肌肉超声和血浆单核细胞趋化蛋白-1对脓毒症ICU获得性衰弱的诊断价值

Diagnostic accuracy of muscle ultrasound and plasma monocyte chemoattractant protein-1 for ICU-acquired weakness in patients with sepsis

目的探讨肌肉超声参数和血浆单核细胞趋化蛋白-1(MCP-1)水平对脓毒症ICU获得性衰弱(ICU-AW)的诊断价值。方法采用前瞻性观察性研究方法,纳入2021年4月至10月河南省人民医院重症医学科收治的脓毒症患者作为研究对象。记录患者的一般资料,每天对纳入患者采用医学研究委员会(MRC)的肌力评分标准进行评分,直至转出重症监护病房(ICU),期间连续2次且间隔24 h总MRC评分<48分的患者纳入ICU-AW组,≥48分者纳入非ICU-AW组。使用超声测量患者入ICU 1、4、7 d股直肌厚度(RF-MLT)、股直肌横截面积(RF-CSA)及股中间肌厚度(VI-MLT);同期收集患者血浆样本,采用酶联免疫吸附试验(ELISA)检测MCP-1水平。比较两组患者各项指标的差异;采用二元Logistic回归法分析脓毒症患者发生ICU-AW的危险因素;绘制受试者工作特征曲线(ROC曲线),分析超声参数和血浆MCP-1水平对脓毒症ICU-AW的诊断价值。结果共纳入99例脓毒症患者,其中非ICU-AW组68例,ICU-AW组31例。与非ICU-AW组相比,ICU-AW组患者年龄更大,序贯器官衰竭评分(SOFA)、急性生理学与慢性健康状况评分Ⅱ(APACHEⅡ)、脓毒性休克比例和血乳酸更高,格拉斯哥昏迷评分(GCS)更低;二元Logistic回归分析显示,APACHEⅡ评分和脓毒性休克是脓毒症患者发生ICU-AW的危险因素〔优势比(OR)及95%可信区间(95%CI)分别为1.310(1.138~1.509)、0.232(0.072~0.746),均P<0.05〕。脓毒症患者入ICU 1、4、7 d RF-MLT、RF-CSA和VI-MLT均随时间延长逐渐降低;与非ICU-AW组相比,ICU-AW组患者7 d RF-MLT更低〔cm:0.32(0.22,0.47)比0.45(0.34,0.63),P<0.05〕,7 d RF-CSA萎缩率更高〔25.85%(10.37%,34.28%)比11.65%(2.28%,22.41%),P<0.05〕;ROC曲线分析显示,7 d RF-MLT对脓毒症ICU-AW有诊断价值,ROC曲线下面积(AUC)为0.688(95%CI为0.526~0.849),当临界值为0.41 cm时,敏感度为66.7%,特异度为68.4%。ICU-AW组患者入ICU 1、4、7 d血浆MCP-1水平均较非ICU-AW组显著升高;ROC曲线分析显示,1、4、7 d血浆MCP-1对脓毒症ICU-AW均具有诊断价值,AUC及95%CI分别为0.732(0.629~0.836)、0.865(0.777~0.953)、0.891(0.795~0.986);当临界值分别为206.3、410.9、239.5 ng/L时,敏感度分别为87.1%、64.0%、82.4%,特异度分别为54.4%、96.1%、86.2%。结论超声测量的7 d肌肉质量参数及血浆MCP-1水平对脓毒症ICU-AW均具有一定的诊断价值。

Objective To explore the diagnostic accuracy of muscle ultrasound and plasma monocyte chemoattractant protein-1(MCP-1)for ICU-acquired weakness(ICU-AW)in patients with sepsis.Methods A prospective observational study was conducted.Patients with sepsis admitted to the intensive care unit(ICU)of Henan Provincial People's Hospital from April 2021 to October 2021 were enrolled.The demographic data were collected.The enrolled patients were evaluated with Medical Research Council(MRC)score every day until discharged from ICU.During this period,patients with total MRC score<48(for two consecutive times and a time interval of 24 hours)were divided into ICU-AW group,those with total MRC score≥48 were served as non-ICU-AW group.On the 1st,4th and 7th day following admission into ICU,ultrasound was used to measure the muscle linear thickness of the rectus femoris(RF-MLT),the cross sectional area of the rectus femoris(RF-CSA)and the muscle linear thickness of the vastus intermedius muscle(VI-MLT).And meanwhile,the plasmas samples of patients were collected to measure MCP-1 concentration by enzyme-linked immunosorbent assay(ELISA).The difference of each index was compared between the ICU-AW group and the non-ICU-AW group.The risk factors of ICU-AW in patients with sepsis were analyzed by binary Logistic regression.Besides,receiver operator characteristic curve(ROC curve)was plotted,the diagnostic value of ultrasound parameters and plasma MCP-1 level for ICU-AW in patients with sepsis was analyzed.Results A total of 99 septic patients were enrolled,with 68 patients in the ICU-AW group and 31 patients in the non-ICU-AW group.Compared with the patients in the ICU-AW group,the patients in the non-ICU-AW group tended to be older,and had higher sequential organ failure assessment(SOFA)score,higher acute physiology and chronic health evaluationⅡ(APACHEⅡ)score,higher rates of septic shock,higher blood lactic acid and lower Glasgow coma score(GCS).Binary Logistic regression analysis showed that APACHEⅡscore and septic shock were the risk factors of ICU-AW for septic patients[odds ratio(OR)and 95%confidence interval(95%CI)were 1.310(1.138-1.509)and 0.232(0.072-0.746),respectively,both P<0.05].The RF-MLT,RF-CSA and VI-MLT on the 1st,4th and 7th ICU day was falling over time.Compared with the patients in the ICU-AW group,the patients in the non-ICU-AW group had smaller RF-MLT on the 7th day[cm:0.32(0.22,0.47)vs.0.45(0.34,0.63),P<0.05]and higher 7-day RF-CSA atrophy rate[25.85%(10.37%,34.28%)vs.11.65%(2.28%,22.41%),P<0.05].According to ROC curve analysis,7-day RF-MLT had diagnostic value for ICU-AW of septic patients.Area under ROC curve(AUC)was 0.688(95%CI was 0.526-0.849);when the cut-off value was 0.41 cm,the sensitivity and the specificity were 66.7%and 68.4%.The levels of plasma MCP-1 in the ICU-AW group were significantly higher than those in the non-ICU-AW group on the 1st,4th and 7th day.ROC curve analysis showed that the plasma MCP-1 levels on the 1st,4th and 7th day played a significant role to diagnose ICU-AW for septic patients,the AUC and 95%CI were 0.732(0.629-0.836),0.865(0.777-0.953),0.891(0.795-0.986),respectively.When the cut-off values were 206.3,410.9,239.5 ng/L,the sensitivity was 87.1%,64.0%,82.4%,and the specificity was 54.4%,96.1%,86.2%,respectively.Conclusion The muscle mass parameters on the 7th day of bedside ultrasound and plasma MCP-1 levels had certain diagnostic values for ICU-AW in patients with sepsis.