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动态联合监测血清淀粉样蛋白A、血清可溶性髓系细胞触发受体-1、D-二聚体对Sepsis患者预后的评估价值:前瞻性巢式病例对照研究
doi: 10.3969/j.issn.1674-9081.20190051
Value of Dynamic Combined Monitoring of Serum Amyloid A Protein, Soluble Triggering Receptor Expressed on Myeloid Cell-1, and D-Dimer in Evaluating the Prognosis of Patients with Sepsis:A Prospective Nested Case-control Study
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摘要:
目的 探讨血清淀粉样蛋白A(serum amyloid A protein, SAA)、血清可溶性髓系细胞触发受体-1(soluble triggering receptor expressed on myeloid cell-1, sTREM-1)、D-二聚体在Sepsis患者预后评估中的价值。 方法 2018年1月至2019年2月, 前瞻性纳入海南省人民医院ICU收治的Sepsis患者, 检测患者诊断Sepsis后第1、3、7天的SAA、sTREM-1、D-二聚体、C-反应蛋白(C-reactive protein, CRP)、降钙素原(procalcitonin, PCT)水平、并记录患者急性生理和慢性健康状况评估(acute physiology and chronic health evaluation Ⅱ, APACHE Ⅱ)结果, 将诊断Sepsis后28 d内死亡患者作为研究组(死亡组), 存活患者作为对照组(生存组), 采用多因素Logistic回归分析和受试者工作特征(receiver operator characteristic, ROC)曲线分析各指标与患者预后的相关性及对预后的评估价值。 结果 共82例符合纳入和排除标准的Sepsis患者入选本研究, 其中男性51例, 女性31例, 平均年龄(68.17±9.94)岁。死亡组30例, 生存组52例, 两组年龄、性别、体质量指数差异无统计学意义(P均>0. 05)。死亡组与生存组在诊断Sepsis后第1、3、7天SAA、sTREM-1、D-二聚体、CRP和PCT水平及APACHEⅡ评分差异均具有统计学意义(P均 < 0.05)。诊断Sepsis后第1天, SAA(P=0.004)、sTREM-1(P=0.025)、CRP(P=0.005)、PCT(P=0.016)均为预测Sepsis预后的独立相关因素, 且SAA、sTREM-1水平在第1、3、7天与APACHEⅡ评分呈正相关(P均 < 0.05), 而D-二聚体仅在第3天和第7天与APACHEⅡ评分呈正相关(P均 < 0.05)。ROC曲线发现, SAA第1、3、7天的曲线下面积均最大(分别为0.878、0.916、0.954), sTREM-1第3天和第7天(0.907、0.929)的ROC曲线下面积均大于CRP(0.897、0.927)和PCT(0.892、0.890), SAA+sTREM-1+D二聚体联合检测在第1、3、7天的ROC曲线下面积分别为0.918、0.974、0.984。 结论 SAA、sTREM-1和D-二聚体的动态联合监测结果可作为Sepsis的预后指标, 且优于CRP、PCT等传统预测指标。 -
关键词:
- 血清淀粉样蛋白A /
- 血清可溶性髓系细胞触发受体-1 /
- D-二聚体 /
- Sepsis
Abstract:Objective The aim of this study was to investigate the clinical significance of serum amyloid A protein (SAA), soluble triggering receptor expressed on myeloid cell-1(sTREM-1), and D-Dimer in the evaluation of prognosis of sepsis. Methods From January 2018 to February 2019, patients with sepsis who were prospectively included in the ICU of Hainan Provincial People's Hospital were tested for the levels of SAA, sTREM-1, D-Dimer, C-reactive protein (CRP), and procalcitonin (PCT).Patients' acute physiology and chronic health evaluation Ⅱ (APACHE Ⅱ) scores were recorded. The patients who died within 28 days after the diagnosis of sepsis were included in the study group (death group), otherwise the septic patients were included in the control group (survival group). The multivariate Logistic regression analysis and the receiver operator characteristic (ROC) curve were used to analyze the correlation of each index with the prognosis of patients and the evaluation value. Results A total of 82 patients with sepsis who met the inclusion and exclusion criteria were selected for this study, 51 males and 31 females, with an average age of (68.17±9.94) years. There were 30 cases in the death group and 52 cases in the survival group. There was no significant difference in age, sex, and body mass index between the two groups (all P>0.05). There were significant differences in APACHE Ⅱ scores, SAA, sTREM-1, D-Dimer, CRP, and PCT level between the survival group and the death group on the 1st, 3rd and 7th day after the diagnosis (all P < 0.05). Multivariate Logistic regression analysis showed that SAA (P=0.004), sTREM-1 (P=0.025), CRP (P=0.005), and PCT (P=0.016) were independent predictors for the prognosis of sepsis. It was also found that there was a positive correlation of SAA and sTREM-1 levels with APACHE Ⅱ scores on the 1st, 3rd and 7th day (all P < 0.05), and there was a positive correlation between