载脂蛋白A-I联合血清淀粉样蛋白A判断脓毒症及脓毒症休克患者的病情及预后价值  

The value of apolipoprotein A-Ⅰcombined with serum amyloid A in judging the severity and prognosis of patients with sepsis and septic shock

作　　者：谭睿 杨鹏磊 王晶[3] 郑瑞强 缪红军[1] 於江泉 Tan Rui;Yang Penglei;Wang Jing;Zheng Ruiqiang;Miao Hongjun;Yu Jiangquan(Department of Emergency/Critical Medicine,Children's Hospital of Nanjing Medical University,Nanjing 210008,China;Department of Intensive Care Unit,Jiangdu People’s Hospital,Yangzhou 225200,China;Medical College,Yangzhou University,Yangzhou 225001,China;Department of Intensive Care Unit,Northern Jiangsu People’s Hospital,Yangzhou 225001,China)

机构地区：[1]南京医科大学附属儿童医院急诊重症医学科,南京210008 [2]扬州市江都人民医院重症医学科,扬州225200 [3]扬州大学医学院,扬州225001 [4]苏北人民医院重症医学科,扬州225001

出　　处：《中华急诊医学杂志》2024年第5期643-650,共8页Chinese Journal of Emergency Medicine

基　　金：南京市科委(社发)(201723004);扬州市重点医学人才项目(ZDRC2018045);江苏省六个一拔尖人才项目(LGY2019036);江苏省"333工程"(BRA2020183)。

摘　　要：目的通过研究血清淀粉样蛋白A(serum amyloid A protein,SAA)和载脂蛋白A-Ⅰ(apolipoproteinA-Ⅰ,ApoA-Ⅰ)的水平与脓毒症患者病情严重程度及预后的相关性,为脓毒症寻找新的临床预后标志物。方法研究前瞻性纳入2021年9月至2022年2月收入江苏省苏北人民医院重症医学科的患者,需符合Sepsis-3确诊为脓毒症且18岁≤年龄≤80岁。纳入研究后于0 h、24 h、72 h抽取外周静脉血,检测ApoA-Ⅰ和SAA水平,计算72 hΔSAA和72 hΔApoA-Ⅰ。记录患者一般情况、实验室指标、急性生理学与慢性健康状况评分Ⅱ(acute physiology and chronic health evaluationⅡ,APACHEⅡ)、序贯器官衰竭评分等。患者根据生存结局分为存活组和死亡组,根据是否合并休克分为休克组和非休克组。用Logistic回归方法将ApoA-Ⅰ和SAA结合建立联测指标。使用受试者工作特征曲线分析SAA、ApoA-Ⅰ、72 hΔApoA-Ⅰ、72 hΔSAA以及SAA联合ApoA-Ⅰ预测脓毒症患者预后的价值。结果108例患者纳入分析,非休克组48例,休克组60例;存活组77例,死亡组31例。休克组和非休克组、死亡组和存活组间各时间点SAA和ApoA-Ⅰ水平差异有统计学意义(均P<0.05)。各时间点SAA水平与APACHEⅡ评分呈正相关(均P<0.001),ApoA-Ⅰ水平与APACHEⅡ评分呈负相关(均P<0.01)。SAA可以预测脓毒症死亡风险,其中24 h SAA的曲线下面积(area under curve,AUC)最大(AUC=0.713,P=0.001),敏感度为65.3%,特异度为72.7%。ApoA-Ⅰ可以预测脓毒症死亡风险,其中72 h ApoA-Ⅰ的AUC最大(AUC=0.743,P<0.001),敏感度为69.4%,特异度为77.1%。24 h SAA和72 h ApoA-Ⅰ联合检测的AUC绝对值较单一指标增大(AUC=0.758,P<0.05),Z检验提示其对脓毒症患者死亡风险预测较单一指标无显著提升(P>0.05)。结论血清SAA、APOA-Ⅰ水平能反映脓毒症患者病情的严重程度,可作为脓毒症患者判断预后的独立指标。SAA和APOA-Ⅰ联合后的总体诊断效能较单一指标无明显改变。Objective This study aimed to investigate the correlation between the levels of serum amyloid A protein(SAA)and apolipoprotein A-Ⅰ(ApoA-Ⅰ)with the severity and prognosis of septic patients,in order to find new clinical prognostic markers for sepsis patients.Methods This study prospectively included patients admitted to the intensive care unit of Northern Jiangsu People's Hospital from September 2021 to February 2022.Patients were diagnosed with sepsis according to the Sepsis-3 criteria and aged between 18 and 80 years old.Peripheral venous blood samples were collected at 0 h,24 h,and 72 h after inclusion in the study,measured the levels of ApoA-Ⅰand SAA,and the 72 hΔSAA and 72 hΔApoA-Ⅰwere calculated..Patient demographics,laboratory parameters,acute physiology and chronic health evaluationⅡ(APACHEⅡ)scores,sequential organ failure assessment scores,etc.,were recorded.Patients were divided into survival and death groups based on outcomes,and were divided into shock and non-shock groups based on the presence of shock.Logistic regression was used to combine ApoA-I and SAA to establish a new combined index.Receiver Operating Characteristic curve analysis was performed to evaluate the predictive value of SAA,ApoA-Ⅰ,72 hΔApoA-Ⅰ,72 hΔSAA and the combined SAA and ApoA-Ⅰfor the prognosis of sepsis patients.Results A total of 108 patients were included in the analysis,with 48 cases in the non-septic shock group and 60 cases in the septic shock group;77 cases in the survival group and 31 cases in the death group.There were statistically significant differences in SAA and ApoA-Ⅰlevels at each time point between the shock and non-shock groups(all P<0.05),as well as between the death and survival groups(all P<0.05).SAA levels at each time point were positively correlated with APACHEⅡscores(all P<0.001),while ApoA-Ⅰlevels at each time point were negatively correlated with APACHEⅡscores(all P<0.01).SAA levels could predict the risk of death in sepsis patients,with the highest area under curve(AUC)val

关 键 词：脓毒症 脓毒性休克 载脂蛋白A-Ⅰ 血清淀粉样蛋白A 预后 

分 类 号：R459.7[医药卫生—急诊医学]