血清SAA和ACTH表达水平与重症细菌感染性疾病的关系及对患者治疗效果的评估

The relationship between serum SAA and ACTH expression levels and severe bacterial infectious diseases and evaluation of treatment effects in patients

目的:探讨血清淀粉样蛋白A(SAA)和促肾上腺皮质激素(ACTH)表达水平与重症细菌感染性疾病的关系,分析其对患者治疗效果的评估价值.方法:选取2018年1月~2019年1月我院重症监护室收治的126例感染性疾病患者,根据细菌培养结果分为细菌感染组(n=74)和非细菌感染组(n=52),另选取同期60名体检健康者为对照组.比较各组血清SAA、ACTH水平及白细胞计数(WBC),观察细菌感染组治疗后不同治疗后各时间段血清SAA、ACTH水平及WBC和序贯器官衰竭评估(SOFA)评分变化,ROC曲线分析血清SAA、ACTH水平及WBC对重症细菌感染性疾病的诊断价值.结果:非细菌感染组、细菌感染组血清SAA、ACTH水平及WBC明显高于对照组,细菌感染组血清SAA、ACTH水平及WBC明显高于非细菌感染组;细菌感染组治疗后1d、7d、14d、出院前血清SAA、ACTH水平及WBC和SOFA评分逐渐降低,但WBC下降较慢,治疗后1d、7d、14d仍处于较高水平.ROC曲线显示,WBC诊断重症细菌感染性疾病的AUC与SAA、ACTH诊断无差异,SAA+ACTH诊断重症细菌感染性疾病的AUC明显大于WBC、SAA、ACTH诊断,且敏感度和特异度最高.结论:重症细菌感染性疾病患者血清SAA、ACTH水平明显提升,可实时监测治疗效果,联合检测血清SAA、ACTH水平可提升感染类型诊断价值.

Objective To investigate the relationship between the expression levels of serum amyloid A(SAA)and adrenocorticotropic hormone(ACTH)and severe bacterial infectious diseases,and to analyze their value in evaluating the therapeutic effect of patients.Methods 126 patients with infectious diseases admitted to the intensive care unit of our hospital(January 2018 to January 2019)were selected and divided into bacterial infection group(n=74)and non-bacterial infection group(n=52)according to the results of bacterial culture,and another 60 healthy persons undergoing physical examination during the same period were selected as the control group.Compare serum SAA,ACTH levels and white blood cell count(WBC)of each group,observe serum SAA,ACTH levels,WBC and sequential organ failure assessment(SOFA)score changes after different treatments in the bacterial infection group,and ROC curve analysis the diagnostic value of serum SAA,ACTH levels and WBC for severe bacterial infectious diseases.Results Serum SAA,ACTH and WBC levels in the control group,non-bacterial infection group,and bacterial infection group gradually increased;In the bacterial infection group,serum SAA,ACTH levels and WBC and SOFA scores gradually decreased Id,7d,14d after treatment and before discharge;The ROC curve showed that there was no difference between the AUC of WBC in the diagnosis of severe bacterial infectious diseases and the diagnosis of SAA and ACTH.The AUC of SAA+ACTH in the diagnosis of severe bacterial infectious diseases was significantly greater than that of WBC,SAA,ACTH and the sensitivity and specificity were the highest.Conclusion Serum SAA and ACTH levels in patients with severe bacterial infectious diseases have been significantly increased,the therapeutic effect can be monitored in real time,combined detection of serum SAA and ACTH levels can improve the diagnostic value of infection types.