肾上腺髓质素前体中段肽水平对脓毒症患者诊断及预后的评估价值

Value of serum mid-regional proadrenomedullin levels for the diagnosis and prognosis evaluation of sepsis patients

目的探讨血清肾上腺髓质素前体中段肽(MR-proADM)水平对脓毒症患者诊断及预后预测的价值。方法选择重症加强治疗病房成人脓毒症患者82例作为患者组,根据患者病情严重程度分为脓毒症亚组24例、严重脓毒症组32例、脓毒性休克组26例;同时选择同期60例健康体检者作为健康组。检测健康组和患者组患者入院24 h内血清MR-proADM、降钙素原(PCT)水平,记录脓毒症患者急性生理学与慢性健康状况评分系统Ⅱ(APACHEⅡ)评分及28 d预后,并进行各组间比较。采用Pearson相关分析MRproADM与PCT、APACHEⅡ评分的相关性;绘制受试者工作特征曲线(ROC)分析MR-proADM、PCT诊断脓毒症和评估预后的价值。结果患者组血清MR-proADM、PCT水平均明显高于健康组(P均<0. 05),且随着脓毒症病情的加重,患者血清MR-proADM、PCT水平逐渐升高。脓毒症患者中28 d死亡22例(26. 7%),其中脓毒症亚组3例(12. 5%)、严重脓毒症组7例(21. 9%)、脓毒性休克组12例(46. 2%)。脓毒症患者血清MR-proADM水平与PCT、APACHEⅡ评分均呈正相关(r=0. 852,0. 740,P均<0. 05)。ROC曲线分析显示,MR-proADM、PCT诊断脓毒症的ROC曲线下面积(AUC)和95%可信区间(95%CI)分别为0. 881[0. 826,0. 937]、0. 847[0. 78,0. 914],P均<0. 05; MR-proADM截断值> 1. 5 nmol/L时诊断脓毒症的敏感度为81. 7%,特异度为80. 5%,与PCT相当。MR-proADM评估预后的AUC明显高于PCT(0. 945比0. 816,P <0. 05);当MR-proADM截断值为4.16 nmol/L时评估预后的敏感度为89.4%,特异度为89.2%。结论 MRproADM可作为诊断及评估脓毒症患者预后的生物标志物之一。

Objective It is to investigate the value of mid-regional proadrenomedullin(MR-proADM)in diagnosis and prognosis in patients with sepsis.Methods A total of 82 patients with sepsis treated in intensive care unit(ICU)were selected as the patient group,and they were divided into three groups:sub sepsis group(n=24),severe sepsis group(n=32)and septic shock group(n=26),and 60 healthy persons were enrolled as control group.The levels of serum MR-proADM,procalcitonin(PCT)were detected in the healthy group and patient group,and the acute physiology and chronic health evaluationⅡ(APACHEⅡ)score,and 28-day prognosis of the sepsis patients were recorded.Pearson correlation analysis was used to analyze the correlation between MR-proADM and PCT and APACHEⅡscores.The receiver operating characteristic curve(ROC)was used to analyze the value of MR-proADM,PCT in the diagnosis of sepsis and assessment of prognosis.Results The levels of serum MR-proADM and PCT were significantly higher in the patient group than those in the healthy group(P<0.05),and the levels of serum MR-proADM and PCT increased gradually with the severity of sepsis increasing.Twenty-two patients(26.7%)died in the patient group within 28 days,including 3 cases(12.5%)in the subsepsis group,7 cases(21.9%)in the severe sepsis group,and 12 cases(46.2%)in the septic shock group.The levels of serum MR-proADM were positively correlated with PCT and APACHEⅡscores in patients with sepsis(r=0.852,0.740,P<0.05).ROC curve analysis showed that the area under the ROC curve(AUC)and 95%confidence interval(95%CI)for MR-proADM and PCT diagnosis of sepsis were 0.881[0.826,0.937],0.847[0.78,0.914],respectively,P all<0.05;the sensitivity of diagnosis of sepsis with MR-proADM cut-off value>1.5 nmol/L was 81.7%,and the specificity was 80.5%,which was equivalent to PCT.The prognostic AUC of MR-proADM was significantly higher than that of PCT(0.945 vs 0.816,P<0.05).When the cutoff value of MR-proADM was 4.16 nmol/L,the prognostic sensitivity was 89.4%and the specificity was 89.2%.Conclusion MR-proADM can be used as a biomarker for the diagnosis and evaluation of the prognosis of patients with sepsis.