人组织激肽释放酶结合蛋白在脓毒性休克患者预后评估中的价值

Value of human tissue kalkinase-binding protein in prognostic evaluation of patients with septic shock

目的研究人组织激肽释放酶结合蛋白(Kallistatin,Ks)在脓毒性休克患者预后评估中的价值,为脓毒性休克患者的病情评估及预后判断提供新的思路及临床依据。方法本研究是基于前瞻性数据收集的回顾性分析研究,选择2017年10月-2020年01月就诊于新疆医科大学第一附属医院急救创伤中心抢救室及急救中心重症监护室明确诊断脓毒性休克的患者79例,收集并比较存活组与死亡组患者的医疗资料,建立COX回归模型分析影响脓毒性休克患者28d全因死亡率的独立危险因素。绘制Kallistatin的受试者工作特征曲线,根据kallistatin的Cut-off值将患者分为两组,绘制Kaplan-meier曲线比较脓毒性休克患者的累计生存率,Log-Rank检验比较两组间是否存在差异。结果根据入院28天内患者的预后情况分为存活组53例,死亡组26例,病死率32.9%。入院时患者的血浆kallistatin水平与健康受试者存在显著差异3.9(2.8,4.7)vs 14.4(13.6,15.4),P<0.001;存活组患者血浆kallistatin水平与死亡组患者存在显著差异4.21±1.22 vs 3.16±1.26,P<0.001。COX回归分析均显示:kallistatin为影响脓毒性休克患者预后状况的保护性因素(β<0,P<0.05)。绘制kallistatin的受试者工作特征曲线,经计算截断值为3.99ug/ml,曲线下面积为0.727,灵敏度为62.3%,特异度为80.8%,95%置信区间为0.607-0.847,P=0.001。根据kallistatin的Cut-off值为3.99 ug/ml,将所有脓毒性休克患者分为两组:KS≥3.99 ug/ml组和KS<3.99 ug/ml组,运用Kaplan-Meier曲线比较两组脓毒性休克患者28天累积生存率,差异具有统计学意义(Log-Rank=15.309,P<0.001)。结论血浆kallistatin水平是脓毒性休克患者预后评估中的保护性因素,入院时血浆kallistatin<3.99ug/ml提示预后不良,其对脓毒性休克患者的预后评估有一定的预测价值。

Objective To study the value of human tissue Kallistatin(KS)in prognostic evaluation of patients with septic shock,and to provide new ideas and clinical basis for septic shock patients’assessment and prognosis.Methods This study was a retrospective study based on prospective data collection.A total of 79 patients admitted to the emergency room and intensive care unit of the First Affiliated Hospital of Xinjiang Medical University from October 2017 to January 2020 were selected for definite diagnosis of septic shock.The medical data of the survival group and the death group were collected and compared.COX regression model was established to analyze the independent risk factors for 28d all-cause mortality in septic shock patients.Patients were divided into two groups according to the Cut-off value of kallistatin.Kaplan-meier curve was drawn to compare the cumulative survival rate of patients with septic shock,and Log-Rank test was used to compare whether there were differences between the two groups.Results According to the prognosis of patients within 28 days of admission,they were divided into 53 cases in the survival group and 26 cases in the death group.The mortality was 32.9%.Plasma kallistatin levels at admission were significantly different from healthy subjects 3.9(2.8,4.7)vs 14.4(13.6,15.4),P<0.001;plasma kallistatin levels in patients in the survival group were significantly different from those in the death group 4.21±1.22 vs 3.16±1.26,P<0.001.COX regression analysis showed that kallistatin was a protective factor affecting the prognosis of patients with septic shock(β<0,P<0.05).The kallistatin receiver working characteristic curve was drawn.The calculated cutoff value was 3.99 ug/ml,the area under the curve was 0.727,the sensitivity was 62.3%,the specificity was 80.8%,and the 95%confidence interval was 0.607-0.847,P=0.001.According to the cut-off value of kallistatin of 3.99 ug/ml,all patients with septic shock were divided into two groups:KS≥3.99 ug/ml group and KS<3.99 ug/ml group.Kaplan-Meier curve was used to compare the two groups of sepsis The 28-day cumulative survival rate of patients with shock was statistically significant(Log-Rank=15.309,P<0.001).Conclusion kallistatin is an protective factor that affects the prognosis of patients with septic shock,Plasma kallistatin<3.99 ug/ml can indicates poor prognosis at admission,and it can be used to guide the assessment of the prognosis of patients with septic shock to a certain extent.