应用组织型纤溶酶原激活物-抑制剂复合物评价脓毒症严重程度的临床价值

Clinical value of tissue-type plasminogen activator-inhibitor complexes to evaluate the severity of sepsis

目的内毒素和低灌注可导致脓毒症患者血管内皮细胞损害,进而引起组织型纤溶酶原激活物-抑制剂复合物(t-PAIC)水平显著升高。文中探讨t-PAIC用于评价脓毒症严重程度的临床价值。方法选择2018年5月至2019年10月解放军联勤保障部队第九〇八医院重症医学科收治的163例脓毒症患者,按照脓毒症3.0诊断标准分为脓毒症组(n=104)和脓毒性休克组(n=59),比较2组患者的t-PAIC水平变化。结果与脓毒症组患者[10.75(7.10~16.30)ng/mL]相比,脓毒性休克组患者的t-PAIC[35.20(18.60~48.10)ng/mL]显著升高(P<0.001)。Spearson相关分析显示脓毒症患者乳酸水平、序贯器官衰竭评分(SOFA)与t-PAIC水平均呈正相关(r分别为0.56、0.50,P<0.001)。单因素logistic回归显示,t-PAIC(OR=1.11,95%CI 1.071~1.144,P<0.001)与脓毒性休克的发生相关。t-PAIC诊断脓毒性休克的曲线下面积为0.858(P<0.001),灵敏度、特异度、阳性预测值和阴性预测值分别为0.780、0.788、0.676、0.863。根据其Cut-off值分组显示t-PAIC<18.2 ng/mL的急性生理与慢性健康评分、SOFA评分、乳酸水平及弥散性血管内凝血发生率较t-PAIC≥18.2 ng/mL组患者明显降低(P<0.05),且t-PAIC<18.2 ng/mL的生存率较t-PAIC≥18.2 ng/mL组患者升高约2.2倍。结论t-PAIC与脓毒症严重程度相关。t-PAIC≥18.2 ng/mL脓毒症患者病死率明显升高。

Objective Sepsis patients with bacterial endotoxin and low perfusion can lead to vascular endothelial cell damage,resulting in a significant increase of the the tissue-type plasminogen activator-inhibitor complexes(tPAIC)levels.In this paper,we discuss the clinical value of tPAIC to evaluate the severity of sepsis.Methods A total of 163 sepsis patients admitted to the ICU Department of the 908th Hospital of the Chinese PLA Joint Logistic Support Force from May 2018 to October 2019 were analyzed.They were divided into two groups according to 3.0 criteria for the diagnosis of sepsis:sepsis group(n=104)and septic shock group(n=59),and the tPAIC level changes were compared in these two groups.Results tPAIC[35.20(18.60-48.10 ng/mL)]was significantly higher(P<0.001)in the patients with sepsis shock group[10.75(7.10-16.30 ng/mL)],compared to patients with septic group.Spearson correlation analysis showed that both lactic acid levels in patients with sepsis and sequential organ failure assessment(SOFA)were positively correlated with tPAIC levels(r as 0.56 and 0.50 respectively,P<0.001).Single factor logistic regression showed that tPAIC(OR=1.11,95%CI 1.071 to 1.144,P<0.001)was associated with the occurrence of septic shock.tPAIC area under the curve of the diagnosis of septic shock was 0.858(P<0.001),and the sensitivity,specificity,positive predictive value and negative predictive value was 0.780,0.788,0.676,0.863,respectively.The Cut-off showed that the acute physiology and chronic health evaluation,SOFA,lactic acid levels and the incidence of diffuse intravascular coagulation of tPAIC<18.2 ng/mL decreased significantly compared to those of the tPAIC<18.2 ng/mL(P<0.05),and the survival rate of the patients in tPAIC<18.2 ng/mL increased 2.2 times than that of the patients in tPAIC≥18.2 ng/mL.Conclusion tPAIC is associated with sepsis severity and the fatality rate of the sepsis patients in the tPAIC acuity 18.2 ng/mL increased significantly.