血清MAPK、SDC1水平与脓毒症并发急性呼吸窘迫综合征患者炎症因子及入院30 d内死亡的关系  

The relationship between serum MAPK and SDC1 levels with inflammatory markers and 30 d mortality in patients with sepsis complicated with acute respiratory distress syndrome

作　　者：史克洁 钱雪锋 张衎 刘军[1] SHI Kejie;QIAN Xuefeng;ZHANG Kan;LIU Jun(Department of Intensive Care Medicine,the Affiliated Suzhou Hospital of Nanjing Medical University/Suzhou Municipal Hospital,Suzhou,Jiangsu 215005,China)

机构地区：[1]南京医科大学附属苏州医院/苏州市立医院重症医学科,江苏苏州215005

出　　处：《检验医学与临床》2025年第4期433-438,共6页Laboratory Medicine and Clinic

基　　金：国家自然科学基金项目(82200031);中华国际医学交流会基金项目(20200928)。

摘　　要：目的探讨血清丝裂原活化蛋白激酶(MAPK)、多配体蛋白聚糖1(SDC1)水平与脓毒症并发急性呼吸窘迫综合征(ARDS)患者炎症因子及入院30 d内死亡的关系。方法选取2021年5月至2024年5月于该院治疗的单纯脓毒症患者135例(非ARDS组)、脓毒症并发ARDS患者121例(ARDS组)及体检健康的志愿者128例(对照组)为研究对象。根据ARDS组患者入院30 d内生存情况分为死亡组、存活组。采用酶联免疫吸附试验检测各组血清MAPK、SDC1、炎症因子[白细胞介素-6(IL-6)、C反应蛋白(CRP)和降钙素原(PCT)]水平;采用Pearson相关分析MAPK、SDC1水平与上述炎症因子的相关性;采用多因素Logistic回归分析脓毒症并发ARDS患者入院30 d内死亡的影响因素;采用受试者工作特征(ROC)曲线分析血清MAPK、SDC1对脓毒症并发ARDS患者入院30 d内死亡的预测价值。结果相比于对照组,非ARDS组、ARDS组血清MAPK、SDC1、IL-6、CRP、PCT水平升高(P<0.05),相比于非ARDS组,ARDS组血清MAPK、SDC1、IL-6、CRP、PCT水平升高(P<0.05)。Pearson相关分析结果显示,ARDS组患者血清MAPK水平与IL-6、CRP、PCT水平均呈正相关(r=0.710、0.660、0.701,P<0.05),SDC1水平与IL-6、CRP、PCT水平亦均呈正相关(r=0.783、0.689、0.663,P<0.05)。与存活组相比,死亡组血清MAPK、SDC1、IL-6、CRP、PCT水平均升高(P<0.05)。多因素Logistic回归分析结果显示,MAPK、SDC1、IL-6、CRP、PCT为脓毒症并发ARDS患者入院30 d内死亡的影响因素(P<0.05)。ROC曲线分析结果表明,血清MAPK、SDC1预测脓毒症并发ARDS患者入院30 d内死亡的曲线下面积(AUC)分别为0.787、0.829,二者联合预测的AUC为0.883,优于MAPK、SDC1单独预测的AUC(Z=2.120、2.242,P<0.05)。结论脓毒症并发ARDS患者血清MAPK、SDC1水平升高,且与炎症因子水平密切相关,二者联合可有效预测脓毒症并发ARDS患者的预后。Objective To investigate the relationship between serum levels of mitogen-activated protein kinase(MAPK)and syndecan-1(SDC1)with inflammatory markers and 30 d mortality in patients with sepsis complicated by acute respiratory distress syndrome(ARDS).Methods A total of 135 patients with sepsis alone(non-ARDS group),121 patients with sepsis complicated by ARDS(ARDS group),and 128 healthy volunteers(control group)treated at the hospital from May 2021 to May 2024 were selected.Patients in the ARDS group were further divided into the death group and the survival group based on their 30 d survival status after admission.Enzyme-linked immunosorbent assay(ELISA)was used to detect serum levels of MAPK,SDC1 and inflammatory markers[interleukin-6(IL-6),C-reactive protein(CRP)and procalcitonin(PCT)]in each group.Pearson correlation analysis was performed to evaluate the correlation between MAPK,SDC1 and the aforementioned inflammatory markers.Multivariate Logistic regression was used to analyze the factors influencing 30 d mortality in patients with sepsis complicated by ARDS.Receiver operating characteristic(ROC)curve analysis was conducted to assess the predictive value of serum MAPK and SDC1 for 30 d mortality in patients with sepsis complicated by ARDS.Results Compared with the control group,serum levels of MAPK,SDC1,IL-6,CRP and PCT were elevated in both the non-ARDS group and the ARDS group(P<0.05).Compared with the non-ARDS group,serum levels of MAPK,SDC1,IL-6,CRP and PCT were elevated in the ARDS group(P<0.05).Pearson correlation analysis showed that serum MAPK level was positively correlated with IL-6,CRP and PCT levels in the ARDS group(r=0.710,0.660,0.701,P<0.05),and SDC1 was also positively correlated with IL-6,CRP and PCT levels(r=0.783,0.689,0.663,P<0.05).The serum levels of MAPK,SDC1,IL-6,CRP and PCT were higher in the death group than those in the survival group(P<0.05).Multivariate Logistic regression analysis showed that MAPK,SDC1,IL-6,CRP and PCT were factors influencing 30 d mortality in patients with sep

关 键 词：脓毒症 急性呼吸窘迫综合征 丝裂原活化蛋白激酶 多配体蛋白聚糖1 预后 

分 类 号：R446.11[医药卫生—诊断学] R563.8[医药卫生—临床医学]