脓毒症患者血清MIF和D-D及PCT水平与病情进展的关系及预测价值

The relationship between serum MIF,D-D,PCT levels and disease progression in patients with sepsis and their predictive value for prognosis

目的分析脓毒症患者血清巨噬细胞移动抑制因子(MIF)、D-二聚体(D-D)、降钙素原(PCT)水平与病情进展的关系及对预后的预测价值。方法选取2020年1月-2021年12月郑州大学第一附属医院急诊医学部收治的125例脓毒症患者作为观察组,选取同期进行体检的35名健康体检者作为对照组,比较两组血清MIF、D-D、PCT水平;根据脓毒症患者不同病情严重程度和治疗结局分别将其分为脓毒症组(n=68)、脓毒性休克组(n=57)和生存组(n=64)、死亡组(n=61),比较不同病情严重程度和不同治疗结局脓毒症患者血清MIF、D-D、PCT水平。采用受试者工作特征(ROC)曲线分析上述指标单独与联合检测的诊断效能。结果观察组血清MIF、D-D、PCT水平分别为(53.41±3.19)ng/mL、(2.03±0.75)mg/L、(6.01±1.89)ng/mL,均高于对照组(30.27±3.02)ng/mL、(0.42±0.02)mg/L、(1.44±0.03)ng/mL,差异均有统计学意义(t=38.40、12.59、14.31,P均<0.05)。脓毒性休克组的血清MIF、D-D、PCT水平均高于脓毒症组,差异均有统计学意义(t=5.53、3.24、3.65,P均<0.05)。所有患者中,生存64例(51.20%),病死61例(48.80%),脓毒性休克组的病死率较高(χ^(2)=4.94,P<0.05)。死亡组血清MIF、D-D、PCT水平均高于生存组,差异均有统计学意义(t=4.13、3.90、6.09,P均<0.05)。ROC曲线分析显示,上述各血清指标联合检测诊断脓毒症患者死亡的AUC为0.903,高于各指标单一检测。结论随着脓毒症患者病情的持续进展,血清MIF、D-D、PCT水平逐渐升高,且其水平变化对脓毒症患者预后有一定的预测价值,联合检测有利于提升整体诊断效能。

Objective To analyze the relationship between serum migration inhibitory factor(MIF),D-dimer(D-D),procalcitonin(PCT)levels and disease progression in patients with sepsis and their predictive value for prognosis.Methods The clinical data of 125 patients with sepsis admitted to the Emergency Medicine Department of the First Affiliated Hospital of Zhengzhou University from January 2020 to December 2021 were retrospectively collected as the observation group,and the physical examination data of 35 healthy subjects who underwent physical examination in the First Affiliated Hospital of Zhengzhou University during the same period were collected as the control group.The levels of serum MIF,D-D and PCT were compared between the two groups.According to different severity and treatment outcomes of sepsis patients,they were divided into sepsis group(68 cases),septic shock group(57 cases),survival group(64 cases),and death group(61 cases).The levels of serum MIF,D-D and PCT of sepsis patients with different disease severity and different treatment outcomes were compared,and the diagnostic efficacy of the above indicators alone and in combination was analyzed.Results The levels of MIF,D-D and PCT in the observation group were(53.41±3.19)ng/mL,(2.03±0.75)mg/L and(6.01±1.89)ng/mL,respectively,which were higher than those in the control group(30.27±3.02)ng/mL,(0.42±0.02)mg/L and(1.44±0.03)ng/mL;the differences were significant(t=38.40,12.59,14.31;all P<0.05).The serum MIF,D-D and PCT levels in the septic shock group were higher than those in the sepsis group;the differences were significant(t=5.53,3.24,3.65;all P<0.05).Among all patients,64 cases(51.20%)survived and 61 cases(48.80%)died,and the septic shock group had a higher fatality rate(χ^(2)=4.94,P<0.05).The serum MIF,D-D and PCT levels in the death group were higher than those in the survival group,and the differences were statistically significant(t=4.13,3.90,6.09;all P<0.05).The results of ROC curve analysis showed that the AUC of the combined detection of serum indicators to diagnose the prognosis of sepsis patients with death was 0.903,which was higher than those of the single detection of indicators.Conclusions With the continuous progress of patients with sepsis,the levels of serum MIF,D-D and PCT gradually increased,and the changes of their levels had certain predictive value for the prognosis of patients with sepsis.Combined diagnosis was beneficial to improve the overall diagnostic efficiency.