肝素结合蛋白、中性粒细胞与淋巴细胞比值和降钙素原在急诊老年脓毒症患者中的应用价值

Application value of heparin binding protein,neutrophil to lymphocyte ratio and procalcitonin in emergency elderly patients with sepsis

目的探讨肝素结合蛋白(HBP)、中性粒细胞与淋巴细胞比值(NLR)和降钙素原(PCT)对急诊老年脓毒症患者病情和预后的评估价值。方法选择首都医科大学宣武医院急诊科2020年1月至2021年12月老年脓毒症住院患者158例,入院后给予全血细胞、生化全项、胸部CT、病原学检查、PCT和HBP等检查,根据检查结果进行急性生理与慢性健康状况评估(APACHEⅡ)评分,随访28 d,根据患者预后分成生存组120例和死亡组38例。分别比较2组患者APACHEⅡ评分、NLR、C反应蛋白(CRP)、PCT、HBP和白细胞计数(WBC);分析HBP、NLR、PCT与APACHEⅡ评分的相关性,应用多元logistic回归分析老年脓毒症患者预后的危险因素;比较HBP、NLR和PCT预测老年脓毒症患者死亡的受试者工作特征曲线(ROC)下面积的区别。结果死亡组患者APACHEⅡ评分、HBP、NLR和PCT均大于生存组(P<0.05);HBP、NLR、PCT与APACHEⅡ评分呈正相关(r=0.264,0.337,0.372,P值均<0.01);多元logistic回归分析显示HBP和PCT升高为老年脓毒症患者预后的独立危险因素;PCT预测死亡的ROC曲线下面积为0.867(95%CI:0.809~0.925),HBP的ROC曲线下面积为0.826(95%CI:0.755~0.897),NLR的ROC曲线下面积为0.707(95%CI:0.616~0.799)。结论PCT、NLR和HBP均对急诊老年脓毒症患者的病情和预后有良好的预测评估价值。

Objective To investigate the value of heparin binding protein(HBP),neutrophil to lymphocyte rate(NLR)and procalcitonin(PCT)in evaluating the condition and prognosis of elderly patients with sepsis in emergency.Methods One hundred and fifty-eight elderly patients with sepsis were selected in the emergency department of Xuanwu Hospital of Capital Medical University from January 2020 to December 2021.After admission,they were given blood routine,biochemical examination,Chest CT,etiological examination,PCT and HBP examination,and acute physiology and chronic health evaluation(APACHEⅡ)scores.They were followed up for 28 days.According to the prognosis,they were divided into the survival group(120 cases)and the death group(38 cases).The differences of white blood cell count(WBC),NLR,C-reactive protein(CRP),PCT,HBP and APACHEⅡscores were compared between the two groups;The correlation between HBP,NLR,PCT and APACHEⅡscore was analyzed,Multivariate logistic regression was used to analyze the risk factors of prognosis in elderly patients with sepsis;The difference of area under receiver operating characteristic curve(ROC)of HBP,NLR and PCT in predicting mortality was compared in elderly patients with sepsis.Results The levels of HBP,PCT,NLR and APACHEⅡscores in death group were higher than those in survival group(P<0.05);HBP,NLR,PCT were correlated with APACHEⅡscore(r=0.264,0.337,0.372,all P<0.01);Multivariate logistic regression analysis showed that elevated HBP and PCT were independent risk factors for the prognosis of elderly sepsis patients;The area under the ROC curve(AUC)of PCT in predicting mortality was 0.867(95%CI:0.809-0.925),the AUC of HBP was 0.826(95%CI:0.755-0.897),and the AUC of NLR was 0.707(95%CI:0.616-0.799).Conclusions PCT,NLR and HBP have good predictive value for the condition and prognosis of elderly patients with sepsis in emergency.