联合检测外周血TIRAP、FOXO3a、HBP预测脓毒症患者近期预后的价值及意义

Value and significance of combined peripheral blood TIRAP,FOXO3a and HBP in predicting the short-term prognosis of patients with sepsis

目的探讨联合检测外周血TOLL/白介素-1受体相关蛋白(TIRAP)、叉头蛋白转录因子3a(FOXO3a)、肝素结合蛋白(HBP)对脓毒症患者近期预后的预测价值。方法回顾性收集2020年1月—2022年12月本院205例脓毒症患者的临床资料,根据28 d生存情况分为生存组157例、死亡组48例。统计两组外周血TIRAP、FOXO3a、HBP及急性生理功能和慢性健康状况评分系统Ⅱ(APACHEⅡ)、序贯器官衰竭评估(SOFA)评分。分析TIRAP、FOXO3a、HBP与APACHEⅡ、SOFA评分的相关性。采用Logistic回归方程分析TIRAP、FOXO3a、HBP交互作用对脓毒症近期预后的影响。评价TIRAP、FOXO3a、HBP联合预测脓毒症近期预后的价值。结果死亡组入院第1、3、7天外周血TIRAP、HBP水平及APACHEⅡ、SOFA评分高于生存组,FOXO3a水平低于生存组(P<0.05);入院第1天,脓毒症死亡患者TIRAP、HBP水平与APACHEⅡ、SOFA评分呈正相关,FOXO3a与APACHEⅡ、SOFA评分呈负相关(P<0.05);TIRAP×FOXO3a×HBP在脓毒症近期预后中存在交互作用(P<0.05);入院第1天外周血TIRAP+FOXO3a+HBP联合预测预后的曲线下面积(AUC)大于TIRAP+FOXO3a、TIRAP+HBP、FOXO3a+HBP,预测效能更佳(P<0.05)。结论脓毒症预后不良患者外周血TIRAP、HBP水平升高,FOXO3a水平降低,其水平变化与病情严重程度、近期预后有关,联合检测其水平可提高近期预后的预测效能。

Objective To investigate the predictive value of combined detection of TOLL/interleukin-1 receptor associated protein(TIRAP),FOXO3a(FOXO3a)and heparin-binding protein(HBP)in peripheral blood for the short term prognosis of patients with sepsis.Methods Clinical data of 205 patients with sepsis in our hospital from January 2020 to December 2022 were retrospectively collected and divided into survival group(157 cases)and death group(48 cases)according to 28 day survival.TIRAP,FOXO3a,HBP,Acute Physiological and Chronic Health EvaluationⅡ(APACHEⅡ),Sequential Organ failure Assessment(SOFA)scores in peripheral blood of the two groups were analyzed.The correlation between TIRAP,FOXO3a,HBP and APACHEⅡand SOFA scores was analyzed.Logistic regression equation was used to analyze the effect of interaction of TIRAP,FOXO3a and HBP on the short-term prognosis of sepsis.The combined value of TIRAP,FOXO3a and HBP in predicting the short-term prognosis of sepsis was evaluated.Results The levels of TIRAP,HBP,APACHEⅡand SOFA in peripheral blood of the death group were higher than those of the survival group on the 1st,3rd and 7th day after admission,while the FOXO3a level was lower than that of the survival group(P<0.05).On the first day after admission,the levels of TIRAP and HBP were positively correlated with APACHEⅡand SOFA scores,while FOXO3a was negatively correlated with APACHEⅡand SOFA scores(P<0.05).TIRAP×FOXO3a×HBP had an interactive effect on the short-term prognosis of sepsis(P<0.05).The AUC of TIRAP+FOXO3a+HBP in peripheral blood on the 1st day after admission was greater than that of TIRAP+FOXO3a,TIRAP+HBP and FOXO3a+HBP,and the predictive efficacy was better(P<0.05).Conclusion The levels of TIRAP,HBP and FOXO3a in peripheral blood of patients with poor prognosis of sepsis are increased,and the changes of their levels are related to the severity of the disease and the short-term prognosis.Combined detection of their levels can improve the predictive efficacy of short-term prognosis.