脓毒症幸存者出院时血清胰岛素样生长因子2水平与长期认知障碍的相关性研究

Study of correlation between the level of serum insulin-like growth factor-2 at discharge and long-term cognitive impairment in sepsis survivors

目的探讨脓毒症幸存者出院时血清胰岛素样生长因子2(IGF-2)水平与长期认知障碍的关系。方法选取2016年3月至2019年6月在海南医学院第二附属医院东湖分院治疗并幸存出院的152例脓毒症患者为研究对象,在出院后1年时运用蒙特利尔认知评估(MoCA)量表评估其认知能力水平。依据出院后1年时是否存在认知障碍将患者分为认知障碍组(32例)和认知正常组(120例)。收集并比较2组患者的临床资料及出院时血清IGF-2水平。采用Pearson相关分析方法分析脓毒症幸存者血清IGF-2水平与MoCA评分的相关性;应用多因素Logistic回归模型分析脓毒症幸存者长期认知障碍的影响因素;绘制受试者工作特征(ROC)曲线评估各指标对脓毒症幸存者长期认知障碍的预测价值。结果本研究中脓毒症幸存者长期认知障碍发生率为21.1%(32/152)。认知障碍组患者年龄、合并糖尿病比例、序贯器官衰竭估计(SOFA)评分、脓毒性休克比例、急性呼吸窘迫综合征比例及谵妄比例明显大于/高于认知正常组,而受教育年限、血清IGF-2水平明显少于/低于认知正常组(均P<0.05)。Pearson相关分析显示,脓毒症幸存者血清IGF-2水平与MoCA量表评分呈显著正相关(r=0.534,P<0.001)。多因素Logistic回归分析结果显示,年龄(比值比=1.069,95%置信区间:1.018~1.122,P=0.007)、SOFA评分(比值比=1.823,95%置信区间:1.306~2.546,P<0.001)、血清IGF-2水平(比值比=0.986,95%置信区间:0.979~0.993,P<0.001)及谵妄(比值比=7.467,95%置信区间:2.187~25.487,P=0.001)均为脓毒症幸存者长期认知障碍的独立影响因素。ROC曲线分析结果显示,血清IGF-2水平预测脓毒症幸存者长期认知障碍的AUC明显大于SOFA评分、年龄及谵妄(0.806比0.671、0.674、0.632,Z=2.060、1.962、2.862,P=0.039、0.047、0.004)。当血清IGF-2水平截点为229.6μg/L时,预测长期认知障碍的敏感度为71.9%,特异度为80.0%。结论血清IGF-2水平与脓毒症幸存者长期认知障碍密切相关,对长期认知障碍具有较高的预测价值。

Objective To explore the correlation between the level of serum insulin-like growth factor-2(IGF-2)at discharge and long-term cognitive impairment in sepsis survivors.Methods A total of 152 sepsis patients treated and discharged from Donghu Branch of the Second Affiliated Hospital of Hainan Medical University from March 2016 to June 2019 were selected.The cognitive function of the patients were assessed by the Montreal Cognitive Assessment(MoCA)1 year after discharge.The patients were divided into the cognitive impairment group(n=32)and cognitive normal group(n=120)according to whether there was cognitive impairment 1 year after discharge.The clinical data and the level of serum IGF-2 at discharge were collected and compared between the two groups.Pearson correlation analysis was used to explore the correlation between the level of IGF-2 and the MoCA score in sepsis survivors.Multivariate Logistic regression model was used to analyze the influence factors associated with long-term cognitive impairment in sepsis survivors.Receiver operating characteristic(ROC)curve was used to evaluate the predictive value of each marker for long-term cognitive impairment in sepsis survivors.Results The incidence of long-term cognitive impairment in this study was 21.1%(32/152).The age,proportion of diabetes,Sepsis-related Organ Failure Assessment(SOFA)score,proportion of septic shock,proportion of acute respiratory distress syndrome and proportion of delirium in the cognitive impairment group were significantly greater/higher than those in the cognitive normal group,while the education period and the level of serum IGF-2 in the cognitive impairment group was significantly less/lower than those in the cognitive normal group(all P<0.05).Pearson correlation analysis showed that the level of IGF-2 was positively correlated with MoCA score(r=0.534,P<0.001).Multivariate Logistic regression analysis showed that age[odds ratio(OR)=1.069,95%confidence interval(CI):1.018-1.122,P=0.007,SOFA score(OR=1.823,95%CI:1.306-2.546,P<0.001),IGF-2(OR=0.986,95%CI:0.979-0.993,P<0.001)and delirium(OR=7.467,95%CI:2.187-25.487,P=0.001)]were independent influence factors of long-term cognitive impairment in sepsis survivors.ROC curve analysis showed that the area under curve of serum IGF-2 level was significantly greater than that of SOFA score,age and delirium(0.806 vs 0.671,0.674,0.632;Z=2.060,1.962,2.862;P=0.039,0.047,0.004).When the cut-off point of serum IGF-2 was 229.6μg/L,the sensitivity and specificity to predict cognitive impairment were 71.9%and 80.0%,respectively.Conclusion The level of serum IGF-2 is closely related to long-term cognitive impairment in sepsis survivors,and has a high predictive value for long-term cognitive impairment.