D-Dimer and APACHE Ⅱ scores on the 3rd and 7th day (all P < 0.05). It was found that the areas under ROC curve of SAA on the 1st, 3rd and 7th day were the largest (0.878, 0.916, 0.954, respectively). On the 3rd and 7th day, the areas under the ROC curve of sTREM-1 were (0.907, 0.929) larger than those of CRP (0.897, 0.927) and PCT (0.892, 0.890). The areas under the ROC curve (0.918, 0.974, 0.984, respectively) of the combined detection of SAA, sTREM-1, and D-Dimer on the 1st, 3rd and 7th day were larger than those of the individual indexes. Conclusions The dynamic joint monitoring results of SAA, sTREM-1, and D-Dimer can be used as the prognostic indicators for sepsis, and have a higher predictive value than traditional indicators such as CRP and PCT. 利益冲突 无 -
表 1 Sepsis患者生存组与死亡组一般临床资料比较
组别 年龄
(x±s，岁)性别
(男/女，n)BMI
(x±s，kg/m2)生存组(n=52) 67.27±9.76 33/19 21.42±2.12 死亡组(n=30) 69.73±10.23 18/12 21.81±1.77 p值 0.282 0.756 0.403 BMI:体质量指数 
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表 2 Sepsis患者生存组与死亡组各血清学指标及APACHE Ⅱ评分比较(x±s)
组别 SAA(mg/L) sTREM-1(ng/L) D-二聚体(mg/L) CRP(mg/L) PCT(μg/L) APACHE Ⅱ评分 第1天 生存组(n=52) 89.42±37.07 112.46±26.42 1.93±0.59 120.12±43.32 3.29±1.36 17.83±2.10 死亡组(n=30) 123.60±19.65 141.10±19.76 2.24±0.42 178.10±32.92 6.00±2.63 21.23±1.83 t值 -4.676 -5.569 -2.787 -6.824 -5.256 -7.396 P值 ＜0.001 ＜0.001 0.007 ＜0.001 ＜0.001 ＜0.001 第3天 生存组(n=52) 111.96±42.17 114.75±19.05 2.19±0.62 128.08±54.31 3.10±0.91 17.87±2.11 死亡组(n=30) 210.83±55.21 147.00±15.66 2.77±0.48 236.13±65.27 6.51±2.84 23.40±2.11 t值 -8.485 -7.86 -4.342 -8.054 -6.381 -11.456 P值 ＜0.001 ＜0.001 ＜0.001 ＜0.001 ＜0.001 ＜0.001 第7天 生存组(n=52) 124.63±51.00 111.90±23.28 2.37±0.88 123.31±58.74 3.09±1.09 17.29±2.38 死亡组(n=30) 255.40±47.17 154.90±19.97 3.58±1.04 268.10±85.48 7.79±3.88 26.00±2.96 t值 -11.488 -8.472 -5.612 -9.070 -6.477 -14.589 P值 ＜0.001 ＜0.001 ＜0.001 ＜0.001 ＜0.001 ＜0.001 SAA：血清淀粉样蛋白A；sTREM-1：血清可溶性髓系细胞触发受体-1；CRP：C-反应蛋白；PCT：降钙素原；APACHE Ⅱ：急性生理和慢性健康状况评估
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表 3 Sepsis患者预后的多因素分析
项目 β值 SE值 Wald值 P值 OR值 95% CI SAA 0.041 0.014 8.503 0.004 1.042 1.013~1.071 sTREM-1 0.052 0.023 5.046 0.025 1.053 1.007~1.102 D-二聚体 1.590 1.063 2.238 0.135 4.905 0.611~39.382 CRP 0.039 0.14 7.727 0.005 1.039 1.011~1.068 PCT 0.927 0.383 5.854 0.016 2.526 1.193~5.352 SAA、sTREM-1、CRP、PCT：同表 2
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[1] Sinto R, Suwarto S, Widodo D. Comparison of Survival Prediction with Single versus Combination Use of Microcircula-tion End Point Resuscitation in Sepsis and Septic Shock[J]. Acta Med Indones, 2018, 50:275-282. [2] Zarjou A, Agarwal A. Sepsis and acute kidney injury[J]. J Am Soc Nephrol, 2011, 22:999-1006. doi: 10.1681/ASN.2010050484 [3] Reinhart K, Daniels R, Kissoon N, et al. Recognizing Sepsis as a Global Health Priority- A WHO Resolution[J]. N Engl J Med, 2017, 377:414-417. doi: 10.1056/NEJMp1707170 [4] Duggan S, Leonhardt I, Hunniger K, et al. Host response to Candida albicans bloodstream infection and sepsis[J]. Virulence, 2015, 6:316-326. https://www.ncbi.nlm.nih.gov/pubmed/25785541 [5] 陈兴旺, 赖剑波, 姚志军, 等.血和尿中可溶性髓样细胞触发受体-对脓毒症患者的早期诊断及预后评估价值[J].