血栓调节蛋白对脓毒症休克患者预后预测价值的临床研究  

Prognostic value of thrombomodulin in patients with septic shock

作　　者：曾庆波 张念清[1] 何龙平 龚海林 王芳[2] 宋景春[2] ZENG Qingbo;ZHANG Nianqing;HE Longping;GONG Hailin;WANG Fang;SONG Jingchun(Intensive Care Unit 2,Nanchang Hongdu Hospital of Traditional Chinese Medicine,Nanchang 330000,Jiangxi;Intensive Care Unit,the 908th Hospital of Chinese PLA Logistic Support Force,Nanchang 330002,Jiangxi,China)

机构地区：[1]南昌市洪都中医院急重症二科,南昌330000 [2]中国人民解放军联勤保障部队第九○八医院重症医学科,南昌330002

出　　处：《临床检验杂志》2024年第6期436-440,共5页Chinese Journal of Clinical Laboratory Science

摘　　要：目的探讨血浆血栓调节蛋白(TM)对脓毒症休克患者预后的预测价值。方法回顾性分析2018年5月至2022年11月第九O八医院重症医学科收治的180例脓毒症休克患者的临床资料。根据30d随访结局将患者分为生存组(106例)和死亡组(74例)。采用倾向性评分匹配(PSM)方法,基于年龄、性别、基础疾病、原发感染灶、实验室检查结果和疾病严重程度评分等混杂因素,将患者进行1:1匹配后生存组与死亡组均为57例。比较两组患者的TM等凝血分子标志物水平,并进行Logistic回归、受试者工作特征(ROC)曲线、生存和相关性分析。结果PSM后,死亡组TM水平[18.3(13.2,22.3)TU/mL]显著高于生存组[13.7(9.0,18.3)TU/mL](P<0.05)。多因素Logistic回归分析显示,TM是脓毒症休克患者30d死亡的独立危险因素(OR=1.137,95%CI:1.023~1.262,P<0.005)。ROC曲线分析显示,TM、急性生理与慢性健康评分(APACHEI)和序贯器官衰竭评估(SOFA)评分预测30d死亡的ROC曲线下面积(AUCROC)分别为0.665、0.627和0.600。根据TM最佳临界值(17.9TU/mL)分层的Kaplan-Meier生存分析显示,TM<17.9TU/mL组的30d生存率是TM≥17.9TU/mL组的1.56倍(Log-Rank检验,P<0.0001)。Spearman相关分析显示,TM水平与APACHEIⅡ评分(r=0.10,P<0.005)和SOFA评分(r=0.35,P<0.005)均呈正相关。结论血浆TM水平对评估脓毒症休克患者预后具有较好的预测价值,可作为判断脓毒症休克预后的潜在生物标志物。Objective To investigate the prognostic value of plasma thrombomodulin(TM)in patients with septic shock.Methods A retrospective analysis was conducted on the clinical data of 180 patients with septic shock admitted to the intensive care unit of the 908th Hospital from May 2018 to November 2022.The patients were divided into survival group(106 cases)and death group(74 ca-ses)based on the 30-day follow-up outcomes.Propensity score matching(PSM)was used to match 57 surviving patients with 57 de-ceased patients in a 1:1 ratio,based on confounding factors such as age,gender,underlying diseases,primary infection site,laborato-ry results and disease severity scores.TM and other coagulation molecular markers were compared between the two groups,and logistic regression,receiver operating characteristic(ROC)curve,survival and correlation analyses were performed.Results After PSM,the TM levels in the death group(18.3[13.2,22.3]TU/mL)were significantly higher than those in the survival group(13.7[9.0,18.3]TU/mL)(P<0.05).Multivariate logistic regression analysis showed that TM was an independent risk factor for 30-day mortality in the patients with septic shock(OR=1.137,95%CI:1.023-1.262,P<0.005).R0C curve analysis revealed that the areas under the curve(AUCs)for predicting 30-day mortality were 0.665,0.627 and 0.600 for TM,Acute Physiology and Chronic Health Evaluation II(APACHE II)and Sequential Organ Failure Assessment(SOFA)scores,respectively.Kaplan-Meier survival analysis stratified by the optimal TM cut-off value(17.9 TU/mL)showed that the 30-day survival rate of the TM<17.9 TU/mL group was 1.56 times that of the TM≥17.9 TU/mL group(Log-Rank test,P<0.0001).Spearman correlation analysis demonstrated that TM levels were positively correlated with APACHE I(r=0.10,P<0.005)and SOFA scores(r=0.35,P<0.005).Conclusion Plasma TM has showed a good predictive value for assessing the prognosis of patients with septic shock and may serve as a potential biomarker for determining the prognosis of septic shock.

关 键 词：血栓调节蛋白 脓毒症休克 预后 倾向性评分 

分 类 号：R446[医药卫生—诊断学]