视黄醇结合蛋白4对脓毒症的诊断与预后评估价值分析

Diagnostic and prognostic value analysis of retinol-binding protein 4 in sepsis

目的 探究视黄醇结合蛋白4(RBP4)对脓毒症的诊断与预后评估价值。方法 选取2020年7月至2021年1月在武汉大学人民医院重症监护病房就诊的脓毒症患者116例(脓毒症组)和非感染性重症患者88例(非脓毒症组),再选取同时期体检健康者138例(对照组)。根据有无肝、肾损伤将脓毒症组分为肝损伤组(40例)、肾损伤组(47例)和无肝肾损伤组(29例);根据入院28 d生存情况将脓毒症组分为存活组(75例)和死亡组(41例)。每组再按性别分为男性组和女性组。检测所有研究对象的血清RBP4、白蛋白、肌酐和降钙素原水平,统计分析各组间RBP4差异。分析脓毒症患者血清RBP4水平与血清白蛋白、肌酐水平的相关性。采用受试者工作特征曲线分析RBP4和降钙素原单独或联合检测对脓毒症的诊断效能。分析RBP4对脓毒症患者短期生存率的预测价值。结果 男性和女性脓毒症组血清RBP4水平均低于相应的对照组和非脓毒症组且非脓毒症组RBP4水平均低于对照组(均P<0.05)。男性和女性肝损伤组的RBP4水平均低于相应的无肝肾损伤组和肾损伤组,且无肝肾损伤组的RBP4水平均低于肾损伤组(均P<0.05)。男性与女性脓毒症组患者血清RBP4水平与血清白蛋白、肌酐水平均呈正相关(均P<0.05)。RBP4和降钙素原联合诊断男性患者脓毒症的曲线下面积(AUC)为0.933,敏感度为95.21%,特异度为88.43%,诊断女性患者脓毒症的AUC为0.924,敏感度为92.30%,特异度为83.02%。男性和女性存活组血清RBP4水平均高于相应的死亡组(均P<0.05)。高RBP4脓毒症患者(男性≥35 mg/L,女性≥22 mg/L)短期死亡率低于低RBP4脓毒症患者(男性<35 mg/L,女性<22 mg/L),高RBP4水平是脓毒症生存的积极预后标志(男性脓毒症组:χ^(2)=5.457,P=0.019;女性脓毒症组:χ^(2)=7.107,P=0.008)。结论 脓毒症患者血清RBP4水平降低,其水平与肝肾功能密切相关。RBP4与降钙素原联合检测能提高对脓毒症的诊断效能。RBP4与脓毒症患者短期生存率有关,有一定预测价值。

Objective To investigate the diagnostic and prognostic value of retinol-binding protein 4(RBP4) in sepsis. Methods From July 2020 to January 2021, 116 patients with sepsis(sepsis group) and 88 patients with severe infection(non-sepsis group) were selected from Intensive Care Unit, Renmin Hospital of Wuhan University, and then 138 healthy subjects(control group) were selected. According to liver or kidney injury, the sepsis group was divided itno liver injury group(40 cases), kidney injury group(47 cases), and non liver and kidney injury group(29 cases). According to the 28 d survival after admission, sepsis group was divided into survival group(75 cases) and death group(41 cases). Each group was divided into male group and female group separately. Serum levels of RBP4, albumin, serum creatinine(Scr) and procalcitonin(PCT) were measured in all study subjects, and difference of RBP4 among the groups was statistically analyzed. The correlation of the serum level of RBP4 with levels of serum albumin and Scr in patients with sepsis was analyzed. The diagnostic efficacy of RBP4 and PCT in sepsis was analyzed by receiver operating characteristic curve. The predictive value of RBP4 in the short-term survival rate of patients with sepsis was analyzed. Results The serum level of RBP4 in male and female sepsis groups were lower than that in control groups and non-sepsis groups in the corresponding gender, and the level of RBP4 in non-sepsis groups were lower than that in control groups(all P<0.05). The level of RBP4 in male and female liver injury groups were lower than that in non liver and kidney injury groups and kidney injury groups in the corresponding gender, and the level of RBP4 in non liver and kidney injury groups were lower than that in kidney injury group(all P<0.05). The serum level of RBP4 in both male and female sepsis groups were positively correlated with serum levels of albumin and Scr(all P<0.05). The area under the curve(AUC) of the combination of RBP4 and PCT was 0.933 to diagnose sepsis in male, the sensitivity was 95.21%, and the specificity was 88.43%;the AUC in female was 0.924, the sensitivity was 92.30%, and the specificity was 83.02%. The serum level of RBP4 in male and female survival groups was higher than that in death group in the corresponding gender(both P<0.05). Compared with sepsis patients with low RBP4(male<35 mg/L, female<22 mg/L), patients with high RBP4 sepsis(male≥35 mg/L, female≥22 mg/L) had lower short-term mortality. High RBP4 level was a positive prognostic marker of survival in patients with sepsis(male sepsis group: χ^(2)=5.457, P=0.019;female sepsis group: χ^(2)=7.107,P=0.008). Conclusions The serum level of RBP4 decreases in patients with sepsis and it is closely related to liver and kidney function. The combined detection of RBP4 and PCT can improve the diagnostic efficacy of sepsis. RBP4 is related to the short-term survival rate of sepsis and has certain predictive value.