血浆PAP、TM、t-PAIC表达预测脓毒症102例预后效能  

The efficacy of plasma fibrinolytic enzymeα2-antiplasmin complex,thrombomodulin,and tissue plasminogen activator-inhibitor 1 complex in predicting the prognosis of 102 cases of sepsis

作　　者：刘妮 姜慧英[1] 王鹏飞[1] 刘连义[1] LIU Ni;JIANG Huiying;WANG Pengfei;LIU Lianyi(Department of Clinical Laboratory,Beijing Jingmei Group General Hospital,Beijing 102300,China)

机构地区：[1]北京京煤集团总医院检验科,北京102300

出　　处：《安徽医药》2025年第3期565-569,I0005,共6页Anhui Medical and Pharmaceutical Journal

基　　金：北京京煤集团总医院院级科研自主项目(ZZ2024-05)。

摘　　要：目的探讨纤溶酶α2抗纤溶酶复合物(PAP)、凝血酶调节蛋白(TM)、组织纤溶酶原激活剂-抑制剂1复合物(t-PAIC)表达对脓毒症预后的预测价值。方法选取北京京煤集团总医院2020年6月至2022年12月收治的102例脓毒症病人,根据28 d生存预后分为死亡组(n=28)、存活组(n=74),比较两组一般资料及入院第1天、第3天、第7天血浆PAP、TM、t-PAIC表达、血清降钙素原(PCT)、白细胞介素(IL)-6,采用logistic回归方程筛选脓毒症预后的影响因素,采用危险度分析不同血浆PAP、TM、t-PAIC表达对脓毒症预后的影响,采用受试者操作特征曲线(ROC曲线)、决策曲线进行效能分析。结果两组急性生理学和慢性健康状况评价Ⅱ(APACHEⅡ)评分、序贯器官衰竭评估(SOFA)评分、弥散性血管内凝血比较,差异有统计学意义(P<0.05);死亡组入院第1天、第3天、第7天血浆PAP[(7.02±2.11)mg/L、(6.11±1.83)mg/L、(4.89±1.45)mg/L]、TM[(26.63±7.98)TU/mL、(23.38±7.01)TU/mL、(21.15±6.34)TU/mL]、t-PAIC[(24.42±7.30)μg/L、(20.22±6.06)μg/L、(17.96±5.38)μg/L]及血清PCT、IL-6表达高于存活组[(4.88±1.46)μg/L、(4.30±1.28)μg/L、(3.41±1.03)μg/L,(18.22±5.47)TU/mL、(16.37±4.91)TU/mL、(14.70±4.43)TU/mL,(17.02±5.11)μg/L、(13.98±4.20)μg/L、(12.55±3.77)μg/L](P<0.05);logistic回归显示,APACHEⅡ评分、SOFA评分及入院第1天血浆PAP、TM、t-PAIC、PCT、IL-6是脓毒症预后的高危因素(P<0.05);危险度分析显示,入院第1天血浆PAP、TM、t-PAIC高表达病人死亡风险是低表达的1.987、2.404、3.133倍(P<0.05);ROC曲线、决策曲线显示,入院第1天血浆PAP、TM、t-PAIC表达联合预测脓毒症预后的曲线下面积、净收益率优于单独预测。结论血浆PAP、TM、t-PAIC高表达是脓毒症预后不良的高危因素,且以上指标联合预测脓毒症预后具有较好价值参考和临床效用。Objective To explore the predictive value of plasminogenα2 anti-plasminase complex(PAP),thrombomodulin(TM)and tissue plasminogen activator-inhibitor 1 complex(t-PAIC)in the prognosis of sepsis.Methods A total of 102 patients with sepsis admitted to the Beijing Jingmei Group General Hospital from June 2020 to December 2022 were selected and assigned into a death group(n=28)and a survival group(n=74)according to their 28-day survival prognosis.The general data and the expression levels of plasma PAP,TM,t-PAIC,serum procalcitonin(PCT),interleukin(IL)-6 on the first,third,and seventh days of admission were compared between the two groups.The logistic regression equation was used to screen the factors affecting the prognosis of sepsis.The risk analysis was used to analyze the impact of different plasma PAP,TM,t-PAIC expressions on the prognosis of sepsis.The receiver operating characteristic(ROC)curve and decision curve were used for efficacy analysis.Results There were significant differences in the acute physiology and chronic health evaluation Ⅱ(APACHEⅡ)score,the sequential organ failure assessment(SOFA)score,and disseminated intravascular coagulation between the two groups(P<0.05).On the first,third,and seventh days of admission,the death group had higher plasma PAP[(7.02±2.11)mg/L,(6.11±1.83)mg/L,(4.89±1.45)mg/L],TM[(26.63±7.98)TU/mL,(23.38±7.01)TU/mL,(21.15±6.34)TU/mL],t-PAIC[(24.42±7.30)μg/L,(20.22±6.06)μg/L,(17.96±5.38)μg/L],and serum PCT and IL-6 expression levels than the survival group[(4.88±1.46)μg/L,(4.30±1.28)μg/L,(3.41±1.03)μg/L,(18.22±5.47)TU/mL,(16.37±4.91)TU/mL,(14.70±4.43)TU/mL,(17.02±5.11)μg/L,(13.98±4.20)μg/L,and(12.55±3.77)μg/L,respectively](P<0.05).Logistic regression analysis results showed that APACHEⅡscore,SOFA score,and plasma PAP,TM,t-PAIC,PCT,and IL-6 on the first day of admission were high-risk factors for sepsis prognosis(P<0.05).The risk analysis results showed that the mortality risks of patients with high expression levels of plasma PAP,TM,and t-PAIC

关 键 词：脓毒症 决策曲线 纤溶酶α2抗纤溶酶复合物 凝血酶调节蛋白 组织纤溶酶原激活剂-抑制剂1复合物 预后 预测 

分 类 号：R73[医药卫生—肿瘤]