脂多糖结合蛋白在脓毒症患者诊断和预后预测中的作用

Measurement of serum lipopolysaccharide binding protein for diagnosis and prognosis prediction in septic patients

目的:探讨脂多糖结合蛋白(LBP)在脓毒症患者诊断和预后预测中的作用。方法:挑选ICU的患者共80名,患者分为全身炎症反应综合征(SIRS)组(阴性对照组)、脓毒症存活组和脓毒症死亡组;所有患者均于进入ICU后24 h内采集血清样本并进行APACHEⅡ评分分析;另挑选10名健康志愿者血清作为正常对照组;ELISA检测各组样本血清LBP、C反应蛋白(CRP)和降钙素原(PCT)浓度;并以APACHEⅡ评分、血清LBP、CRP和PCT浓度对脓毒症诊断和预后预测做ROC曲线,评价LBP在脓毒症患者诊断和预后预测中的作用。结果:与SIRS组相比,脓毒症组的APACHEⅡ评分、血清LBP、CRP、PCT浓度均升高(P<0.05);与脓毒症存活组相比,死亡组的APACHEⅡ评分和血清LBP浓度升高(P<0.05),而血清CRP和PCT浓度在脓毒症存活组与死亡组之间的差异无统计学意义;LBP血清浓度高于26.84 mg/L时诊断脓毒症的敏感性和特异性分别为97.1%和95.9%;LBP血清浓度高于54.16 mg/L时预测脓毒症预后的敏感性和特异性分别为85.2%和80.0%。结论:与传统的脓毒症生物标志物CRP、PCT相比,LBP在脓毒症的诊断和预测方面都具有更好的效果。

AIM： To investigate the role of lipopolysaccharide binding protein（ LBP） for diagnosis and prognosis prediction in the septic patients. METHODS： A total number of 80 ICU patients were enrolled. The patients were divided into systemic inflammatory response syndrome（ SIRS） group and sepsis group,the patients in sepsis group were divided into non-survivor sub-group and survivor sub-group. We collected the serum samples and analyzed acute physiology and chronic health evaluation（ APACHE） II score on the first day of the patients hospitalized in ICU. In addition,we also selected 10 healthy volunteers and collected their serum samples. The serum concentrations of LBP,C-reactive protein（ CRP） and procalcitonin（ PCT） were measured by ELISA. ROC analysis of LBP,CRP,PCT and APACHE II score was conducted to discriminate among critically ill patients with sepsis and predict the prognosis of the patients with sepsis. RESULTS： The levels of the 4 indicators in the septic patients were higher than those in the patients of SIRS（ P 0. 05）. In addition,serum LBP and APACHE II score in the non-survivor sub-group were higher than those in the survivor sub-group（ P 0. 05）,whereas no difference of the PCT and CRP levels between survivors and non-survivors with sepsis was observed. LBP levels greater than 26. 84 mg / L had 97. 1% sensitivity and 95. 9% specificity to discriminate between SIRS and sepsis. LBP levels greater than 54. 16 mg / L had 85. 2% sensitivity and 80. 0% specificity for prognosis of unfavorable outcome. CONCLUSION： LBP level was more accurately correlated with diagnosis or prognosis prediction than CRP or PCT in patients with sepsis.