肝素结合蛋白联合人体抗菌肽LL-37对脓毒症患者预后的评估价值

The value of heparin-binding protein combined with human antibacterial peptide LL-37 in evaluating the prognosis of patients with sepsis

目的检测脓毒症患者外周血中肝素结合蛋白(HBP)和人体抗菌肽LL-37的水平,并探讨其对脓毒症患者的预后价值。方法收集重症医学科(ICU)收治的脓毒症患者(脓毒症组,n=46)、脓毒性休克患者(脓毒性休克组,n=27)和同时期的健康体检志愿者(对照组,n=30);记录患者的性别、年龄、入院时间、入院24 h内的血培养结果和器官衰竭情况。采用免疫比浊法检测降钙素原、血乳酸和C反应蛋白的水平,记录APACHEⅡ、SOFA评分;酶联免疫吸附试验检测患者外周血HBP和人体抗菌肽LL-37的水平;治疗28 d后根据临床转归将患者分为存活组和死亡组;受试者工作曲线分析HBP、人体抗菌肽LL-37单独及联合检测对脓毒症预后的评估价值。结果脓毒症组、脓毒性休克组和对照组患者在性别和年龄方面差异无统计学意义(P>0.05),脓毒性休克组血培养阳性率和器官衰竭数均高于脓毒症组(P<0.05);脓毒症组和脓毒性休克组降钙素原、C反应蛋白、血乳酸、APACHEⅡ、SOFA评分及HBP、LL-37的水平均高于对照组,且随着感染程度的加重呈逐渐升高趋势,差异有统计学意义(P<0.001);死亡组和存活组中血清中降钙素原和C反应蛋白的水平差异无统计学意义(P>0.05),死亡组患者的血乳酸水平高于存活组(P<0.05)。死亡组患者APACHEⅡ和SOFA评分均高于存活组,差异有统计学意义(P<0.001),血清中HBP和LL-37的水平均高于存活组(P<0.001);HBP和LL-37联合检测对脓毒症预后估测的敏感度(90.7%)分别高于HBP(75.4%)和LL-37(62.4%)的单独检测。结论脓毒症患者血清中HBP和LL-37的水平明显升高,联合检测更有利于评估脓毒症患者的预后。

Objective To assess the levels of heparin-binding protein and human antibacterial peptide LL-37 in peripheral blood of patients with sepsis and to investigate its prognostic value in patients with sepsis. Methods Patients with sepsis who were treated in the Department of Critical Care Medicine(ICU) from January 2016 to December 2018, and volunteers who were in our hospital for physical examination were enrolled. The patient′s gender, age, time of admission, blood culture results and organ failure within 24 hours of admission were recorded. The levels of procalcitonin, blood lactate and C-reactive protein were assessed by immunoturbidimetry, and APACHE II and SOFA scores were recorded. Enzyme-linked immunosorbent assay(ELISA) was used to assessed the levels of peripheral blood heparin-binding protein and human antibacterial peptide LL-37. After 28 days treatment, the patients were divided into survival group and death group according to clinical outcome. The receiver operating curve was used to analyze the prognostic value of heparin-binding protein, human antibacterial peptide LL-37 alone and combined detection. Results A total of 46 patients with sepsis, 27 patients with septic shock and 30 healthy volunteers were screened. There were no significant differences in gender or age among the three groups(P>0.05). The positive rate of blood culture and organ failure in patients with septic shock were significantly higher than those in the sepsis group(P<0.05). The levels of procalcitonin, c-reactive protein, blood lactate, APACHE Ⅱ, SOFA score, and HBP, LL-37 in the sepsis group and the septic shock group were significantly higher than those in the control group, and gradually increased with the severity of infection(P<0.001). The serum levels of procalcitonin, c-reactive protein and blood lactate in the death group were significantly higher than those in the survival group(P<0.05), and the APACHE Ⅱ and SOFA scores were significantly higher than those in the surviving group(P<0.001). The levels of HBP and LL-37 were higher than those of the survival group(P<0.001). The combined sensitivity of HBP and LL-37 for the prognosis of sepsis was significantly higher than that of the separate test. Conclusion The levels of HBP and LL-37 in serum of patients with sepsis are significantly increased. Combined detection is more beneficial to evaluate the prognosis of patients with sepsis.