血清Tau蛋白、Ghrelin在脓毒症相关性脑病鉴别诊断中的应用及意义

Application and significance of serum Tau protein and Ghrelin in differential diagnosis of sepsis associated encephalopathy

目的探讨血清Tau蛋白、生长激素释放肽(Ghrelin)在脓毒症相关性脑病(SAE)鉴别诊断中的应用及意义。方法选取2021年2月—2023年2月我院收治的112例SAE患者作为研究组,遵循1∶1原则纳入同期112例脓毒症患者作为对照组。统计两组脓毒症确诊后12 h、24 h、48 h血清Tau蛋白、Ghrelin水平,Spearman分析血清Tau蛋白、Ghrelin水平与病情程度、脑损伤程度的相关性,绘制受试者工作特征曲线(ROC)及曲线下面积(AUC)分析血清Tau蛋白、Ghrelin水平联合诊断效能,绘制卡普兰-迈耶曲线(K-M)分析不同血清Tau蛋白、Ghrelin水平患者生存状况。结果脓毒症确诊后12 h、24 h、48 h后,研究组血清Tau蛋白高于对照组,Ghrelin低于对照组,且研究组中重度脑损伤程度、中高危病情程度患者血清Tau蛋白高于轻度脑损伤程度、低危病情程度患者,Ghrelin低于轻度脑损伤程度、低危病情程度患者(P<0.05);SAE患者脓毒症确诊后24 h血清Tau蛋白、Ghrelin水平与脑损伤程度、病情程度呈显著相关(r_(1)值=0.633、0.656,r_(2)值=-0.642、-0.638,均P<0.05);ROC曲线分析显示,脓毒症确诊24 h后血清Tau蛋白、Ghrelin联合诊断SAE效能[AUC:0.945,95%CI:0.907~0.971]优于单一诊断[AUC:0.819,95%CI:0.762~0.867;AUC:0.821,95%CI:0.764~0.869];K-M曲线显示,脓毒症确诊后24 h后Tau蛋白高表达者生存率低于低表达者,Ghrelin高表达者生存率高于低表达者(P<0.05)。结论血清Tau蛋白、Ghrelin在SAE患者中呈高表达,且与脑损伤程度显著相关,联合检测有助于提高诊断效能,确定合理防治措施,加快疾病转归。

Objective To investigate the application and significance of serum Tau protein and growth hormone releasing peptide(Ghrelin)in the differential diagnosis of sepsis associated encephalopathy(SAE).Methods 112 SAE patients admitted to our hospital from February 2021 to February 2023 were selected as the study group,and 112 patients with sepsis were included as the control group according to the 1:1 principle.Serum Tau protein and Ghrelin levels were measured 12 hours,24 hours and 48 hours after sepsis was diagnosed in the 2 groups.The correlation between serum Tau protein and Ghrelin levels and the degree of disease and brain injury was analyzed by Spearman.Receiver operating characteristic(ROC)curve and area under curve(AUC)were plotted to analyze the combined diagnostic efficiency of serum Tau protein and Ghrelin levels,and Kaplan-Meyer curve(K-M)was plotted to analyze the survival status of patients with different serum Tau protein and Ghrelin levels.Results 12 hours,24 hours,48 hours after the diagnosis of sepsis,the serum Tau protein of the study group was higher than that of the control group,the Ghrelin was lower than that of the control group,and the serum Tau protein of the study group was higher in the patients with moderate to severe brain injury and moderate to high risk disease than in the patients with mild brain injury and low risk disease.Ghrelin was lower than those with mild brain injury and low critical disease(P<0.05).The levels of serum Tau protein and Ghrelin at 24 hours after the diagnosis of sepsis in SAE patients were significantly correlated with the degree of brain injury and disease(r_(1)=0.633,0.656,r_(2)=-0.642,-0.638,all P<0.05).ROC showed that the combined diagnostic efficacy of serum Tau protein and Ghrelin 24 hours after sepsis diagnosis[AUC:0.945,95%CI:0.907-0.971]was better than that of single diagnosis[AUC:0.819,95%CI:0.762-0.867;AUC:0.821,95%CI:0.764-0.869];the K-M curve showed that 24 hours after the diagnosis of sepsis,the survival rate of those with high Tau expression was lower than that of those with low Tau expression,and the survival rate of those with high Ghrelin expression was higher than that of those with low Ghrelin expression(P<0.05).Conclusion Serum Tau protein and Ghrelin are highly expressed in SAE patients,and are significantly correlated with the degree of brain injury.Combined detection is helpful to improve the diagnostic efficiency,determine reasonable prevention and treatment measures,and accelerate the outcome of the disease.