尿8-氧化鸟嘌呤核苷对衰弱老年脓毒症患者短期预后的评估价值  

Evaluation value of urinary 8-oxo-7,8-dihydroguanosine in the short-term prognosis of sepsis in frail elderly patients

作　　者：常杰[1] 温伟[2] 全锦花[2] 黄大海[1] 付春毅[2] 王凡[2] 蔡剑平[3] 马亚情 党亚敏 陈超杰 Chang Jie;Wen Wei;Quan Jinhua;Huang Dahai;Fu Chunyi;Wang Fan;Cai Jianping;Ma Yaqing;Dang Yamin;Chen Chaojie(Health and Medical Department,Beijing Hospital,National Center of Gerontology,Institute of Geriatric Medicine,Chinese Academy of Medical Sciences,Beijing 100730,China;Emergency Department,Beijing Hospital,National Center of Gerontology,Institute of Geriatric Medicine,Chinese Academy of Medical Sciences,Beijing 100730,China;Beijing Hospital,National Center of Gerontology,Beijing Institute of Geriatrics,National Health Commission,Beijing Key Laboratory of Geriatric Medicine,National Health Commission,Beijing 100730,China)

机构地区：[1]北京医院保健医疗部、国家老年医学中心、中国医学科学院老年医学研究院,北京100730 [2]北京医院急诊科、国家老年医学中心、中国医学科学院老年医学研究院,北京100730 [3]北京医院、国家老年医学中心、国家卫生健康委北京老年医学研究所、国家卫生健康委北京老年医学重点实验室,北京100730

出　　处：《中华老年医学杂志》2025年第2期162-166,共5页Chinese Journal of Geriatrics

基　　金：睿E(睿意)急诊医学研究专项基金(R2020004)。

摘　　要：目的探讨尿8-氧化鸟嘌呤核苷(8-oxo-7,8-dihydroguanosine,8-oxoGuo)对衰弱老年脓毒症患者短期预后的评估价值。方法采用横断面研究,纳入2021年3月至2022年3月收治于北京医院急诊重症监护室(emergency intensive care unit,EICU)的62例衰弱老年脓毒症患者,根据28 d预后分为死亡组和存活组,收集两组患者入院时的尿液标本及临床资料,采用同位素稀释高效液相-串联质谱法检测尿液中RNA氧化标志物8-oxoGuo水平。结果共纳入62例衰弱老年脓毒症患者,年龄(85.1±6.3)岁,其中28 d死亡组36例、存活组26例。单因素分析结果显示,存活组体温、血降钙素原、序贯器官功能衰竭评估(sequential organ failure assessment,SOFA)、尿8-oxoGuo水平均低于死亡组,平均动脉压高于死亡组,差异具有统计学意义(均P<0.05)。Spearman相关性分析结果显示,尿8-oxoGuo与衰弱老年脓毒症患者血降钙素原和SOFA均呈正相关(r=0.426、0.768,均P<0.05)。多因素logistic回归分析结果显示,尿8-oxoGuo、SOFA是衰弱老年脓毒症患者28 d死亡的独立危险因素(OR=1.936、1.427,P=0.006、0.002)。尿8-oxoGuo、SOFA预测衰弱老年脓毒症患者28 d预后的受试者工作特征曲线下面积分别为0.761、0.741,具有统计学意义(均P<0.001)。结论尿8-oxoGuo对衰弱老年脓毒症患者短期预后具有良好的预测价值。Objective To investigate the significance of urinary 8-oxo-7,8-dihydroguanosine(8-oxoGuo)in assessing the short-term prognosis of sepsis in frail elderly patients.Methods We conducted a cross-sectional study involving 62 frail elderly patients diagnosed with sepsis who were admitted to the Emergency Intensive Care Unit(EICU)at Beijing Hospital between March 2021 and March 2022.Based on their 28-day prognosis,the patients were categorized into two groups:those who died and those who survived.Upon admission,we collected urine samples and clinical data from both groups.We employed isotope dilution high-performance liquid chromatography-mass spectrometry to measure the levels of the RNA oxidation marker 8-oxoGuo in the urine.Results A total of 62 frail elderly patients[aged(85.1±6.3)years]diagnosed with sepsis were included in the study,comprising 36 patients in the 28-day mortality group and 26 patients in the survival group.Univariate analysis revealed that the survival group had significantly lower body temperature,blood calcitonin(PCT)levels,sequential organ failure assessment(SOFA)scores,and urinary 8-oxoGuo levels compared to the mortality group.Additionally,the survival group exhibited a higher mean arterial pressure(MAP)than the mortality group,with all differences reaching statistical significance(all P<0.05).Spearman correlation analysis indicated that urinary 8-oxoGuo levels were positively correlated with both PCT and SOFA scores in frail elderly sepsis patients(r=0.426,0.768,both P<0.05).Furthermore,logistic regression analysis identified urinary 8-oxoGuo and SOFA as independent risk factors for 28-day mortality in this population(OR=1.936,1.427;P=0.006,0.002).The area under the receiver operating characteristic curve(AUC)for urinary 8-oxoGuo and SOFA in predicting the 28-day prognosis of frail elderly sepsis patients was 0.761 and 0.741,respectively,both demonstrating statistical significance(both P<0.001).Conclusions Our findings suggest that urinary 8-oxoGuo possesses strong predictive value for the

关 键 词：脓毒症 鸟嘌呤核苷酸类 衰弱 

分 类 号：R459.7[医药卫生—急诊医学]