血清HBP、neopterin联合USP13预测脓毒症患者临床转归的临床研究  

Clinical Study of Serum HBP,Neopterin Combined with USP13 in Predicting the Clinical Outcome of Patients with Sepsis

作　　者：刘玮 陈传慧 李连芳[1] 徐杰[1] 周倩 李剑[1] LIU Wei;CHEN Chuan-hui;LI Lian-fang;XU Jie;ZHOU Qian;LI Jian(Department of Intensive Care Medicine,Ji'nan Fifth People's Hospital,Ji'nan,Shandong,250022,China)

机构地区：[1]济南市第五人民医院重症医学科,山东济南250022

出　　处：《现代生物医学进展》2024年第18期3565-3569,3584,共6页Progress in Modern Biomedicine

基　　金：济南市科技计划项目(2022-2-82);山东省医药卫生科技发展计划项目(2019WS065)。

摘　　要：目的:研究血清肝素结合蛋白(HBP)、新喋呤(neopterin)联合泛素特异性蛋白酶13(USP13)预测脓毒症患者临床转归的临床价值。方法:选取2021年6月~2023年6月我院收治的157例脓毒症患者,根据是否发生脓毒性休克分组为未休克组(n=93)和休克组(n=64),比较两组血清HBP、neopterin、USP13水平。统计157例脓毒症患者入院28 d死亡情况,比较死亡组和生存组资料及血清HBP、neopterin、USP13水平,采用多因素Logistic回归模型分析脓毒症患者入院28 d死亡的影响因素,采用受试者工作特征(ROC)曲线分析血清HBP、neopterin、USP13对脓毒症患者入院28 d死亡的预测价值。结果:与未休克组相比,休克组血清HBP、neopterin显著升高(P<0.05),血清USP13显著降低(P<0.05)。157例脓毒症患者入院28 d死亡47例,发生率为29.94%。与生存组相比,死亡组急性生理与慢性健康状况评分Ⅱ(APACHE-Ⅱ)、合并糖尿病比例、序贯器官衰竭评估评分(SOFA)、HBP、neopterin显著升高(P<0.05),血清USP13显著降低(P<0.05)。多因素Logistic回归分析显示,APACHEⅡ评分升高、SOFA评分升高、合并糖尿病、HBP升高、neopterin升高及USP13降低是脓毒症患者入院28 d死亡的危险因素(P<0.05)。ROC曲线显示,血清HBP、neopterin、USP13、HBP+neopterin、neopterin+USP13、HBP+USP13、HBP+neopterin+USP13预测脓毒症患者入院28 d死亡的曲线下面积(AUC)(95%CI)分别为0.722(0.627~0.818)、0.768(0.691~0.844)、0.647(0.547~0.747)、0.849(0.779~0.919)、0.845(0.780~0.910)、0.832(0.755~0.910)、0.923(0.876~0.969),HBP+neopterin+USP13联合预测的效能显著优于单项或两项检测(P<0.05)。结论:血清HBP、neopterin高水平、血清USP13低水平与脓毒症患者入院28 d死亡及脓毒性休克有关,血清HBP、neopterin联合USP13检测可有效预测脓毒症患者入院28 d死亡。Objective:To study the clinical value of serum heparin binding protein(HBP),neopterin(neopterin)and ubiquitin specific protease 13(USP13)in predicting the clinical outcome of patients with sepsis.Methods:157 patients with sepsis who were admitted to our hospital from June 2021 to June 2023 were selected,and patients were divided into non-shock group(n=93)and shock group(n=64)according to whether septic shock occurred,the levels of serum HBP,neopterin and USP13 were compared between two groups.The 28 d mortality of 157 patients with sepsis were counted,the data of death group and survival group and the levels of serum HBP,neopterin and USP13 were compared,the influencing factors of 28 d death in patients with sepsis upon admission were analyzed by multivariate Logistic regression model,the predictive value of serum HBP,neopterin and USP13 of 28 d death in patients with sepsis upon admission were analyzed by receiver operating characteristic(ROC)curve.Results:Compared with non-shock group,the serum HBP and neopterin in shock group were significantly increased(P<0.05),and the serum USP13 was significantly decreased(P<0.05).157 patients with sepsis admitted for 28 d and 47 deaths,with an incidence of 29.94%.Compared with survival group,the acute physiology and chronic health status score II(APACHE-II),the proportion of complicated with diabetes mellitus,sequential organ failure assessment score(SOFA),HBP and neopterin in death group were significantly increased(P<0.05),and serum USP13 was significantly decreased(P<0.05).Multivariate Logistic regression analysis showed that,elevated APACHE II score,elevated SOFA score,complicated with diabetes mellitus,elevated HBP,elevated neopterin and decreased USP13 were risk factors for 28 d death in patients with sepsis upon admission(P<0.05).ROC curve showed that,the area under the curve(AUC)(95%CI)of serum HBP,neopterin,USP13,HBP+neopterin,neopterin+USP13,HBP+USP13,HBP+neopterin+USP13 for predicting 28 d death in patients with sepsis upon admission were 0.722(0.627~0.818),0.76

关 键 词：HBP NEOPTERIN USP13 脓毒症 脓毒性休克 预测价值 

分 类 号：R631.2[医药卫生—外科学] R605.971[医药卫生—临床医学]