摘要
目的通过测定血清可溶性ST2(soluble ST2,sST2)浓度,探讨其对脓毒症患者预后的判断价值。方法收集北京医院急诊科脓毒症患者63例,并选择30例健康体健人员作为对照组,采用ELISA法分别测定其血清sST2浓度,根据是否伴有休克分为普通脓毒症组(44例)及脓毒性休克组(19例),根据脓毒症确诊28d后结局分为死亡组(18例)与存活组(45例),记录入组时患者每分钟呼吸频率、氧合指数、白细胞计数、降钙素原(PCT)、C反应蛋白(CRP)、血肌酐、血清总胆红素等资料。统计处理采用SPSS23.0软件。计量资料采取成组t检验,计数资料采取矿检验,对生存状况进行Logistic二元回归分析及ROC曲线分析。结果脓毒症组患者血清sST2水平(1382.12±384.07)pg/mL明显高于对照组(569.28±163.46)pg/mL(P〈0.05),脓毒性休克组sST2水平(1675.49±457.59)pg/mL较普通脓毒症组(1255.44±265.70)pg/mL高(P〈0.05);脓毒性休克组28d病死率(63.16%)明显高于普通脓毒症组(13.64%)(P〈0.05)。28d结局死亡组病例的PCT(16.37±16.36)ng/mL及血清sST2(1794.47±335.18)pg/mL均比之存活组升高(P〈0.05oROC曲线分析示sST2的AUC(0.917)大于PCT(0.884),敏感度(88.9%)高于PCT(72.2%),特异度(82.2%)低于PCT(93.3%),二者联合其AUC为0.944。结论血清sST2对脓毒症有一定的辅助诊断价值,并且可用来判断脓毒症患者预后。PCT和血清sST2对评估患者不良结局有一定的意义,与PCT相比,sST2对脓毒症预后的判定敏感度更高,特异度不足,二者联合判断可能更有意义。
Objective To study the predictive value of serum soluble ST2 (sST2) in patients with sepsis. Methods A total of 63 patientswith sepsis and 30 healthy subjects as a control group in the emergency Department, Beijing Hospital, National Center of Gerontology, were enrolled in the study. Serum sST2 concentrations were measured by ELISA method. Patients were divided into sepsis group (n=44) and septic shock group (n=19). According to 28-day mortality after the diagnosis of sepsis, patients were divided into death group (n=18) and survival group (n=45). Respiratory rate, oxygenation index, white blood cell count, procalcitonin (PCT), C reactive protein (CRP), serum creatinine (CRE), total bilirubin (TBIL) of patients and control subjects were measured. SPSS 23.0 software was used for the statistical analyses. The measurement data was analyzed by t test and the enumeration data was analyzed by Chi square test. The survival status was analyzed by Logistic binary regression analysis and ROC curve analysis. Results The serum sST2 level (1 382.12±384.07) pg/mL in sepsis group was significantly higher than that in control group (569.28±163.46) pg/mL (P〈0.05). in septic shock group, 28-day mortality rate (63.16%) and serum sST2 level (1 675.49±457.59) pg/mL was higher than those in sepsis group (13.64%) (1255.44 ± 265.70) pg/ml (P〈0.05). The PCT (16.37±16.36) ng/mL and serum sST2 level (1 794.47±335.18)pg/mL in death group were higher than those in survival group (P〈0.05). The ROC curve showed that the AUC of sST2 was larger than that of PCT (0.917 vs. 0.884), the sensitivity was higher than that of PCT (88.9% vs. 72.2%), and the specificity was lower than that of PCT (82.2% vs. 93.3%). The combination AUC of sST2 and PCT was 0.944. Conclusions Serum sST2 has a certain value in the diagnosis of sepsis, and can be used to predict the prognosis of patients with sepsis. The higher the sST2 value, the worse the prognosis. Compared with PCT, sST2 is more sensitive in the prognosis of sepsis, but the specificity is not high enouph. The measurement of sST2 level coupled with PCT level may be more useful.
作者
孔夏
张新超
Kong Xia;Zhang Xinchao(Emergency Department, Belting Hospital, National Center of Gerontology, Beifing, 100730, China (Kong X, Zhang XC)
出处
《中华急诊医学杂志》
CAS
CSCD
北大核心
2018年第4期394-398,共5页
Chinese Journal of Emergency Medicine
基金
卫生部卫生行业科研专项基金(201002011)