摘要
目的探讨血清肽酰基精氨酸脱亚氨酶2(PAD2)、降钙素原(PCT)及C反应蛋白(CRP)对脓毒症的诊断价值。方法选择2022年1-12月武汉大学人民医院重症监护室收治的111例脓毒症患者(脓毒症组),50例非脓毒症患者(非脓毒症组),及同期48名健康体检者(对照组)。酶联免疫吸附试验检测血清PAD2水平,自动化学发光免疫分析仪检测血清PCT水平,全自动蛋白分析仪检测CRP水平。比较3组PAD2、PCT、CRP水平差异,采用多因素logistic回归分析影响脓毒症的危险因素;Spearman相关性检验分析PAD2与PCT、CRP的相关性;受试者工作特征(ROC)曲线分析PAD2、PCT和CRP对脓毒症的诊断价值;Kappa一致性检验分析诊断准确性。结果脓毒症组血清PAD2、PCT及CRP水平[35.49(23.91,53.41)ng/mL、10.60(3.20,16.90)ng/mL、108.29(40.25,168.72)mg/L]高于非脓毒症组[22.52(12.89,33.64)ng/mL、2.85(1.58,4.46)ng/mL、33.99(15.38,58.09)mg/L]和对照组[9.83(7.33,15.22)ng/mL、0.04(0.04,0.06)ng/mL、3.00(3.00,3.00)mg/L],差异均有统计学意义(P均<0.05);且非脓毒症组PAD2、PCT及CRP水平高于对照组,差异均有统计学意义(P均<0.05)。PAD2、PCT、CRP水平升高是脓毒症发生的独立危险因素(P均<0.01)。血清PAD2水平与PCT、CRP成正相关(r=0.384、0.319,P均<0.001)。血清PAD2、PCT、CRP联合检测诊断脓毒症的曲线下面积(AUC)为0.955,均高于PAD2、PCT、CRP单独检测的0.845、0.882、0.870,差异均有统计学意义(Z=5.028、3.998、4.204,P均<0.001);且血清PAD2、PCT、CRP联合检测的kappa为0.779,均高于PAD2、PCT、CRP单独检测的0.521、0.611、0.576。结论脓毒症患者血清PAD2、PCT、CRP水平升高,是脓毒症发生的危险因素,三者联合诊断价值最高。
Objective To investigate the diagnostic value of serum peptidylarginine deiminase 2(PAD2),procalcitonin(PCT)and C⁃reactive protein(CRP)in sepsis.Methods A total of 111 sepsis patients(sepsis group)and 50 non⁃sepsis patients(non⁃sepsis group)admitted to the Intensive Care Unit of Renmin Hospital of Wuhan University from January to December 2022 were selected,and 48 healthy subjects(control group)were selected during the same period.Serum PAD2 levels were measured by ELISA,PCT levels were measured by automatic chemiluminescence immunoassay,and CRP levels were measured by automatic protein analyzer.The levels of PAD2,PCT and CRP were compared among the three groups;multivariate logistic regression analysis was used to identify the risk factors affecting sepsis;Spearman correlation test was used to analyze the correlation between PAD2 and PCT,CRP.Receiver operating characteristic(ROC)curve was used to analyze the diagnostic value of PAD2,PCT and CRP for diagosis of sepsis;kappa consistency test was used to analyze the diagnostic accuracy.Results The levels of serum PAD2,PCT and CRP in the sepsis group[35.49(23.91,53.41)ng/mL,10.60(3.20,16.90)ng/mL,108.29(40.25,168.72)mg/L]were significantly higher than those in the non⁃sepsis group[22.52(12.89,33.64)ng/mL,2.85(1.58,4.46)ng/mL,33.99(15.38,58.09)mg/L]and the control group[9.83(7.33,15.22)ng/mL,0.04(0.04,0.06)ng/mL,3.00(3.00,3.00)mg/L](all P<0.05);and those in the non⁃sepsis group were higher than those in the control group(all P<0.05).Serum PAD2 level was positively correlated with PCT and CRP(r=0.384,0.319;both P<0.05).Increased levels of PAD2,PCT and CRP were independent risk factors for sepsis(all P<0.01).The area under the curve(AUC)of serum PAD2 combined with PCT and CRP for the diagnosis of sepsis was 0.955,which was higher than that of PAD2,PCT and CRP alone(0.845,0.882,0.870),respectively(Z=5.028,3.998,4.204,all P<0.001);The Kappa of serum PAD2 combined with PCT and CRP was 0.779,which was higher than that of PAD2,PCT and CRP alone(0.521,0.611,0.576).Conclusions The levels of serum PAD2,PCT and CRP in patients with sepsis were increased,which were risk factors for sepsis.And the combination of the three had the highest diagnostic value.
作者
王历
彭适
蔡馨
汤冬玲
张平安
WANG Li;PENG Shi;CAI Xin;TANG Dongling;ZHANG Pingan(Department of Clinical Laboratory,Renmin Hospital of Wuhan University,Wuhan,Hubei 430060,China)
出处
《热带医学杂志》
CAS
2024年第9期1230-1234,I0004,共6页
Journal of Tropical Medicine
基金
国家自然科学基金(81773444)
湖北省卫健委面上科研项目(WJ2023M073)。
