肝素结合蛋白在脓毒症早期诊断及预后评估中的价值

Value of heparin-binding protein in the early diagnosis and prognosis evaluation of sepsis

目的研究肝素结合蛋白(HBP)在脓毒症早期诊断及预后评估中的价值。方法选择2019年1月至2022年1月收治的182例脓毒症患者,按脓毒症指南标准将其分为脓毒症非休克组(114例)及脓毒症休克组(68例);按临床预后将其分为脓毒症存活组(142例)及脓毒症死亡组(40例)。另选取同期健康体检者80名为健康组。比较各组入院24 h内的HBP、降钙素原(PCT)、C反应蛋白(CRP)水平及白细胞计数(WBC),采用受试者工作特征(ROC)曲线分析上述指标在脓毒症早期诊断及预后评估中的价值。结果脓毒症非休克组及脓毒症休克组的HBP、PCT、CRP水平及WBC均高于健康组(P<0.05);脓毒症休克组的HBP、PCT、CRP水平高于脓毒症非休克组(P<0.05);脓毒症非休克组与脓毒症休克组的WBC比较,差异无统计学意义(P>0.05)。HBP、PCT、CRP、WBC对脓毒症均有一定诊断价值(P<0.05),且HBP的诊断价值最高[曲线下面积(AUC)=0.947],HBP取截断值10.50 ng/mL时,灵敏度为80.22%,特异度为92.50%。脓毒症死亡组的HBP、PCT、CRP水平及WBC均高于脓毒症存活组(P<0.05)。Logistic回归分析结果显示,HBP、PCT是影响脓毒症患者预后的危险因素(P<0.05)。ROC曲线分析结果显示,HBP、PCT的AUC分别为0.724、0.862,两者联合检测的AUC为0.877。结论HBP在脓毒症诊断中有较好的临床价值,是脓毒症预后的独立危险因素,且联合PCT检测能更好地评估脓毒症患者预后。

Objective To investigate the value of heparin-binding protein(HBP)in the early diagnosis and prognosis evaluation of sepsis.Methods A total of 182 patients with sepsis admitted from January 2019 to January 2022 were selected.According to the guidelines of sepsis,the patients were divided into sepsis non-shock group(114 cases)and sepsis shock group(68 cases);according to the clinical prognosis,the patients were divided into sepsis survival group(142 cases)and sepsis death group(40 cases).In addition,80 healthy subjects in the same period were selected as healthy group.The levels of HBP,procalcitonin(PCT),C-reactive protein(CRP)and white blood cell(WBC)within 24 h after admission were compared among all groups,and the value of the above indexes in early diagnosis and prognosis evaluation of sepsis was analyzed by receiver operating characteristic(ROC)curve.Results The levels of HBP,PCT,CRP and WBC in the sepsis shock group and the sepsis non-shock group were higher than those in the healthy group(P<0.05);the levels of HBP,PCT and CRP in the sepsis shock group were higher than those in the sepsis non-shock group(P<0.05);there was no significant difference in WBC between the sepsis non-shock group and the sepsis shock group(P>0.05).HBP,PCT,CRP and WBC all had certain diagnostic value in sepsis(P<0.05),and HBP had the highest diagnostic value[area under the curve(AUC)=0.947].When the cut-off value of HBP was 10.50 ng/mL,the sensitivity was 80.22%,and the specificity was 92.50%.The levels of HBP,PCT,CRP and WBC in the sepsis death group were higher than those in the sepsis survival group(P<0.05).Logistic regression analysis results showed that HBP and PCT were the risk factors affecting the prognosis of sepsis patients(P<0.05).ROC curve analysis results showed that the AUC of HBP and PCT were 0.724 and 0.862 respectively,and the AUC of combined detection of the two was 0.877.Conclusion HBP has good clinical value in the diagnosis of sepsis and is an independent risk factor for sepsis prognosis.Combined with PCT detection can better evaluate the prognosis of patients with sepsis.