感染性休克患者PCSK9水平及其对预后评估价值的分析

Analysis of the level of PCSK9 in patients with septic shock and its prognostic value

目的探讨感染性休克患者体内前蛋白转化酶枯草溶菌素9(proprotein convertase subtilisin/kexin 9,PCSK9)水平及其对患者预后的评估价值。方法回顾性分析2019年1月至2022年3月江苏大学附属宜兴人民医院收治的感染性休克患者135例,根据1周内的转归情况分为预后不良组(n=58)和好转组(n=77),比较两组治疗前及治疗后1d、3d、5d的PCSK9、超敏C反应蛋白(hypersensitive C-reactive protein,hs-CRP)、降钙素原(procalcitonin,PCT)的水平。采用受试者操作特征(receiver operator characteristic,ROC)曲线评价治疗5d后的PCSK9、hs-CRP、PCT水平对感染性休克患者预后的评估价值。结果预后不良组各个时间点的PCSK9水平均高于好转组,差异有统计学意义(P<0.05)。治疗后5d的PCSK9水平预测感染性休克预后的曲线下面积为0.843,敏感度72.4%、特异性88.3%,均高于hs-CRP、PCT这两个指标,差异有统计学意义(P<0.05)。结论感染性休克患者外周血PCSK9水平明显上调,动态监测PCSK9水平有助于评估患者治疗后的预后情况。

Objective To investigate the level of proprotein convertase subtilisin/kexin type 9(PCSK9)in patients with septic shock and its prognostic value.Methods A retrospective analysis was performed on 135 patients with septic shock who were treated in Yixing People's Hospital from January 2019 to March 2022,and they were selected and divided into the poor prognosis group(n=58)and the improved group(n=77)according to the outcome within 1 week.Compared the levels of PCSK9,hypersensitive C-reactive protein(hs-CRP),and procalcitonin(PCT)in the group before treatment and 1 day,3 days and 5 days after treatment.The receiver operator characteristic(ROC)curve was used to evaluate the prognostic value of PCSK9,hs-CRP and PCT levels after 5 days of treatment in patients with septic shock.Results Compared with the improved group,the poor prognosis group had higher PCSK9 levels at each time point,and the differences were statistically significant(P<0.05).The area under the curve of PCSK9 level 5 days after treatment for predicting the prognosis of septic shock was 0.843,the sensitivity was 72.4%,and the specificity was 88.3%,which were higher than those of hs-CRP and PCT,and the differences were statistically significant(P<0.05).Conclusion The level of PCSK9 in peripheral blood of patients with septic shock is significantly up-regulated.Dynamic monitoring of PCSK9 level is helpful to evaluate the prognosis of patients after treatment.