实用医学杂志, 2013, 29:3874-3877. http://www.cnki.com.cn/Article/CJFDTotal-SYYZ201323033.htm [6] Mithal LB, Palac HL, Yogev R, et al. Cord Blood Acute Phase Reactants Predict Early Onset Neonatal Sepsis in Preterm Infants[J].PLoS One, 2017, 12:e0168677. doi: 10.1371/journal.pone.0168677 [7] Singer M, Deutschman CS, Seymour CW, et al. The third international consensus definitions for sepsis and septic shock(Sepsis-3)[J]. JAMA, 2016, 315:801-810. doi: 10.1001/jama.2016.0287 [8] Balakrishnan M, Gandhi H, Shah K, et al. Hydrocortisone, Vitamin C and thiamine for the treatment of sepsis and septic shock following cardiac surgery[J]. Indian J Anaesth, 2018, 62:934-939. http://www.ijaweb.org/article.asp?issn=0019-5049;year=2018;volume=62;issue=12;spage=934;epage=939;aulast=Balakrishnan;type=0 [9] Cornillon J, Bouteloup M, Lambert C. Evaluation of procalcitonin and CRP as sepsis markers in 74 consecutive patients admitted with prolonged febrile neutropenia[J]. J Infect, 2011, 63:93-95. doi: 10.1016/j.jinf.2011.05.010 [10] Su L, Feng L, Song Q, et al. Diagnostic value of dynamics serum sCD163, sTREM-1, PCT, and CRP in differentiating sepsis, severity assessment, and prognostic prediction[J]. Mediators Inflamm, 2013, 2013:969875. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3713373/ [11] Giamarellos-Bourboulis EJ, Norrby-Teglund A, Mylona V, et al. Risk assessment in sepsis:a new prognostication rule by APACHE Ⅱ score and serum soluble urokinase plasminogen activator receptor[J]. Crit Care, 2012, 16:R149. doi: 10.1186/cc11463 [12] Townsend TR. Can serum amyloid A concentrations aid diagnosis of synovial sepsis?[J]. Vet Rec, 2017, 181:423-424. doi: 10.1136/vr.j4751 [13] Troia R, Gruarin M, Foglia A, et al. Serum amyloid A in the diagnosis of feline sepsis[J]. J Vet Diagn Invest, 2017, 29:856-859. doi: 10.1177/1040638717722815 [14] Jabor A, Holub Z, Franekova J, et al. Serum amyloid A as an effective marker for the assessment of surgical trauma and risk of post-operative complications[J]. Ceska Gynekol, 2006, 71:131-136. [15] Bouchon A, Facchetti F, Weigand MA, et al. TREM-1 amplifies inflammation and is a crucial mediator of septic shock[J]. Nature, 2001, 410:1103-1107. doi: 10.1038/35074114 [16] Patoulias D, Kalogirou MS, Patoulias I. Triggering Receptor Expressed on Myeloid Cells- (TREM-1) and its soluble in the plasma form (sTREM-1) as a diagnostic biomarker in neonatal sepsis[J]. Folia Med Cracov, 2018, 58:15-19. doi: 10.1007/s11684-017-0505-z [17] Bouchon A, Dietrich J, Colonna M. Cutting edge:inflammatory responses can be triggered by TREM-1, a novel receptor expressed on neutrophils and monocytes[J]. J Immunol, 2000, 164:4991-4995. doi: 10.4049/jimmunol.164.10.4991 [18] Alkan OS, Ozer EA, Ilhan O, et al. Diagnostic value of urine soluble triggering receptor expressed on myeloid cells (sTREM-1) for late-onset neonatal sepsis in infected preterm neonates[J]. J Int Med Res, 2018, 46:1606-1616. doi: 10.1177/0300060517749131 [19] Tripodi A. D-dimer testing in laboratory practice[J]. Clin Chem, 2011, 57:1256-1262. doi: 10.1373/clinchem.2011.166249 [20] Thachil J, Fitzmaurice DA, Toh CH. Appropriate use of D-dimer in hospital patients[J]. Am J Med, 2010, 123:17-19. doi: 10.1016/j.amjmed.2009.09.011 [21] Semeraro F, Ammollo CT, Caironi P, et al. Low D-dimer levels in sepsis:Good or bad?[J]. Thromb Res, 2018, 174:13-15. [22] Kountchev J, Bijuklic K, Bellmann R, et al. Reduction of D-dimer levels after therapeutic administration of antithrombin in acquired antithrombin deficiency of severe sepsis[J]. Crit Care, 2005, 9:R596-R600. doi: 10.1186/cc3808 [23] Su L, Li H, Xie A, et al. Dynamic changes in amino acid concentration profiles in patients with sepsis[J]. PLoS One, 2015, 10:e121933. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4388841/ [24] 罗运山, 刘易林, 邓霞梅, 等. PCT、sTREM-1结合APACHE Ⅱ评分对脓毒症诊断和预后的价值[J].实用医学杂志, 2017, 33:586-590. http://www.cnki.com.cn/Article/CJFDTotal-SYYZ201704023.htm -
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