GFAP、D-DI、PCT水平与脓毒症患者病情严重程度、预后的关系

Relationship between GFAP,D-DI,PCT levels and the severity and prognosis of sepsis patients

目的探讨胶质纤维酸性蛋白(GFAP)、D-二聚体(D-DI)、降钙素原(PCT)水平与脓毒症患者病情严重程度、预后的关系。方法回顾性分析该院接收诊疗的60例脓毒症患者作为脓毒症组,按病情严重程度将其分为重症组(n=24)和轻症组(n=36),另选同期于该院体检的50例健康者作为对照组。比较各组患者血清指标[GFAP、MBP、D-二聚体(D-DI)、纤维蛋白降解产物(FDP)、降钙素原(PCT)]水平,并比较不同病情程度患者相关评分[急性生理与慢性健康评分状况Ⅱ(APACHEⅡ)、序贯器官衰竭(SOFA)]及预后指标。进一步分析血清指标与APACHEⅡ、SOFA、预后指标的关系,用受试者工作特征(ROC)曲线评价血清指标联合对患者的诊断价值。结果脓毒症组血清GFAP、MBP、D-DI、FDP和PCT水平均高于对照组,差异有统计学意义(P<0.05)。与轻症组比较,重症组GFAP、MBP、D-DI、FDP、PCT水平及APACHEⅡ评分、SOFA评分均更高,ICU住院时间与机械通气时间均更长(P<0.05)。经Pearson相关性分析发现,GFAP、MBP、D-DI、FDP、PCT水平均与APACHEⅡ评分、SOFA评分、ICU住院时间、机械通气时间、28 d病死率呈显著正相关(P<0.05)。GFAP、D-DI、PCT联合诊断灵敏度为81.33%、特异度为87.09%和曲线下面积(AUC)为0.932,优于单一指标。Cox多因素分析显示GFAP、MBP、D-DI、FDP、PCT、APACHEⅡ、SOFA、ICU住院时间、机械通气时间均与28 d病死率密切相关(P<0.05)。结论GFAP、D-DI联合PCT对脓毒症患者病情具有良好的诊断价值,且与患者病情程度及预后密切相关。

Objective To investigate the relationship between the levels of glial fibrillary acidic protein(GFAP),D-dimer(D-DI),procalcitonin(PCT)and the severity and prognosis of sepsis.Methods A retro-spective analysis was performed on 60 patients with sepsis treated and treated in Shenzhen Longgang Central Hospital as sepsis group,and they were divided into severe group(n=24)and mild group(n=36)according to the severity of the disease,and 50 healthy patients were selected as control group.Serum indexes[GFAP,MBP,D-dimer(D-DI),fibrin degradation product(FDP),procalcitonin(PCT)]of the two groups and pa-tients with different disease levels were compared.Relative scores(acute physiological and chronic health score statusⅡ(APACHEⅡ),sequential organ failure(SOFA))and prognostic indexes of patients with dif-ferent disease levels were compared.The relationship between serum indexes and APACHEⅡ,SOFA and prognostic indexes was further analyzed,and the diagnostic value of serum indexes combined in patients was e-valuated by receiver operating characteristic curve(ROC).Results The serum levels of GFAP,MBP,D-DI,FDP and PCT in sepsis group were higher than those in control group,and the differences were statistically significant(P<0.05).Compared with the mild group,the level of GFAP,MBP,D-DI,FDP,PCT,APACHEⅡscore and SOFA score were higher in the severe group,and the length of ICU stay and mechanical ventila-tion time were longer(P<0.05).Pearson correlation analysis showed that GFAP,MBP,D-DI,FDP and PCT levels were significantly positively correlated with APACHEⅡscore,SOFA score,ICU stay time,mechanical ventilation time and 28-day mortality(P<0.05).The diagnostic sensitivity,specificity and AUC of GFAP,D-DI and PCT combined were 81.33%,87.09%and 0.932,which were better than single index.COX multivari-ate analysis showed that GFAP,MBP,D-DI,FDP,PCT,APACHEⅡ,SOFA,ICU stay time,mechanical venti-lation time were closely related to 28-day mortality(P<0.05).Conclusion GFAP,D-DI combined with PCT has a good diagnostic value in sepsis patients,and is closely related to the severity of the patient's disease and prognosis.