PI联合CitH3及PCSK9在脓毒性休克患者预后评估中的价值  

The value of peripheral perfusion index combined with serum citrullinated histone H3 and proprotein convertase subtilisin/kexin type 9 in prognostic evaluation of septic shock patients

作　　者：徐丽娜 任思思[1] 李焱[1] 李国峰 XU Li-na;REN Si-si;LI Yan;LI Guo-feng(Department of Emergency,Tianjin Beichen Hospital,Tianjin 300400,China;不详)

机构地区：[1]天津市北辰医院急诊科,天津300400 [2]天津市北辰医院重症医学科,天津300400

出　　处：《广东医学》2025年第2期256-260,共5页Guangdong Medical Journal

基　　金：天津市北辰区科技计划项目(SHGY-2022002)。

摘　　要：目的探究外周灌注指数(peripheral perfusion index,PI)联合血清瓜氨酸组蛋白H3(serum citrullinated histone 3,CitH3)、前蛋白转化酶枯草溶菌素9(proprotein convertase subtilisin/kexin type 9,PCSK9)对脓毒性休克患者预后评估的作用。方法选择于2022年3月至2024年3月天津市北辰医院就诊的脓毒性休克患者120例作为观察对象。根据28 d内死亡情况分为死亡组(n=43)和生存组(n=77)。Pearson法分析PI与血清CitH3、PCSK9的相关性。脓毒性休克患者预后的影响因素采用多因素logistic回归分析。绘制受试者工作特征(ROC)曲线分析脓毒性休克患者死亡的预测价值。结果死亡组和生存组序贯器官衰竭量表(SOFA)评分[(7.86±1.78)分vs.(5.91±1.39)分]、急性生理与慢性健康评分(APACHE-Ⅱ)评分[(21.83±3.52)分vs.(19.13±2.81)分]、血清肿瘤坏死因子-α(TNF-α)水平[(159.87±23.63)μg/L vs.(124.56±19.85)μg/L]比较差异有统计学意义(P<0.05)。与生存组比较,死亡组血清CitH3、PCSK9[(64.37±21.75)pg/mL vs.(36.28±10.09)pg/mL,(489.25±93.17)ng/mL vs.(338.19±78.43)ng/mL]水平较高,PI较低[0.98±0.29 vs.1.54±0.31](P<0.05)。PI与血清CitH3、PCSK9呈负相关(r=-0.499、-0.516,P<0.001),血清CitH3与PCSK9呈正相关(r=0.504,P<0.001)。多因素logistic回归分析得知,PI为影响脓毒症休克患者死亡的保护因素,CitH3、PCSK9、TNF-α为危险因素(P<0.05)。PI预测脓毒性休克患者死亡的AUC为0.831,血清CitH3预测脓毒性休克患者死亡的AUC为0.830,血清PCSK9预测脓毒性休克患者死亡的AUC为0.854,三者联合预测脓毒性休克患者死亡的AUC为0.957,三者联合优于各自单独预测(P<0.05)。结论PI降低,血清CitH3,PCSK9水平升高与脓毒性休克患者预后相关,三者联合对脓毒性休克患者预后具有较高的预测价值。Objective To explore the prognostic value of combining the peripheral perfusion index(PI),serum citrullinated histone H3(CitH3),and proprotein convertase subtilisin/kexin type 9(PCSK9)in septic shock patients.Methods A total of 120 septic shock patients from Tianjin Beichen Hospital,diagnosed between March 2022 and March 2024,were included.Patients were divided into two groups based on 28-day mortality:the death group(n=43)and the survival group(n=77).The Pearson correlation coefficient was used to analyze the relationship between PI and serum CitH3,PCSK9 levels.Factors influencing prognosis were assessed using multivariate logistic regression analysis.Receiver operating characteristic(ROC)curves were constructed to evaluate the predictive value of PI,CitH3,and PCSK9 for mortality.Results The death group and survival group showed statistically significant differences in the Sequential Organ Failure Assessment(SOFA)score(7.86±1.78 vs.5.91±1.39),Acute Physiology and Chronic Health EvaluationⅡ(APACHEⅡ)score(21.83±3.52 vs.19.13±2.81),and serum tumor necrosis factor-α(TNF-α)levels[(159.87±23.63)μg/L vs.(124.56±19.85)μg/L](P<0.05).Compared to the survival group,the death group had higher serum levels of CitH3[(64.37±21.75)pg/mL vs.(36.28±10.09)pg/mL]and PCSK9[(489.25±93.17)ng/mL vs.(338.19±78.43)ng/mL],and a lower PI(0.98±0.29 vs.1.54±0.31)(P<0.05).A negative correlation was found between PI and both CitH3(r=-0.499)and PCSK9(r=-0.516)(P<0.001).Additionally,CitH3 and PCSK9 were positively correlated(r=0.504,P<0.001).Multivariate logistic regression analysis revealed that PI was a protective factor for septic shock mortality,while CitH3,PCSK9,and TNF-αwere risk factors(P<0.05).The area under the curve(AUC)for PI,CitH3,and PCSK9 in predicting mortality were 0.831,0.830,and 0.854,respectively.The combined AUC of all three markers was 0.957,which was higher than any individual marker(P<0.05).Conclusion A lower PI and higher serum levels of CitH3 and PCSK9 are associated with poor prognosis in septic sho

关 键 词：外周灌注指数 瓜氨酸组蛋白H3 前蛋白转化酶枯草溶菌素9 脓毒性休克 预后 

分 类 号：R459.7[医药卫生—急诊医学] R631.4[医药卫生—治疗学]