可溶性CD14亚型对急性百草枯中毒患者的病情评估及预后的影响

The effect of soluble CD14-st on the assessment and prognosis of patients with acute paraquat poisoning

目的探讨可溶性CD14亚型（sCD14-st，又称Presepsin）与急性百草枯中毒（acuteparaquatpoisoning，APP）患者病情严重程度与预后的关系。方法2013年1月至2016年1月入住河北医科大学附属哈励逊国际和平急救医学部的82例APP患者，其中根据百草枯中毒严重程度分为轻度中毒组20例、中度中毒组36例、重度中毒组26例；根据患者预后分为存活组28例和死亡组54例；同期健康体检者50例作为对照组。所有入选APP患者分别于治疗前、治疗后72h、7d抽静脉血10mL，对照组于体检时抽取静脉血3mL，用化学发光酶联免疫法测定血清中Presepsin浓度；抽取静脉血检测C反应蛋白（CRP）、肿瘤坏死因子-α（TNF-α）、白细胞介素-6（IL-6）及白细胞介素-10（IL-10）水平，同时观察治疗前、治疗后72h、7d患者急性生理学和慢性健康状况（APACHE）1I评分，多组间比较采用重复测量的方差分析、两组间比较采用成组t检验比较检测指标的变化，采用x2检验比较28d病死率情况，采用Pearson相关检验分析APP患者血Presepsin水平与其生存率的相关性。结果与对照组比较，治疗前和治疗后72h、7d，不同程度中毒组患者Prespsin、CRP、TNF-α、IL-6水平和APACHE1I评分升高，IL-10水平降低，且中度中毒组与轻度中毒组、重度中毒组与轻度中毒组和中度中毒组比较，差异均有统计学意义（P〈0．05）。治疗前和治疗后72h、7d死亡组较存活组血Presepsin、CRP、TNF-α、IL-6水平和APACHEII评分升高，IL．10水平降低（P〈0．05）；不同程度中毒组患者病死率分别为25．00％、69．44％和92．31％，且中度中毒组与轻度中毒组、重度中毒组与轻度中毒组和中度中毒组比较，差异均有统计学意义（P〈0．05）。APP患者人院时血清Prespsin水平和APACHEII评分的受试者工作特征曲线（ROC曲线）下面积（AUC）分别为0．862、0．731，Prespsin对APP患者28d病死率的预测能力优于APACHE1I评分（P〈0．05），APP患者血Presepsin水平与其生存率呈负相关（r=-0．285，P=0．009）。结论血清Prespsin水平监测有助于APP患者病情严重程度的评估、指导治疗和判断预后。

Objective To investigate the relationship between soluble CD14-st （Presepsin） and assessment, prognosis in patients with aeute paraquat poisoning （APP）. Methods A total of 82 patients with APP treated in Emergency Department of Harrison International Peace Hospital Affiliated to Hebei Medical University from January 2013 to January 2016 were divied into three groups： mild poisoning group （ n = 20） , moderate poisoning group （ n = 36 ） and severe poisoning group （ n = 26 ）. According to theoutcomes, patients were divided into survivor group （ n = 28 ） and non-survivor group （ n = 54）. Another 50 healthy subjects were selected as control group. In control group, samples of 3 mL venous blood from 50 healthy subjects were collected for laboratory examination. Samoles of 10 mL venous blood from all patients were collected before and 72 hours, 7 days after treatment to detect presepsin, C reactive protein （CRP） , tumor necrosis factor α （TNF-α）, interleukin-6 （IL-6） and interleukin-10 （IL-10）. Betbre and 72 hours, 7 days after treatment, the change of Acute physiology and chronic health evaluation （APACHE） Ⅱ score and the outcomes in 28 days were observed. The variance analysis of repeated measures was used for comparison among multiple groups, and the t test was used to compare changes of detected biomarkers between two groups, and the outcomes in 28 days between two groups were compared with chi square test. Pearson correlation test was used to analyze the correlation between Presepsin in patients with APP and the survival rate. Results APACHE Ⅱ scores and the serum level of prespsin, CRP, TNF-α, IL-6 at admission and 72 hours, 7 days ＇after treatment in three poisoning groups were significantly increased compared with control group, IL-10 were decreased compared with control group （P 〈 0. 05 ）, and there were significant differences in those biomarkers between moderate group and mild group, and between severe group and mild group, moderate group （P 〈0. 05）. At admission, 72 h, 7 d after admission, APACHE Ⅱ score and the serum levels of presepsin, CRP, TNF-α, IL-6 in non-survivor group were higher than those in survivor group, and IL-10 in non-survivor was lower than that in survivor group （ P 〈 0. 05 ）. The mortality rates of these 3 groups were 25.00%, 69. 44% and 92. 31%, demonstrating significant differences among three groups （P 〈 0. 05 ）. The AUCs were 0. 862 and 0. 731 for presepsin and APACHE Ⅱ score respectively at admission. The predictive capability of presepsin for 28-day mortality was superior over that of APACHE Ⅱ score （ P 〈 0. 05 ）. The level of serum presepsin in patients with APP was negatively correlated with the survival rate （ r = - 0. 285, P = 0. 009 ）. Conclusions The detection of prespsin has important clinical value in the severity assessment and prognosis in patients with APP. It is an important guidance for early therapeutic strategy.