Hepcidin对脓毒症患者危重程度及预后评估的研究

Prognostic vaule of hepcidin in patients with sepsis

目的探讨Hepcidin对脓毒症患者危重程度及近期临床预后的评估价值。方法采用观察性研究方法，纳入在2016—03—2016—10间，上海市浦东新区周浦医院ICU收治符合脓毒症（sepsis）患者诊断的77例，入院后收集患者一般资料，明确脓毒症诊断后12h内，留取血样，完善血Hepcidin、白细胞介素-6（IL-6）、降钙素原（PCT）、C-反应蛋白（CRP）及血常规检查，观察并记录24h内最差指标，进行急性生理学与慢性健康状况评分系统11（APACHEⅡ）评分及序贯器官衰竭评分（sequentialorganfailureassessment，SOFA）。根据28d转归分为死亡组及存活组，比较两组间一般资料、各项检验指标及APACHEII评分、SOFA评分。使用Logistic回归模型确定脓毒症预后的独立预测因素，建立受试者工作特征（ROC）曲线，分析独立危险因素对脓毒症预后的预测价值。结果①脓毒症死亡组的Hepcidin、血乳酸、IL-6指标、SOFA评分及APACHEII评分均高于存活组。②将上述指标纳人Logistic回归模型进行分析，结果显示，SOFA评分、IL-6及Hepcidin是患者死亡的独立危险因素，Hepcidin的OR值为13．44、95％CI（2．10—83．27）、P=0．01。⑧绘制ROC曲线，Hepcidin的曲线下面积（AUC）、特异度、敏感度、最佳截断值分别为（0．71、80．00％、55．77％、1．20μg／mL）。④感染性休克Hepcidin、IL-6浓度明显高于脓毒症组（P〈0．05）。结论Hepcidin与脓毒症患者危重程度及近期临床预后密切相关，是脓毒症患者死亡的独立危险因素。

Objective To investigate the prognosis value of hepcidin in elderly patients with sepsis. Methods We performed an observational study. 77 patients with sepsis admitted to intensive care unit in Shanghai Pudong New Area Zhoupu Hospital, from March 2016 to October 2016 were collected, General information was collected after admitted to hospital. Hepcidin, interleukin -6 （IL -6） , proealcitonin （PCT） , C -reactive protein （CRP） , blood routine, sepsis related organ failure assessment （SOFA） and acute physiology and chronic health evaluation （APACHE Ⅱ ） score was collected within 12 hours after the diagnosis of sepsis. According to the 28 days outcome, patients was divided into death group and surviving group. Logistic analysis was used to determine the independent risk factors in prognosis of sepsis. Receiver - operating characteristic （OC） curve was established to analyze the independent risk factors in predicting the prognosis of sepsis. Results Hepcidin, blood lactate, IL - 6, SOFA score and APACHE Ⅱ score were significantly higher in death group than those in surviving group （P =0. O1 or P 〈0. O1 ）. （2）Logistic analysis showed hepcidin, IL - 6 and SOFA score were independent risk factors for the prognosis of sepsis （P -0.01 or P 〈0. O1 ）, the risk raito （RR）was 13.44, and its 95% CI was 2.10 - 83.27. （3）The area under curve （AUC）, sensitivity, specificity, best cutoff value of hepcidin were 0. 71, 80. 00%, 55. 77% and 1. 20 μg/mL, respectively. （4）Hepcidin and IL - 6 were significantly higher in sepsis shock group than in sepsis group （ P 〈 0.05 ）. Conclusion Hepcidin is strongly associated with the severity and outcome in patients with sepsis; hepcidin is the independent risk factors of death in sepsis patients.