脓毒症患者肝素结合性表皮生长因子、降钙素原、血管性血友病因子、高迁移率族蛋白B1表达及与病情进展及预后关系

Analysis of the expression significance of heparin-binding epidermal growth factor,procalcitonin,von Willebrand factor and high mobility group protein B1 in patients with sepsis and their relationship with disease progression and prognosis

目的探讨肝素结合性表皮生长因子(HB-EGF)、降钙素原(PCT)、血管性血友病因子(vWF)、高迁移率族蛋白B1(HMGB1)在脓毒症患者中的表达,及4种因子与脓毒症病情发展和预后的关系。方法选取自2020年9月至2022年4月收治的150例脓毒症患者为研究对象,基于脓毒症严重程度分为脓毒症组(n=74)与脓毒症休克组(n=76),且依据不同预后将脓毒症患者分为存活组(n=107)与死亡组(n=43);同时,随机选取同期行常规体检的75例健康者为健康组。分析各组HB-EGF、PCT、vWF、HMGB1表达水平,观察脓毒症两组急性生理学与慢性健康状况评分系统(APACHEⅡ)和序贯器官衰竭(SOFA)评分;分析HB-EGF、PCT、vWF、HMGB1与APACHEⅡ及SOFA的相关性;分析HB-EGF、PCT、vWF、HMGB1及联合检测对脓毒症的诊断价值;二元Logistic方程分析脓毒症患者死亡的影响因素。结果健康组HB-EGF水平显著高于脓毒症两组,且脓毒症休克组HB-EGF水平最低,PCT、vWF、HMGB1水平健康组最低,脓毒症休克组明显高于脓毒症组;存活组HB-EGF水平显著高于死亡组,但PCT、vWF、HMGB1水平明显低于死亡组;健康组、脓毒症组及脓毒症休克组APACHEⅡ及SOFA均依次降低,差异均有统计学意义(P<0.05)。HB-EGF与APACHEⅡ及SOFA均呈负相关,PCT、vWF、HMGB1与APACHEⅡ及SOFA均呈正相关。HB-EGF、PCT、vWF、HMGB1及联合检测对脓毒症的诊断敏感度分别为76.52%、67.79%、70.44%、69.54%、93.56%,特异度分别为68.99%、77.32%、71.76%、72.96%、88.78%。HB-EGF、PCT、vWF、HMGB1与APACHEⅡ均为脓毒症患者死亡的独立危险因素(P<0.05)。结论HB-EGF、PCT、vWF、HMGB1在不同脓毒症患者中均有不同表达,且与预后具有一定相关性;同时,HB-EGF、PCT、vWF、HMGB1指标对脓毒症均有一定诊断价值,但四者联合诊断价值更高。

Objective To investigate the expressions of heparin-binding epidermal growth factor(HB-EGF),procalcitonin(PCT),von Willebrand factor(vWF)and high mobility group protein B1(HMGB1)in patients with sepsis,and the relationship between these four factors and the development and prognosis of sepsis1.Methods A total of 150 patients with sepsis admitted from September 2020 to April 2022 were selected as the research objects.Based on the severity of sepsis,the patients were divided into sepsis group(n=74)and sepsis shock group(n=76).According to different prognosis,the patients with sepsis were divided into survival group(n=107)and death group(n=43).Meanwhile,75 healthy subjects who underwent routine physical examination during the same period were randomly selected as the healthy group.The expression levels of HB-EGF,PCT,vWF and HMGB1 in each group were analyzed,and the acute physiology and chronic health status scoring system(APACHEⅡ)and sequential organ failure(SOFA)scores were observed in the two groups;to analyze the correlation of HB-EGF,PCT,vWF,HMGB1 with APACHEⅡand SOFA;to analyze the diagnostic value of HB-EGF,PCT,vWF,HMGB1 and their combined detection in sepsis;a binary logistic equation was used to analyze the influencing factors of death in patients with sepsis.Results The level of HB-EGF in the healthy group was significantly higher than that in the sepsis group,and the HB-EGF level in the septic shock group was the lowest,and the levels of PCT,vWF and HMGB1 in the healthy group were the lowest,and the septic shock group was significantly higher than the sepsis group(P<0.05).The level of HB-EGF in the survival group was significantly higher than that in the death group,but the levels of PCT,vWF and HMGB1 were significantly lower than those in the death group(P<0.05).The APACHEⅡand SOFA in the healthy group,the sepsis group and the septic shock group were decreased in turn(P<0.05).And HB-EGF was negatively correlated with APACHEⅡand SOFA,PCT,vWF,HMGB1 were positively correlated with APACHEⅡand SOFA.The diagnostic sensitivities of HB-EGF,PCT,vWF,HMGB1 and combined detection for sepsis were 76.52%,67.79%,70.44%,69.54%and 93.56%.The specificities were 68.99%,77.32%,71.76%,72.96%,88.78%.HB-EGF,PCT,vWF,HMGB1 and APACHEⅡwere independent risk factors for death in sepsis patients.Conclusion HB-EGF,PCT,vWF,and HMGB1 were expressed differently in different sepsis patients,and they are all have a certain correlation with prognosis.It has certain diagnostic value,but the combination of the four has higher diagnostic value and can be widely used in clinical practice.