心外科ICU患者术后感染血清降钙素原、PSGL-1、sICAM-1与心肌肌钙蛋白Ⅰ的变化及意义

Changes and significance of serum procalcitonin,PSGL-1,sICAM-1 and cardiac troponin Ⅰ levels in patients with ICU after cardiac surgery

目的探讨心外科ICU患者术后感染血清降钙素原(PCT)、P-选择素糖蛋白配体1(PSGL-1)、可溶性细胞间粘附因子-1(sICAM-1)与心肌肌钙蛋白I(cTnⅠ)的变化及意义。方法选取本院2016年1月至2019年3月心外科ICU患者108例,根据术后是否发生感染分为感染组37例、未感染组71例,另选择同期健康体检者48例作为对照组。比较3组血清PCT、PSGL-1、sICAM-1、cTnⅠ水平,Logistic回归分析心外科ICU患者术后感染的影响因素,Pearson相关性分析血清PCT、PSGL-1、sICAM-1与cTnⅠ关联性,对比感染组不同预后患者血清PCT、PSGL-1、sICAM-1、cTnⅠ水平,受试者工作特征(ROC)曲线分析各血清因子对预后的预测价值,采用Kaplan-Meier曲线进行生存分析。结果感染组血清PCT、PSGL-1、sICAM-1、cTnⅠ水平高于未感染组、对照组差异有统计学意义(P<0.05);合并基础性疾病、血清PCT、PSGL-1、sICAM-1、cTnⅠ是心外科ICU患者发生术后感染的独立危险因素(P<0.05);血清PCT、PSGL-1、sICAM-1与cTnⅠ呈正相关(P<0.05);感染第3、5天生存者血清PCT、PSGL-1、sICAM-1、cTnⅠ水平低于死亡者(P<0.05);感染第5 d cTnⅠ预测心外科ICU患者术后感染预后的AUC值最大,为0.804;随访28 d,血清PCT、PSGL-1、sICAM-1、cTnⅠ低危组、高危组的生存曲线对比,差异有统计学意义(P<0.05)。结论心外科ICU患者术后感染会引起血清PCT、PSGL-1、sICAM-1、c TnI异常表达,且表达水平与感染发生发展及预后有一定相关性,临床可通过监测上述血清因子表达超早期予以干预治疗,以改善预后。

Objective To investigate the serum levels of procalcitonin(PCT),P-selectin glycoprotein ligand 1(PSGL-1),soluble intercellular adhesion factor-1(sICAM-1),and postoperative infection in patients with cardiac surgery in ICU,and changes and significance of cardiac troponin Ⅰ(cTnⅠ).Methods From January 2016 to March 2019,108 patients with ICU were selected from our hospital.According to whether postoperative infection occurred,they were divided into 37 cases in the infected group and71 cases in the non-infected group,and 48 healthy patients in the same period as the control group. The serum PCT,PSGL-1,sICAM-1,and cTnⅠ levels of the three groups were compared. Logistic regression analysis was used to analyze the influencing factors of postoperative infection in patients with cardiac surgery ICU. The serum PCT,PSGL-1,s ICAM-1,and cTnⅠ levels of patients with different prognosis in the infected group were compared. The receiver operating characteristic(ROC)curve was used to analyze the predictive value of each serum factor for prognosis,and Kaplan-Meier curve was used for survival analysis. Results Serum PCT,PSGL-1,sICAM-1,cTnⅠ levels in the infected group were higher than those in the uninfected group and the control group(P<0.05). Combining basic diseases, serum PCT,PSGL-1,sICAM-1,and c TnI were independent risk factors for postoperative infection in cardiac surgery in ICU patients(P<0.05). Serum PCT,PSGL-1,s ICAM-1 were positively correlated with cTnⅠ(P<0.05). Serum PCT,PSGL-1,sICAM-1,and cTnⅠ levels of survivors on the 3 rd and 5 th day of infection were lower than those who died(P<0.05). On the5 th day of infection,cTnⅠ predicted the maximum AUC value of cardio-surgical infection prognosis after ICU patients,which was 0.804. After 28 days of follow-up,the differences in the survival curves of serum PCT,PSGL-1,s ICAM-1,and cTnⅠ in the low-risk group and the high-risk group were statistically significant(P<0.05). Conclusion Postoperative infection in patients with cardiac surgery in ICU will cause abnormal expression of serum PCT,PSGL-1,sICAM-1,cTnⅠ,and the expression level has a certain correlation with the development and prognosis of infection. Clinical intervention can be carried out by monitoring the serum factor expression in the early stage to improve the prognosis.