高迁移率族蛋白1、乳酸及降钙素原对脓毒症患者病情及预后评估价值研究

Value of high mobility group protein 1,lactic acid and procalcitonin in evaluating the condition and prognosis of patients with sepsis

目的探讨血清高迁移率族蛋白1(HMGB1)、降钙素原(PCT)及血浆乳酸(LAC)对脓毒症患者病情及28 d预后的评估价值。方法选取深圳市人民医院重症医学科自2017年1月至2019年1月收治的86例脓毒症患者为研究对象,根据患者病情严重程度分为脓毒症组(n=65)和脓毒症休克组(n=21),比较各组患者血清HMGB1、PCT及血浆LAC水平,分析上述指标与急性生理学及慢性健康状况评分Ⅱ(APACHEⅡ)的相关性;随访患者入院28 d的存活结局,根据存活结局分为存活组(n=64)和死亡组(n=22),采用受试者工作特征(ROC)曲线评价患者血清HMGB1、LAC及PCT对患者入院28 d预后情况的评估价值。结果脓毒症休克组患者HMGB1、LAC、PCT水平及APACHEⅡ评分均明显高于脓毒症组,两组间比较,差异有统计学意义(P<0.05)。死亡组患者HMGB1、LAC及PCT水平明显高于存活组,两组间比较,差异有统计学意义(P<0.05)。Pearson相关分析显示,患者血清HMGB1、PCT及血浆LAC分别与APACHEⅡ评分呈正相关(r=0.416、0.527、0.459,P=0.011、P<0.001、P=0.006)。ROC曲线分析HMGB1、LAC及PCT水平的ROC曲线下面积分别为0.759、0.800、0.764;当HMGB1≥1.12μg/L时,灵敏度为68.20%,特异度为79.70%;当LAC≥3.27 mmol/L时,灵敏度为54.50%,特异度为93.70%;当PCT≥12.93 ng/ml时,灵敏度为72.70%,特异度为76.60%。联合上述指标检测ROC曲线下面积为0.954,灵敏度为86.40%,特异度为92.20%。结论血清HMGB1、PCT及血浆LAC水平有助于评估脓毒症患者病情严重程度判断及28 d预后,但联合检测的应用价值更高。

Objective To investigate the evaluation value of serum high mobility group protein 1(HMGB1),procalcitonin(PCT)and plasma lactic acid(LAC)for conditions and 28 days prognosis of patients with sepsis.Methods A retrospective study was performed on 86 cases of patients with sepsis who were admitted in ICU from January 2017 to January 2019.According to disease severity,patietns were divided into the sepsis group(n=65)and sepsis shock group(n=21).The levels of serum HMGB1,PCT and plasma LAC were compared among all groups.The correlation between the above indexes and scores of acute physiology and chronic health status scoringⅡ(APACHEⅡ)was analyzed.The survival outcomes of patients at 28 days after admission were followed up.According to survival outcomes,patients were divided into the survival group(n=64)and death group(n=22).The evaluation value of serum HMGB1,plasma LAC and PCT for 28 days prognosis was assessed by receiver operating characteristic(ROC)curve.Results Levels of HMGB1,LAC and PCT and APACHEⅡscores in sepsis shock group were significantly higher than that of sepsis group,and the difference was statistically significant(P<0.05).The levels of HMGB1,LAC and PCT in the death group were significantly higher than those in the survival group(P<0.05).Pearson correlation analysis showed that patients with serum HMGB1,PCT and plasma LAC with APACHEⅡscores were positively correlated,respectively(r=0.416,0.527,0.459,P=0.011,P<0.001,P=0.006).The area under the ROC of HMGB1,LAC and PCT levels in ROC analysis were 0.759,0.800 and 0.764,respectively.When HMGB1≥1.12 g/L,the sensitivity and specificity were 68.20%and 79.70%,respectively.When LAC≥3.27 mmol/L,the sensitivity and specificity were 54.50%and 93.70%,respectively.When PCT≥12.93 ng/ml,the sensitivity and specificity were 72.70%and 76.60%,respectively.Combined with the above indicators,the area under the ROC was 0.954,the sensitivity was 86.40%and specificity was 92.20%.Conclusion Serum HMGB1,PCT and plasma LAC levels are helpful to assess the severity of sepsis patients and determine the prognosis at 28 days,but combined detection is of higher application value.