血小板-单核细胞聚集物表达水平在脓毒症临床诊断中的价值

The efficacy of platelet monocyte aggregation expression levels in the clinical diagnosis of sepsis

目的探讨血小板-单核细胞聚集物(PMA)表达水平在脓毒症临床诊断中的价值。方法回顾性分析2022年1—12月苏州大学附属第一医院感染病科诊治的脓毒症患者41例(脓毒症组)、有感染但未诊断为脓毒症的患者41例(感染组)和同时期健康体检者25名(健康对照组)。脓毒症组根据临床症状进一步分为休克亚组(14例)和未休克亚组(27例)。采用Beckman Coulter公司Navios流式仪器分析所有研究对象的PMA水平,检测降钙素原(PCT)、C反应蛋白(CRP)及血小板。利用非参数检验比较不同组间两个指标的差异,用Spearman相关性分析PMA、PCT、CRP和血小板之间的相关性,通过绘制受试者工作特征曲线评价PMA对脓毒症的诊断价值,采用Kaplan-Meier生存曲线比较不同PMA表达水平脓毒症患者的生存差异。结果脓毒症组、感染组和健康对照组的PMA水平分别为52.66%(27.10%,81.09%)、37.22%(26.52%,54.56%)和15.94%(15.10%,17.02%),PCT水平分别为3.10(0.23,15.35)μg/L、0.15(0.08,0.79)μg/L和0.02(0.02,0.02)μg/L,CRP水平分别为106.6(35.87,175.60)mg/L、76.45(27.20,110.10)mg/L和1.26(0.94,2.42)mg/L,血小板计数分别为116.00(90.25,204.30)×10^(9)/L、192.00(147.30,333.00)×10^(9)/L和199.50(178.00,252.80)×10^(9)/L。脓毒症组的PMA、PCT和CRP显著高于健康对照组(U值分别为0.00、5.00、1.00,P均<0.001),而血小板计数低于健康对照组(U=47.00,P<0.05),与感染组相比PCT、血小板差异有统计学意义(U值分别为84.50、176.50,P均<0.05),而PMA和CRP差异无统计学意义(U值分别为255.00、210.00,P均>0.05)。PMA与PCT、CRP均呈正相关,相关系数分别为0.562和0.447(P均<0.001)。休克亚组和未休克亚组的PMA分别为83.54%(76.51%,86.82%)和43.75%(21.59%,62.83%),且休克亚组显著高于未休克亚组(U=12.00,P<0.05)。PMA诊断脓毒症的曲线下面积为0.750(95%CI 0.657~0.843),最佳截断值为37.99%。PMA≥37.99%的患者与PMA<37.99%的患者生存率差异有统计学意义(χ2=4.805,P<0.05)。结论PMA在脓毒症的诊断中有良好的临床参考价值,可能成为脓毒症诊断的生物标志物。

Objective To evaluate the efficacy of platelet-monocyte aggregates(PMA)in the clinical diagnosis of sepsis.Methods From January 2022 to December 2022,patients in the First Affiliated Hospital of Soochow University were recruited in this study,among which 41 were with sepsis(sepsis group),41 patients had infection but were not diagnosed as sepsis(infection group),and 25 healthy individuals(healthy control group)were simultaneously chosen.Patients with sepsis were divided into the shock group(14 cases)and the non-shock group(27 cases).PMA of all subjects were measured by Beckman Coulter Navios Flow Cytometry and detection of procalcitonin(PCT),C-reactive protein(CRP)and platelet(PLT).The differences of the two indexes between the different groups were compared by nonparametric test.Spearman′s correlation test was used to analyze the correlation among PMA,PCT,CRP and PLT.The diagnostic value of PMA in sepsis was evaluated by drawing the receiver operating characteristic(ROC)curve.Kaplan-Meier survival curve was used to compare the survival time of patient with different PMA.Results The PMA in the sepsis group,infection group and healthy control group were 52.66%(27.10%,81.09%),37.22%(26.52%,54.56%)and 15.94%(15.10%,17.02%),respectively.For the three groups,PCT levels were 3.10(0.23,15.35)μg/L,0.15(0.08,0.79)μg/L and 0.02(0.02,0.02)μg/L,CRP levels were 106.6(35.87,175.60)mg/L,76.45(27.20,110.10)mg/L and 1.26(0.94,2.42)mg/L,and the PLT counts were 116.00(90.25,204.30)×10^(9)/L,192.00(147.30,333.00)×10^(9)/L and 199.50(178.00,252.80)×10^(9)/L.The values for PMA,PCT and CRP levels were significantly higher in the septic group compared to the healthy controls(the U values were 0.00,5.00 and 1.00,P<0.001).But the PLT for the septic group was lower than that from the healthy control(U=47.00,P<0.05).The differences in PCT and PLT were statistically(the U values were 84.50 and 176.50,P<0.05),but there was no significant difference between the PMA and CRP(the U values were 255.00 and 210.00,P>0.05)for the two groups.PMA was positively correlated with PCT(rs=0.562,P<0.001)and CRP(rs=0.447,P<0.001)in patients.The levels of PMA in shock and non-shock groups were 83.54%(76.51%,86.82%)and 43.75%(21.59%,62.83%)respectively(U=12.00,P<0.05).The AUC of PMA in diagnostic of sepsis was 0.750(95%CI 0.657-0.843),the best cut-off value was 37.99%.Survival curve analysis showed that the survival time was significantly lower in the PMA≥37.99%group(χ2=4.805,P<0.05).Conclusion PMA holds significant clinical reference for sepsis diagnosis and has the potential to serve as a biomarker in sepsis diagnostic procedures.