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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

王照良 张文玲 黄涛 郭家权

王照良, 张文玲, 黄涛, 郭家权. 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[J]. 协和医学杂志, 2020, 11(1): 34-39. doi: 10.3969/j.issn.1674-9081.20190051
引用本文: 王照良, 张文玲, 黄涛, 郭家权. 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[J]. 协和医学杂志, 2020, 11(1): 34-39. doi: 10.3969/j.issn.1674-9081.20190051
Zhao-liang WANG, Wen-ling ZHANG, Tao HUANG, Jia-quan GUO. 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[J]. Medical Journal of Peking Union Medical College Hospital, 2020, 11(1): 34-39. doi: 10.3969/j.issn.1674-9081.20190051
Citation: Zhao-liang WANG, Wen-ling ZHANG, Tao HUANG, Jia-quan GUO. 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[J]. Medical Journal of Peking Union Medical College Hospital, 2020, 11(1): 34-39. doi: 10.3969/j.issn.1674-9081.20190051

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
基金项目: 

吴阶平医学基金会临床科研专项资助基金 320.6750.17375

详细信息
    通讯作者:

    张文玲 电话:0731-82650348, E-mail:cszhangwenling@163.com

    黄涛 电话:0898-68642560, E-mail:13005080993@163.com

  • 中图分类号: R595

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

More Information
  • 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。
    利益冲突  无
  • 图  1  本研究患者纳入流程图

    图  2  诊断Sepsis后第1、3、7天各指标受试者工作特征曲线A.第1天;B.第3天;C.第7天

    SSA、sTREM-1、CRP、PCT:同表 2

    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 0.282 0.756 0.403
    BMI:体质量指数
    下载: 导出CSV

    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 -4.676 -5.569 -2.787 -6.824 -5.256 -7.396
      P <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 -8.485 -7.86 -4.342 -8.054 -6.381 -11.456
      P <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 -11.488 -8.472 -5.612 -9.070 -6.477 -14.589
      P <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
    下载: 导出CSV

    表  3  Sepsis患者预后的多因素分析

    项目 β SE Wald值 P OR 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
    下载: 导出CSV

    表  4  血清SAA、sTREM-1、D-二聚体水平与APACHE Ⅱ

    检测时间 SAA sTREM-1 D-二聚体
    r P r P r P
    第1天 0.324 0.003 0.279 0.011 0.162 0.147
    第3天 0.588 <0.001 0.484 <0.001 0.492 <0.001
    第7天 0.716 <0.001 0.551 <0.001 0.429 <0.001
    SAA、sTREM-1、APACHE Ⅱ:同表 2
    下载: 导出CSV
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  • 收稿日期:  2019-03-14
  • 刊出日期:  2020-01-30

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