多配体聚糖-1和可溶性血栓调节蛋白对脓毒症患者病情严重程度及预后的预测价值

Study on the value of Syndecan-1 and sTM in predicting the severity and prognosis of patients with sepsis

目的探讨循环内皮损伤标志物对脓毒症病情严重程度及预后的价值。方法前瞻性纳入51例脓毒症患者,收集入重症医学科(ICU)24 h患者血清,测量内皮损伤标志物含量,同时收集患者的临床资料,根据患者30 d结局分为生存组及死亡组,分析脓毒症内皮功能障碍与病情严重程度及其对预后的预测价值。结果①脓毒症死亡组患者24 h血清多配体聚糖-1(Syndecan-1)高于生存组[mg/mL:104.76(93.03,116.11)vs.69.13(63.29,76.87),P<0.001],血清可溶性血栓调节蛋白(sTM)高于生存组[ng/mL:8.06(6.77,9.45)vs.5.08(4.55,5.27),P<0.001]。②相关分析显示,脓毒症患者血清Syndecan-1与序贯器官衰竭评分(SOFA)(r^(S)=0.522,r 2=0.272,P<0.0001)、急性生理学与慢性健康状况评分系统Ⅱ(APACHEⅡ)评分(r^(S)=0.339,r 2=0.115,P=0.015)呈正相关,血清sTM与SOFA评分(r^(S)=0.485,r 2=0.235,P=0.0003)、APACHEⅡ评分(r^(S)=0.359,r 2=0.129,P=0.0095)呈正相关;③受试者工作特征(ROC)曲线结果显示,Syndecan-1、sTM对脓毒症30 d病死率具有较高的预测价值,其中sTM预测脓毒症预后的最佳临界值为5.86 ng/mL,敏感度为87.5%,特异度为97.17%;Syndecan-1预测脓毒症预后的最佳临界值为84.49 ng/mL,敏感度为93.75%,特异度为91.43%;④以Syndecan-1、sTM临界值分组,KM曲线分析显示,高Syndecan-1、sTM组患者病死率高于低Syndecan-1、sTM组(P<0.0001)。结论脓毒症患者入科24 h内的循环内皮功能障碍与脓毒症病情严重程度密切相关,Syndecan-1和sTM可作为脓毒症患者预后的预测指标。

Objective To explore the predictive value of circulating endothelial injury markers in the disease severity and prognosis of patients with sepsis.Methods 51 patients with sepsis were prospectively included.The serum of patients at 24 hour after admission to the ICU department was collected to measure the markers of endothelial injury.At the same time,the clinical data of patients were collected.According to the 30-day outcome,the patients were divided into the survival group and the death group.The relationship between endothelial dysfunction and the severity of sepsis,and its prognostic value were statistically analyzed.Results①The results of this study showed that Syndecan-1 within 24 h after ICU admission in the death group was higher than that in the survival group[ng/mL:104.76(93.03,116.11)vs.69.13(63.29,76.87),P<0.001],and soluble thrombomodulin(sTM)was significantly higher in the death group than that in the survival group[ng/mL:8.06(6.77,9.45)vs.5.08(4.55,5.27),P<0.001];②Correlation analysis showed that circulating Syndecan-1 was positively correlated with SOFA score(r^(S)=0.522,r 2=0.272,P<0.0001),APACHEⅡscore(r^(S)=0.339,r 2=0.115,P=0.015);and circulating sTM was positively correlated with SOFA score(r^(S)=0.485,r 2=0.235,P=0.0003)and APACHEⅡscore(r^(S)=0.359,r 2=0.129,P=0.0095);③ROC results showed that Syndecan-1 and sTM had higher predictive value for 30-day mortality;The best cut-off value of sTM for predicting the prognosis of sepsis was 5.86 ng/mL,the sensitivity was 87.5%,and the specificity was 97.17%;The best cut-off value of Syndecan-1 for predicting the prognosis of patients with sepsis was 84.49 ng/mL,the sensitivity was 93.75%,and the specificity was 91.43%;④Grouped by the cut-off value Syndecan-1 and sTM,KM curve analysis showed that the mortalities of high level Syndecan-1 and sTM groups were significantly higher than those of low level Syndecan-1 and sTM groups.Conclusions Circulating endothelial dysfunction in the patients with sepsis within 24 hours after ICU admission was closely related to the severity of sepsis and Syndecan-1 and sTM could be used as the predictors of the prognosis in the patients with sepsis.