应用血清RANTES诊断严重脓毒症及预后判断的价值评价

Diagnostic and prognostic value of serum RANTES for patients with severe sepsis

目的：检测严重脓毒症患者血清中受激活调节正常T细胞表达和分泌因子（RANTES）水平，并评价其对严重脓毒症的诊断和预后价值。方法选取严重脓毒症患者40例为严重脓毒症组（SS组），同期门诊体检者20例为对照组，收集临床及实验室参数，计算APACHEⅡ评分和 DIC 评分，采用酶联免疫吸附测定（ELISA）方法检测血清 RANTES 的水平。结果 SS组患者血清RANTES水平[（3175.91±1341.78）pg/ml]较对照组[（5374.27±927.87）pg/ml]下降（P＜0.05）。相关分析显示RANTES与WBC、PLT、AST、TBIL、Cr、PT、APTT、PCT、APACHEⅡ评分和DIC评分均呈显著负相关（P＜0.05），显示RANTES诊断严重脓毒症的AUCSS＝0.917，95%CI 0.817-0.993（P＜0.05），判断严重脓毒症死亡的AUCdeath＝0.786，95%CI 0.650-0.922（P＜0.05）。结论严重脓毒症患者的血清RANTES水平明显降低，并死亡率升高，对严重脓毒症的诊断和预后判断有较好的价值。

ObjectiveTo examine the levels of serum regulated upon activation normal T cell expressed and secreted （RANTES） from severe sepsis patients in an effect to evaluate the value for prognosis and diagnosis for severe sepsis.MethodsSixty patients were divided into 2 groups, severe sepsis group （SS group, 40 cases） and normal group（20 cases）. Clinical data of these patients were collected, including APACHEⅡscore and DIC score. Serum levels of RANTES were measured in patients by ELISA.ResultsThe patients of SS group had lower levels of RANTES[（3 175.91±1 341.78）pg/ml] than the healthy control[（5 374.27±927.87）pg/ml]（P〈0.05）. There were significant negative correlations between RANTES and WBC, PLT, AST, TBIL, Cr, PT, APTT, PCT, APACHEⅡ score and DIC score （P〈0.05）. The areas under the curves （AUC） of RANTES for severe sepsis was 0.917,95%CI=0.817-0.993（P〈0.05）, and AUC of RANTES for death was 0.786, 95%CI=0.650-0.922（P〈0.05）. Conclusion Serum levels of RANTES in patients with severe sepsis significantly decreased, which maybe benefit diagnosis and prognosis for severe sepsis.