血清簇集蛋白、1-磷酸鞘氨醇水平对脓毒症急性肝损伤患者的预后价值

Value of the serum levels of Clusterin and sphingosine 1-phosphate in assessing the prognosis of sepsis patients with acute liver injury

目的 探讨血清簇集蛋白(Clusterin)、1-磷酸鞘氨醇(S1P)水平对脓毒症急性肝损伤患者预后的评估价值。方法 选择2019年3月—2022年5月徐州医科大学附属连云港医院收治的脓毒症急性肝损伤患者127例,根据患者治疗28 d预后情况分为死亡组35例、存活组92例。计量资料两组间比较采用成组t检验,计数资料两组间比较采用χ^(2)检验,对可能影响患者预后的各因素进行单因素及多因素Logistic回归分析,相关性分析采用Pearson相关性分析,采用受试者工作特征曲线分析血清Clusterin、S1P对患者预后评估价值。结果 两组患者肝损伤程度、急性生理学与慢性健康状况评分Ⅱ(APACHEⅡ)、序贯器官衰竭评分(SOFA)、合并急性肾损伤、凝血酶原时间(PT)、国际标准化比值(INR)、Child-Pugh肝功能分级以及C反应蛋白比较差异均有统计学意义(P值均<0.05)。死亡组患者血清Clusterin、S1P水平均显著低于存活组(t值分别11.094、10.390,P值均<0.05)。重度肝损伤患者血清Clusterin、S1P水平显著低于轻、中度肝损伤患者(t值分别为9.825、11.418,P值均<0.05)。多因素回归分析显示,肝损伤程度(OR=1.260,95%CI:1.081~1.468)、APACHEⅡ评分(OR=1.031,95%CI:1.019~1.044)、SOFA评分(OR=1.066,95%CI:1.039~1.094)、Clusterin(OR=0.899,95%CI:0.859~0.940)和S1P(OR=0.824,95%CI:0.749~0.908)为影响脓毒症患者预后的独立危险因素(P值均<0.05)。ROC曲线分析结果显示,血清Clusterin、S1P与二者联合对患者预后评估价值的曲线下面积分别为0.864、0.861、0.949。脓毒症急性肝损伤患者血清Clusterin、S1P与ALT、TBil、PT、INR均呈显著负相关关系(P值均<0.05)。结论 与存活组相比,脓毒症急性肝损伤死亡患者血清Clusterin以及S1P显著降低,且Clusterin以及S1P水平与患者肝损伤程度密切相关,二者联合对脓毒症急性肝损伤患者预后具有着较好的预测价值,有望成为脓毒症急性肝损患者预后预测的潜在标志物。

Objective To investigate the value of the serum levels of Clusterin and sphingosine 1-phosphate(S1P)in assessing the prognosis of sepsis patients with acute liver injury.Methods A total of 127 sepsis patients with acute liver injury who were admitted to Lianyungang Hospital,Xuzhou Medical University,from March 2019 to May 2022 were enrolled,and according to their prognosis after 28 days of treatment,they were divided into death group with 35 patients and survival group with 92 patients.The independentsamples t test was used for comparison of continuous data between two groups,and the chi-square test was used for comparison of categorical data between groups.A pearson correlation analysis was used to investigate the correlation.The prognostic value of serum Clusterin and S1P was analyzed by receiver operating characteristic curve.Results There were significant differences between the two groups in the degree of liver injury, Acute Physiology and Chronic Health Evaluation Ⅱ (APACHEⅡ) score, Sequential OrganFailure Assessment (SOFA) score, the presence or absence of acute kidney injury, prothrombin time( PT), international normalizedratio( INR), Child-Pugh class, and C-reactive protein( all P<0.05). The death group had significantly lower serum levels of Clusterinand S1P than the survival group (t=11.094 and 10.390, both P<0.05). The patients with severe liver injury had significantly lowerserum levels of Clusterin and S1P than those with mild or moderate liver injury (t=9.825 and 11.418, both P<0.05). The multivariateregression analysis showed that the degree of liver injury( odds ratio[ OR]=1.260, 95% confidence interval[ CI]: 1.081 — 1.468, P<0.05), APACHEII score (OR=1.031, 95%CI: 1.019 — 1.044, P<0.05), SOFA score (OR=1.066, 95%CI: 1.039 — 1.094, P<0.05), Clusterin (OR=0.899, 95%CI: 0.859 — 0.940, P<0.05), and S1P (OR=0.824, 95%CI: 0.749 — 0.908, P<0.05) wereindependent risk factors for the prognosis of patients with sepsis. The ROC curve analysis showed that serum Clusterin and S1P usedalone or in combination had an area under the ROC curve of 0.864, 0.861, and 0.949, respectively. Serum Clusterin and S1P weresignificantly negatively correlated with alanine aminotransferase, total bilirubin, PT, and INR in sepsis patients with acute liverinjury( all P<0.05). Conclusion The sepsis patients with acute liver injury who died had significant reductions in serum Clusterinand S1P compared with those who survived, and the levels of Clusterin and S1P are closely associated with the degree of liver injury.The combination of Clusterin and S1P has a good value in predicting the prognosis of sepsis patients with acute liver injury and isexpected to become a potential marker for predicting the prognosis of sepsis patients with acute liver injury.