血清sRAGE、HbA_(1C)表达与脓毒症患者应激性高血糖及其预后相关性

Correlation of serum sRAGE and HbA_(1C) expression with stress hyperglycemia and prognosis in patients with sepsis

目的探究血清可溶性晚期糖基化终末产物受体(sRAGE)、糖化血红蛋白(HbA_(1C))水平与脓毒症患者并发应激性高血糖(SHG)及其预后的关系。方法选取诊治的135例脓毒症患者为研究对象,按脓毒症患者发病24 h内是否发生SHG将其分为SHG组(56例)和正常血糖组(79例)。比较两组一般资料;应用酶联免疫吸附法(ELISA)检测血清sRAGE水平;采用高效液相色谱法检测血清HbA_(1C)水平;比较两组患者28 d死亡率;比较不同预后脓毒症并发SHG患者血清sRAGE、HbA_(1C)水平;利用受试者工作特征(ROC)曲线评估血清sRAGE、HbA_(1C)水平对脓毒症并发SHG患者死亡的预测价值。结果与正常血糖组相比,SHG组患者急性生理与慢性健康评定量表Ⅱ(APACHEⅡ)评分、血清sRAGE、HbA_(1C)水平、序贯器官衰竭评估(SOFA)评分、28 d死亡率均明显升高(P<0.05);与存活组相比,死亡组脓毒症并发SHG患者血清sRAGE、HbA_(1C)水平均明显升高(P<0.05);血清sRAGE、HbA_(1C)预测脓毒症并发SHG患者死亡的曲线下面积(AUC)分别为0.826、0.859,截断值分别为1.70 ng/mL、9.47%,相应敏感度分别为76.7%、73.3%,特异度分别为80.8%、84.6%;两者联合预测脓毒症并发SHG患者死亡的AUC为0.904,其敏感度、特异度分别为86.7%、80.2%。结论血清sRAGE、HbA_(1C)水平升高均与脓毒症并发SHG患者不良预后关系密切,检测血清sRAGE、HbA_(1C)水平有利于临床判定脓毒症并发SHG患者的预后。

Objective To investigate the correlations of levels of serum soluble receptor for advanced glycation end products(sRAGE)and glycosylated hemoglobin A1c(HbA_(1C))with stress hyperglycemia(SHG)and prognosis in sepsis patients.Methods From July 2018 to June 2020,135 patients with sepsis who were treated in our hospital were selected as the research objects,and they were divided into SHG group(56 cases)and normal blood glucose group(79 cases)according to whether SHG occurred within 24 hours after the onset of sepsis.The general data of the two groups were compared.The level of serum sRAGE was assessed by enzyme-linked immunosorbent assay(ELISA).The level of serum HbA_(1C) was assessed by high-performance liquid chromatography.The 28-day mortality of the two groups was compared;so were the levels of serum sRAGE and HbA_(1C) in patients with sepsis complicated with SHG.Receiver operating characteristic(ROC)curve was used to evaluate the predictive values of serum sRAGE and HbA_(1C) levels in patients with sepsis complicated with SHG.Results Compared with those in the normal blood glucose group,the Acute Physiology And Chronic Health EvaluationⅡ(APACHEⅡ)score,serum sRAGE and HbA_(1C) levels,Sequential Organ Failure Assessment(SOFA)score and 28-day mortality rate in SHG group were significantly higher(P<0.05).Compared with those in the survival group,the levels of serum sRAGE and HbA_(1C) in the death group were significantly higher than those in the survival group(P<0.05).The areas under the curve(AUC)of serum sRAGE and HbA_(1C) in predicting the death of sepsis complicated with SHG was 0.826 and 0.859,respectively;with the cut-off value of 1.70 ng/mL and 9.47%,the corresponding sensitivities were 76.7%and 73.3%,respectively,and the specificities were 80.8%and 84.6%,respectively.The AUC of the combined diagnosis was 0.904,and the sensitivity and specificity were 86.7%and 80.2%,respectively.Conclusion The increased levels of serum sRAGE and HbA_(1C) are closely correlated to the poor prognosis of patients with sepsis complicated with SHG.The detection of serum sRAGE and HbA_(1C) levels is helpful to determine the prognosis of patients with sepsis complicated with SHG.