PTX-3、CysC及IL-27检测对脓毒症患者病情诊断及预后价值研究

Value of PTX-3,CysC and IL-27 in diagnosis and prognosis of patients with sepsis

目的:分析脓毒症患者血清穿透素-3(PTX-3)、胱抑素C(CysC)及IL-27水平变化及其与心肌损伤、病情严重程度及预后的相关性。方法:回顾性分析2014年3月至2019年12月于恩施州土家族苗族自治州中心医院接受诊疗的100例脓毒症患者临床资料,根据治疗前病情严重程度分为三组:常规组、严重组、休克组,依次为38、40、22例,比较三组血清PTX-3、CysC、IL-27水平,序贯器官衰竭评分(SOFA),心肌酶[肌酸激酶同工酶(CK-MB)、肌钙蛋白Ⅰ(cTnⅠ)]以及预后(ICU住院时间、机械通气时间及28 d死亡情况),并分析PTX-3、CysC、IL-27与心肌酶及预后的关系。结果:三组治疗前后PTX-3、CysC、IL-27、CK-MB、cTnⅠ水平以及ICU住院时间、机械通气时间水平由低至高均依次为常规组、严重组、休克组,三组间比较差异具有统计学意义(P<0.05);Spearman相关性分析显示,治疗前血清PTX-3、CysC、IL-27及SOFA评分与cTnⅠ、CK-MB均呈正相关(P<0.05);COX多因素分析显示急性心理学与慢性健康状况评分Ⅱ(APACHEⅡ)得分、ICU住院时间、机械通气时间及治疗前血清PTX-3、CysC、IL-27及SOFA评分水平与28 d病死率密切相关(P<0.05)。结论:血清PTX-3、CysC及IL-27与脓毒症患者病情程度、心肌损伤及预后紧密相关,建议临床密切监测以指导临床诊断及治疗。

Objective:To analyze the changes in levels of serum pentraxin-3(PTX-3),cystatin C(CysC)and IL-27 in patients with sepsis,and their relationship with myocardial injury,severity and prognosis.Methods:A retrospective analysis was performed on the clinical data of 100 patients with sepsis diagnosed and treated in Central Hospital of Tujia and Miao Autonomous Prefecture,Enshi Prefecture from March 2014 to December 2019.According to disease severity before treatment,the patients were divided into routine group(38 cases),severe group(40 cases)and shock group(22 cases).The levels of serum PTX-3,CysC and IL-27,sequential organ faliure assessment(SOFA)score,myocardial enzymes[creatine kinase MB(CK-MB)and cardiac troponinⅠ(cTnⅠ)],and prognosis(length of ICU stay,mechanical ventilation time,28-day mortality)were compared among the three groups.The relationship of PTX-3,CysC and IL-27 with myocardial enzymes and prognosis were analyzed.Results:The order of PTX-3,CysC,IL-27,CK-MB and cTnⅠ,length of ICU and mechanical ventilation time from low/short to high/long before and after treatment was as follows:routine group,severe group and shock group,and the differences among the three groups were statistically significant(P<0.05).Spearman correlation analysis showed that serum PTX-3,CysC,IL-27 and SOFA score were positively correlated with cTnⅠ,CK-MB(P<0.05).COX multivariate analysis showed that the Acute Physiology and Chronic Health EvaluationⅡ(APACHEⅡ)score,length of ICU stay,mechanical ventilation time,levels of serum PTX-3,CysC and IL-27,and SOFA score before treatment were closely related to 28-day mortality(P<0.05).Conclusion:Serum PTX-3,CysC and IL-27 are closely related to the severity,myocardial injury and prognosis of patients with sepsis.Close monitoring of these indicators is recommended in clinical practice to guide diagnosis and treatment.