血浆3-DG水平与脓毒症患者病情危重程度及临床预后的关系

To explore the relationship between plasma 3-DG level and severity of sepsis and clinical prognosis

目的:探讨血浆3-脱氧葡萄糖醛酮(3-DG)水平与脓毒症患者病情危重程度及临床预后的关联,为脓毒症患者病情及预后的评估提供参考依据。方法:选取我院收治的120例脓毒症患者及同期50例健康体检者,分别纳入观察组、对照组。检测并比较两组受试者入组时血浆3-DG水平;按照观察组患者入院28 d预后,将其分别纳入存活组、病死组,比较两组入组时、入院第3、7、14天血浆3-DG变化以及急性生理与慢性健康评分系统Ⅱ(APACHEⅡ)、Glasgow昏迷评分(GCS)、器官功能序贯衰竭评分(SOFA)、多器官损伤评分(MODS)变化,分析血浆3-DG与脓毒症患者病情评分的相关性,并应用受试者特征曲线(ROC)分析血浆3-DG预测脓毒症患者病死的价值。结果:观察组入组时血浆3-DG浓度高于对照组,差异有统计学意义(P<0.05)。入院28 d,观察组120例患者中,存活81例,病死39例,病死率为32.50%。存活组与病死组入组时、入院第3、7、14天血浆3-DG水平均持续下降,存活组入组时、入院第3、7、14天血浆3-DG水平均低于病死组,差异有统计学意义(P<0.05)。存活组与病死组入组时、入院第3、7、14天APACHEⅡ、SOFA、MODS评分均持续下降,GCS评分均持续升高,存活组入组时、入院第3、7、14天APACHEⅡ、SOFA、MODS评分均低于病死组,其GCS评分均高于后者,差异有统计学意义(P<0.05)。Pearson相关性分析示,血浆3-DG水平与脓毒症患者APACHEⅡ、SOFA、MODS评分呈正相关,与GCS评分呈负相关(P<0.05)。ROC曲线示,入组时、入院第3、7、14天血浆3-DG水平均可有效预测脓毒症患者病死风险(P<0.05),以入院第3天血浆3-DG≥326.59μg/L为截断值,其灵敏度、特异性分别为82.22%、80.35%,AUC为0.871。结论:血浆3-DG水平的升高伴随着脓毒症患者病情危重程度的加剧与病死风险的上升,早期检测血浆3-DG水平有望指导脓毒症患者的病情及预后评估。

Objective: To explore the relationship between plasma 3-deoxyglucuronide(3-DG) level and severity of sepsis and clinical prognosis, and to provide reference for the assessment of sepsis patients’ condition and prognosis. Methods: 120 sepsis patients and 50 health examinees in our hospital from January 2018 to December 2018 were enrolled in the observation group and the control group respectively. The plasma levels of 3-DG were measured and compared between the two groups at admission. According to the prognosis of 28 days after admission, the patients in the observation group were divided into survival group and fatality group. The changes of plasma 3-DG, APACHE II, Glasgow coma score(GCS) and organ function sequential decline were compared between the two groups at admission, the 3 rd day, the 7 th day and the 14 th day of admission. The correlation between plasma 3-DG and severity score of sepsis patients was analyzed by SOFA and MODS. The value of plasma 3-DG in predicting fatality of sepsis patients was analyzed by ROC. Results: The plasma concentration of 3-DG in the observation group was(296.38±52.97) μg/L, which was higher than that in the control group(91.06±22.38) μg/L, and the difference was statistically significant(P<0.05). After 28 days of hospitalization, 81 patients survived and 39 died in the observation group, with a fatality rate of 32.50%. The plasma 3-DG levels of survival group and fatality group decreased continuously on admission, 3 rd day, 7 th day and 14 th day. The plasma 3-DG levels of survival group were lower than those of fatality group on admission, 3 rd day, 7 th day and 14 th day(P<0.05). The scores of APACHE II, SOFA and MODS of survival group and fatality group decreased continuously at admission, 3 rd day, 7 th day, 14 th day, and increased continuously. The scores of APACHE II, SOFA and MODS of survival group and fatality group were lower than those of fatality group at admission, 3 rd day, 7 th day, 14 th day, and their GCS scores were higher than those of fatality group, with significant difference(P<0.05). Pearson correlation analysis showed that plasma 3-DG level was positively correlated with APACHE II, SOFA, MODS scores in sepsis patients, and negatively correlated with GCS scores(P<0.05). ROC curve showed that plasma 3-DG levels at admission, 3 rd day of admission, 7 th day of admission and 14 th day of admission could effectively predict the mortality risk of sepsis patients(P<0.05). The sensitivity and specificity of plasma 3-DG(≥326.59 μg/L) at 3 rd day of admission were 82.22%, 80.35% and AUC was 0.871, respectively. Conclusion: The increase of plasma 3-DG level is accompanied by the aggravation of the severity of sepsis and the increase of the risk of fatality. Early detection of plasma 3-DG level is expected to guide the assessment of the condition and prognosis of sepsis patients.