外周血成纤维细胞生长因子-21在脓毒症及感染性休克中的表达

Expression of plasma FGF-21 in sepsis and septic shock

目的探讨脓毒症患者外周血成纤维细胞生长因子-21(FGF-21)的表达,及其在感染性休克方面的预测作用.方法采用前瞻性对照研究,根据诊断标准将病例分为脓毒症非感染性休克组(简称脓毒症组)、感染性休克组,检测并记录观察指标.采用ELISA法检测受试者血浆FGF-21表达水平,并与相关指标作比较,结果进行统计学分析.结果本研究最终纳入符合脓毒症诊断标准的急诊科患者41例,其中感染性休克组16例,脓毒症非感染性休克组25例,另取正常成人对照组20例.与正常对照组(pg/mL:36.38±18.83)相比,脓毒症非感染性休克患者(pg/mL:280.97±230.90)血浆FGF-21水平升高,差异有统计学意义(P<0.05);与脓毒症非感染性休克患者相比,感染性休克患者(pg/mL:931.95±590.90)血浆FGF-21水平升高,差异有统计学意义(P<0.05);逻辑回归结果显示,FGF-21和SOFA评分可作为脓毒症患者发生感染性休克的独立预测因子;FGF-21预测感染性休克的ROC曲线下面积(AUC)为0.870(95%CI0.763~0.977).结论脓毒症患者血FGF-21表达水平升高,且其水平与PCT、动脉血乳酸、SOFA评分和APACHEⅡ评分具有良好相关性;FGF-21、SOFA评分可作为感染性休克的独立预测因子,FGF-21有望作为急诊室诊断脓毒症和感染性休克富有价值的生物学标志物.

Objective To investigate the expression of fibroblast growth factor-21(FCF-21)in the patients with sepsis and its predictive effect on septic shock.Methods A prospective controlled study was conducted.The patients were divided into sepsis non-septic shock group(sepsis group),septic shock group according to the diagnostic criteria.The observation index was recorded and detected.The expression of FGF-21 in the plasma was measured by ELISA and compared with the related indexes.The results were analyzed statistically.Results A total of 41 consecutive patients with sepsis were divided into two groups.16 of them were septic shock,and 25 were sepsis but non-septic shock.Another 20 normal adults were involved as control group.Compared with the normal control group(36.38±18.83)pg/mL,the plasma FGF-21 level in the patients with sepsis increased(280.97±230.90)pg/mL and the difference was statistically significant(P<0.05).Compared with sepsis group,plasma FGF-21 was increased in septic shock group(931.95±590.90)pg/mL,and the difference was statistically significant(P<0.05),Logistic regression analysis showed that FGF-21 and SOFA scores were considered as independent predictors of septic shock in the patients with sepsis.The area under the ROC curve of FCF-21 predicting septie shock was 0.870(95%CI0.763-0.977).Conclusion The expression of FCF-21 in sepsis patients is higher than that in normal subjects.Its expression is well correlated with PCT,arterial lactic acid,SOFA score and APACHE II score.FGF-21 and SOFA score can be used as independent predictors of septic shock.FGF-21 is expected to serve as a valuable biomarker for the diagnosis of sepsis and septic shock in the emergency room.