血清LGT蛋白质组和急性生理学与慢性健康状况评分系统Ⅱ对危重病患者预后评估的临床意义

The clinical significance of the relationship between serum lost goodwill target proteome and the acute physiology and chronic health evaluation Ⅱ score of patient with critical illness

目的 探讨危重病患者血清LGT蛋白质组的变化规律,分析其对疾病预后评估的临床意义.方法 采用蛋白芯片技术检测96例危重病患者和30例健康对照者的血清蛋白质组变化.测量LGT蛋白质组的丰度值,结合急性生理学与慢性健康状况评分系统Ⅱ（APACHE Ⅱ）分值,分析LGT蛋白质组对危重病患者预后评估的临床意义.结果 危重病患者血清指纹图谱存在LGT蛋白质组表达谱,APACHE Ⅱ评分≥15分组（35例）LGT蛋白质组丰度[（9.26±7.51）%]明显高于APACHE Ⅱ评分＜15分组（61例）的丰度[（4.19±4.07）%],且两组丰度明显高于健康对照组[（1.52±0.47）%],差异有统计学意义（均P＜0.01）;患者LGT蛋白质组丰度与APACHE Ⅱ评分呈明显正相关（r=0.317,P=0.002）.死亡组（23例）LGT蛋白质组丰度[（10.14±9.23）%]明显高于存活组（73例）的丰度[（5.83±3.57）%,P＜0.01];且LGT蛋白质组丰度≥5%组的病死率[68.0%（17/25）]明显高于丰度＜5%组[8.5%（6/71）,P＜0.01].用LGT蛋白质组预测预后的阳性预测率为68.0%,阴性预测率为91.5%;假阳性率为32.0%,假阴性率为8.5%.结论 LGT蛋白质组与病情的严重程度及预后密切相关,可能成为危重病患者预后评估的重要指标;结合APACHE Ⅱ评分系统可为临床早期评估危重病患者预后提供更可靠的依据.关键词：危重病;急性生理学与慢性健康状况评分系统Ⅱ;

Objective To investigate the expression of serum lost goodwill target（LGT）proteome,and to analyze its clinical significance in evaluating prognosis of patient with critical illness on the basis of acute physiology and chronic health evaluation Ⅱ（APACHE Ⅱ）score. Methods The serum samples were collected from 96 patients with critical illness and 30 healthy volunteers as healthy control. The expression of serum LGT proteome was detected by surface-enhanced laser desorption/ionization-time of flight-mass spectrometry（SELDI-TOF-MS）protein-chip technology. The abundance value of LGT proteome in patients at admission was measured, and at the same time APACHE Ⅱ score was estimated, in order to analyze its clinical significance in patients with critical illness. Results The amount of LGT proteome in APACHE Ⅱ≥15 group[n= 35,（9.26 ± 7. 51）%]was significantly higher than that of APACHE Ⅱ〈 15 group[n= 61,（4. 19 ± 4.07）%], and the LGT proteome amount in both groups was significantly higher than that of the healthy control group[（1.52± 0.47）%, both P〈0.01]. Spearman correlation analysis showed that there was significant positive correlation between the abundance of LGT proteome and the APACHE Ⅱ score （r=0. 317, P=0. 002）. The abundance of LGT proteome in death group[n=23,（10. 14±9. 23）%]was significantly higher than that in survival group[n=73,（5. 83±3.57）%, P〈0. 01]. The fatality rate of the LGT proteome group with average abundance exceeding 5%[68.0%（17/25）]was significantly higher than that of the LGT proteome group with average abundance lower than 5%[8.5%（6/71）, P〈0.01].According to the LGT proteome abundance to evaluate the prognosis of the patients, the positive predict rate was 68.0 %, the negative predict rate was 91.5 %, the false positive rate was 32. 0%, the false negative rate was 8.5%. Conclusion The LGT proteome was intimately correlated with the severity degree of disease condition and prognosis in patients with critical illness. The determination of LGT proteome combined with APACHE Ⅱ score evaluation can probably be an important indicator in evaluating the prognosis of patient with critical illness. Further research on LGT proteome is warranted to facilitate the prognostication and clinical decision-making.