性基因8与血小板活化因子乙酰水解酶联合检测用于早期识别脓毒症与非感染性全身炎症反应综合征的临床价值  

Clinical value of combined detection of placenta associated 8 and platelet activating factor acetylhydrolase for early identification of sepsis and non-infectious systemic inflammatory response syndrome

作　　者：孙钰涵 金嘉琳 林可 刘治德 吴晶 Sun Yuhan;Jin Jialin;Lin Ke;Liu Zhide;Wu Jing(Department of Infectious Diseases,Huashan Hospital,Fudan University,National Medical Center for Infectious Diseases,Shanghai 200040,China)

机构地区：[1]复旦大学附属华山医院感染科,国家传染病医学中心,上海200040

出　　处：《中华传染病杂志》2024年第1期22-27,共6页Chinese Journal of Infectious Diseases

基　　金：国家重点研发计划(2022YFC2009802);上海市2021年度"科技创新行动计划"医学创新研究专项(21Y21920402)。

摘　　要：目的评估胎盘特异性基因8(PLAC8)和血小板活化因子乙酰水解酶(PLA2G7)联合检测在早期识别脓毒症与非感染性全身炎症反应综合征(SIRS)中的临床价值。方法采用横断面研究方法,纳入2022年10月至2023年4月于复旦大学附属华山医院就诊的189例发热疑似感染患者,根据病原学、实验室检查结果和临床诊断分为感染患者和非感染患者,并根据诊断标准进一步筛选出脓毒症患者和非感染性SIRS患者。采用实时荧光聚合酶链反应检测患者外周静脉血PLAC8与PLA2G7的mRNA水平。比较脓毒症组与非感染性SIRS组的血常规,C反应蛋白(CRP)、白细胞介素6(IL-6)、降钙素原等炎症指标,脓毒症相关性器官功能衰竭评价(SOFA)评分,以及PLA2G7与PLAC8的循环阈值(Ct值)的差值[即(PLA2G7-PLAC8)ΔCt值]。统计学比较采用曼-惠特尼U检验,采用受试者操作特征曲线评估(PLA2G7-PLAC8)ΔCt值对脓毒症与非感染性SIRS的鉴别诊断效能。结果189例发热疑似感染患者中,非感染患者80例,其中非感染性SIRS患者51例;感染患者109例,其中脓毒症患者53例。非感染性SIRS组的中性粒细胞比例、CRP、IL-6、降钙素原和SOFA评分均低于脓毒症组,差异均有统计学意义(Z=-2.70、-3.11、-2.16、-3.76、-2.33,均P<0.05)。非感染性SIRS组(PLA2G7-PLAC8)ΔCt值为4.38(1.41),低于脓毒症组的8.18(6.19),差异有统计学意义(U=193.50,P<0.001)。(PLA2G7-PLAC8)ΔCt值鉴别诊断脓毒症与非感染性SIRS的受试者操作特征曲线下面积(AUROC)为0.859,最佳截断值为5.86,灵敏度和特异度分别为82.2%和71.9%,其与降钙素原联合检测的AUROC为0.917,灵敏度和特异度分别为95.6%和70.6%。结论外周血(PLA2G7-PLAC8)ΔCt值对早期识别脓毒症与非感染性SIRS具有较好的临床价值,尤其是与降钙素原联合使用时,可以进一步提高鉴别诊断的准确性。Objective To evaluate the clinical value of combined detection of placenta associated 8(PLAC8)and platelet activating factor acetylhydrolase(PLA2G7)for early identification of sepsis and non-infectious systemic inflammatory response syndrome(SIRS).Methods A cross-sectional study was conducted.A total of 189 febrile patients suspected infection who were admitted to Huashan Hospital,Fudan University from October 2022 to April 2023 were included.Based on etiological,laboratory test results and clinical data,patients were classified as infection or non-infection,and further classified as sepsis or non-infectious SIRS according to diagnostic criteria.Real-time fluorescence polymerase chain reaction was used to detect the mRNA levels of PLAC8 and PLA2G7 in peripheral venous blood of patients.Hematology,inflammatory markers including C-reactive protein(CRP),interleukin-6(IL-6)and procalcitonin,sepsis-related organ failure assessment(SOFA)score,and the difference of cycle threshold(Ct)values between PLA2G7 and PLAC8((PLA2G7-PLAC8)ΔCt value))were compared between the sepsis and non-infectious SIRS groups.Statistical comparison was analyzed using Mann-Whitney U test,and the diagnostic performance of(PLA2G7-PLAC8)ΔCt value in discriminating sepsis from non-infectious SIRS was evaluated using receiver operating characteristic curve.Results Among the 189 febrile patients suspected infection,there were 80 non-infectious patients,including 51 non-infectious SIRS patients,and 109 infection patients,including 53 sepsis patients.The neutrophil ratio,CRP,IL-6,procalcitonin,and SOFA score of non-infectious SIRS patients were lower than those of the sepsis group,and the differences were all statistically significant(Z=-2.70,-3.11,-2.16,-3.76 and-2.33,respectively,all P<0.05).The(PLA2G7-PLAC8)ΔCt value in the non-infectious SIRS group was 4.38(1.41),which was lower than 8.18(6.19)in the sepsis group,with a statistically significant difference(U=193.50,P<0.001).The area under the receiver operating characteristic curve(AUROC)for(PLA

关 键 词：脓毒症 全身炎症反应综合征 分子诊断技术 基因表达 

分 类 号：R459.7[医药卫生—急诊医学]