肝素结合蛋白在脓毒症诊断中的临床应用价值

Diagnostic value of heparin-binding protein in sepsis

目的探讨血浆肝素结合蛋白(HBP)定量检测在脓毒症诊断中的临床应用价值。方法选取20例健康志愿者、79例非脓毒症患者、55例脓毒症患者和42例严重脓毒症患者,采用酶联免疫吸附法检测血浆HBP、降钙素原(PCT)、超敏C反应蛋白(hs-CRP)水平,绘制受试者工作特征(ROC)曲线并计算曲线下面积(AUC),分析各指标对脓毒症的诊断意义;对PCT与HBP、hs-CRP进行线性相关性分析。结果健康对照组、非脓毒症组、脓毒症组、严重脓毒症组HBP分别为(2.14±1.98)、(11.85±11.06)、(10.43±10.21)和(104.97±106.84)ng/ml,健康对照组与非脓毒症组、脓毒症组及严重脓毒症组HBP比较,差异有统计学意义(P<0.01),其中严重脓毒症组高于脓毒症组,差异有统计学意义(P<0.01);非脓毒症组与脓毒症组比较差异无统计学意义(P=0.45)。健康对照组、非脓毒症组、脓毒症组、严重脓毒症组PCT分别为(0.03±0.01)、(0.12±0.06)、(0.78±0.50)和(17.24±23.21)ng/ml,差异有统计学意义(P<0.01)。健康对照组、非脓毒症组、脓毒症组、严重脓毒症组hs-CRP分别为(0.97±1.37)、(13.82±26.28)、(40.14±32.8)和(100.82±66.83)mg/L,差异有统计学意义(P<0.01)。ROC曲线显示,AUC为0.694,且HBP 11.5 ng/ml时灵敏性和特异性分别达73.2%和64.9%。线性相关分析提示PCT与HBP呈正相关(r=0.874,P<0.01);PCT与hs-CRP无线性相关(r=0.470,P=0.133)。结论血浆HBP、PCT、hs-CRP水平不仅可作为脓毒症的检测指标,而且可用于病情严重程度的评估。

[Objective] To investigate the clinical value of blood plasma heparin-binding protein （HBP） in diagnosis of sepsis. [Methods] In this study, 20 healthy volunteers, 79 non-sepsis patients, 55 sepsis and 42 severe sepsis patients were enrolled. The levels of HBP as well as procalcitonin （PCT） and hypersensitive C-reactive protein （hs-CRP） in their blood plasma were measured. Then receiver operating characteristic curve was constructed to calculate the area under the curve （AUC） and obtain the diagnostic capability of these three substances. The correlations of blood plasma level of PCT with HBP and hs-CRP were analyzed at last. [Results] In the control group, non-sepsis, sepsis and severe sepsis groups the mean levels of blood plasma HBP were （2.14 ± 1.98）, （11.85 ± 11.06）, （10.43 ±10.21） and （104.97± 106.84） ng/ml respectively; the PCT levels were （0.03±0.01）, （0.12 ± 0.06）, （0.78±0.50） and （17.24±23.21） ng/ml respectively; and the hs-CRP levels were （0.97 ± 1.37）, （13.82 ± 26.28）, （40.14±32.80） and （100.82 ± 66.83） mg/L respectively. There were significant differences in the HBP levels between the patient groups and the control group （P〈 0.01） and the HBP level in the severe sepsis group was significantly higher than that in the sepsis group （P〈O.O1）. There were significant differences in blood plasma PCT and hs-CRP levels between any two of the groups （P 〈 0.01）. Moreover, the receiver operating characteristic curve showed that the AUC of plasma HBP was 0.694. When HBP level was 11.5 ng/ml, the sensitivity and specificity reached 73.2% and 64.9% respectively. Linear correlation analysis showed a positive correlation between PCT and HBP levels （r=0.874, P〈0.O1）. [Conclusions] The levels of HBP, PCT and hs-CRP in blood plasma could be used to detect sepsis and evaluate the severity of this disease.