血清内皮细胞特异性分子-1、降钙素原水平变化与脓毒症患者APACHEⅡ评分的相关性及临床意义

To investigate the correlation between serum endothelial cell specific molecule-1,procalcitonin levels and APACHEⅡscore in patients with sepsis and its clinical significance

目的探讨血清内皮细胞特异性分子-1(ESM-1)、降钙素原(PCT)水平变化与脓毒症患者急性生理与慢性健康评分(APACHEⅡ评分)的相关性及临床意义。方法选取2021年1月至2023年1月该院收治的100例脓毒症患者作为研究对象,根据入院28 d后预后情况分为病死组(21例)和存活组(79例)。比较病死组和存活组患者不同时间(入院时、治疗3 d后、治疗7 d后)血清ESM-1、PCT水平,以及不同严重程度患者入院时血清ESM-1、PCT水平及APACHEⅡ评分,分析入院时血清ESM-1、PCT水平与APACHEⅡ评分的相关性、入院28 d后病死的影响因素及治疗3、7 d后血清ESM-1、PCT水平,血清ESM-1、PCT水平联合检测对入院28 d后病死的预测价值。结果病死组患者治疗3、7 d后血清ESM-1、PCT水平均高于存活组,差异均有统计学意义(P<0.05);轻度脓毒症患者入院时血清ESM-1、PCT水平及APACHEⅡ评分均低于重度脓毒症患者和脓毒症休克患者,差异均有统计学意义(P<0.05);入院时血清ESM-1、PCT水平与APACHEⅡ评分均呈正相关(P<0.05);多因素Logistic回归分析结果显示,治疗3、7 d后血清ESM-1、PCT水平升高是脓毒症患者入院28 d后病死的危险因素(P<0.05);受试者工作特征曲线分析结果显示,治疗3 d后血清ESM-1、PCT联合检测预测脓毒症患者入院28 d后病死的曲线下面积(AUC)为0.902,灵敏度、特异度分别为90.48%、78.48%;治疗7 d后血清ESM-1、PCT联合检测预测脓毒症患者入院28 d后病死的AUC为0.929,灵敏度、特异度分别为95.24%、83.54%。结论动态监测血清ESM-1、PCT水平有助于评估脓毒症患者的病情程度,且2项指标联合检测可有效预测其预后,可为临床治疗方案制订提供依据。

Objective To investigate the correlation between serum endothelial cell specific molecule-1(ESM-1),procalcitonin(PCT)levels and acute physiology and chronic health evaluation score(APACHEⅡscore)in patients with sepsis and its clinical significance.Methods A total of 100 patients with sepsis admitted to the hospital from January 2021 to January 2023 were selected as the research objects.According to the prognosis after 28 days of admission,they were divided into death group(21 cases)and survival group(79 cases).The serum ESM-1 and PCT levels of patients in death group and survival group at different times(on admission,3 d after treatment and 7 d after treatment)were compared,and the serum ESM-1 and PCT levels and APACHEⅡscore of patients with different severity on admission were compared.The correlation between serum ESM-1 and PCT levels at admission and APACHEⅡscore,the influencing factors of death after 28 d of admission,the serum ESM-1 and PCT levels after 3 and 7 d of treatment,and the predictive value of serum ESM-1 and PCT levels for death after 28 d of admission were analyzed.Results The serum levels of ESM-1 and PCT in death group were significantly higher than those in survival group 3 and 7 d after treatment(P<0.05).The serum ESM-1,PCT levels and APACHEⅡscore of patients with mild sepsis were significantly lower than those of patients with severe sepsis and septic shock(P<0.05).Serum ESM-1 and PCT at admission were positively correlated with APACHEⅡscore(P<0.05).The results of multivariate Logistic regression analysis showed that the increase of serum ESM-1 and PCT after 3 and 7 d of treatment were risk factors for the death of sepsis patients 28 d after admission(P<0.05).The results of receiver operating characteristic curve analysis showed that the area under the curve(AUC)of combined detection of serum ESM-1 and PCT levels after 3 d of treatment to predict the death of sepsis patients after 28 d of admission was 0.902,and the sensitivity and specificity were 90.48%and 78.48%respectively.The AUC of combined detection of serum ESM-1 and PCT levels after 7 d of treatment to predict the 28 d death of sepsis patients was 0.929,and the sensitivity and specificity were 95.24%and 83.54%respectively.Conclusion Dynamic monitoring of serum ESM-1 and PCT levels is helpful to evaluate the severity of sepsis,and the combined detection of the 2 indicators can effectively predict the prognosis,and provide a basis for clinical treatment plan.