老年脓毒症相关性脑病患者预后相关血清标志物表达的临床意义

Clinical significance of prognostic serum marker expression in older adult patients with sepsis-associated encephalopathy

目的探讨老年脓毒症相关性脑病(SAE)患者预后相关血清标志物表达的临床意义。方法采用回顾性研究的方法,分析2019年6月至2021年2月合肥市第二人民医院收治的老年SAE患者79例(研究组)和同期未发生脑病的脓毒症患者121例(对照组)的临床资料,将上述两组差异有统计学意义的指标进行二分类logistic多因素回归分析并绘制生存曲线。结果对照组、研究组的神经元特异性烯醇化酶(NSE)分别为(10.69±4.31)μg/L、(24.84±3.28)μg/L,中枢神经特异蛋白β(S100β)分别为(0.25±0.06)μg/L、(0.53±0.09)μg/L,单核细胞趋化蛋白-1(MCP-1)分别为(99.33±4.87)ng/L、(179.99±6.02)ng/L,丙二醛(MDA)分别为(4.22±0.08)nmol/L、(6.78±0.11)nmol/L,胶质纤维酸性蛋白(GFAP)分别为(0.21±0.08)μg/L、(2.03±0.47)μg/L,降钙素原(PCT)分别为(7.04±2.50)ng/L、(16.23±2.48)ng/L,白细胞介素6(IL-6)分别为(29.91±4.51)ng/L、(69.22±6.79)ng/L,氨基末端脑钠肽前体(NT-proBNP)分别为(868.38±25.28)ng/L、(1037.19±25.34)ng/L,急性生理学与慢性健康状况评价Ⅱ(APACHEⅡ评分)分别为(18.33±2.12)分、(28.89±5.09)分,序贯器官衰竭评分(SOFA评分)分别为(7.69±1.50)分、(14.05±1.55)分。两组患者NSE、S100β、MCP-1、MDA、GFAP、PCT、IL-6、APACHEⅡ评分、SOFA评分差异均有统计学意义(NSE:t=26.25,P<0.01;S100β:t=22.45,P<0.01;MCP-1:t=99.94,P<0.01;MDA:t=33.76,P<0.01;GFAP:t=33.76,P<0.01;PCT:t=25.47,P<0.01;IL-6:t=45.51,P<0.01;APACHEⅡ:t=17.53,P<0.01;SOFA:t=28.92,P<0.01)。logistic回归分析NSE、MCP-1、MDA、GFAP是老年SAE发生的独立危险因素(NSE:t=8.42,P<0.01;MCP-1:t=4.16,P<0.01;MDA:t=18.4,P<0.01;GFAP:t=2.88,P<0.01)。生存曲线提示研究组生存率明显低于对照组。结论NSE、MCP-1、MDA、GFAP是老年SAE发生的独立危险因素。

Objective To investigate the clinical significance of prognostic serum marker expression in older adult patients with sepsis-associated encephalopathy(SAE).Methods The clinical data of 79 older adult patients with SAE who received treatment in The Second People's Hospital of Hefei from June 2019 to February 2021(study group)and 121 sepsis patients without encephalopathy concurrently(control group)were retrospectively analyzed.The indexes with statistically significant difference between the two groups were subjected to multivariate binary logistic regression.Survival curve was plotted.Results There were no significant differences in neuron specific enolase[NSE,(10.69±4.31)μg/L vs.(24.84±3.28)μg/L,t=26.25,P<0.01],S100β[(0.25±0.06)μg/L vs.(0.53±0.09)μg/L,t=22.45,P<0.01],monocyte chemoattractant protein-1[MCP-1,(99.33±4.87)ng/L vs.(179.99±6.02)ng/L,t=99.94,P<0.01],malondialdehyde[MDA,(4.22±0.08)nmol/L vs.(6.78±0.11)nmol/L,t=33.76,P<0.01],glial fibrillary acidic protein[GFAP,(0.21±0.08)μg/L vs.(2.03±0.47)μg/L,t=33.76,P<0.01],procalcitonin[(7.04±2.50)ng/L vs.(16.23±2.48)ng/L,t=25.47,P<0.01],interleukin-6[(29.91±4.51)ng/L vs.(69.22±6.79)ng/L,t=45.51,P<0.01],Acute Physiology and Chronic Health Evaluation II(APACHE II)score[(18.33±2.12)points vs.(28.89±5.09)points,t=17.53,P<0.01],and sequential organ failure assessment score[(7.69±1.50)points vs.(14.05±1.55)points,t=28.92,P<0.01]between the control and study groups.N-terminal pro B-type natriuretic peptide was(868.38±25.28)ng/L and(1037.19±25.34)ng/L in the control and study groups,respectively.Logistic regression analysis revealed that NSE,MCP-1,MDA,and GFAP were the independent risk factors for developing SAE in older adults(NSE:t=8.42,P<0.01;MCP-1:t=4.16,P<0.01;MDA:t=18.4,P<0.01;GFAP:t=2.88,P<0.01).The survival curve indicated that survival rate was significantly lower in the study group than in the control group.Conclusion NSE,MCP-1,MDA,and GFAP are independent risk factors for developing SAE in older adults.