HBP、NT-proBNP及β_(2)-MG与脓毒血症病情严重程度的相关性及预后评估价值

Correlation between HBP,NT-proBNP and β_(2)-MG with severity of sepsis and its prognostic evaluation value

目的探讨肝素结合蛋白(HBP)、氨基末端脑钠肽前体(NT-proBNP)及β_(2)-微球蛋白(β_(2)-MG)与脓毒血症病情严重程度的相关性,并分析其对患者预后的评估价值。方法选取2021年9月至2023年6月在上海市第六人民医院金山分院诊治的脓毒血症患者69例作为研究对象,对其临床资料进行回顾性分析。按病情严重程度将患者分为一般脓毒血症组(23例)、严重脓毒血症组(23例)和脓毒血症休克组(23例),另选取同期在上海市第六人民医院金山分院住院的非脓毒血症患者23例为对照组。根据28 d病死率将脓毒血症患者分为生存组和死亡组。检测并比较各组患者血清HBP、NT-proBNP、β_(2)-MG水平及急性生理学与慢性健康状况评分系统Ⅱ(APACHEⅡ)评分,采用Pearson相关分析血清HBP、NT-proBNP、β_(2)-MG水平与APACHEⅡ评分的相关性,并利用受试者工作特征(ROC)曲线分析其对脓毒血症患者死亡的预测价值。结果一般脓毒血症组、严重脓毒血症组、脓毒血症休克组血清HBP、NT-proBNP、β_(2)-MG水平及APACHEⅡ评分均高于对照组(P<0.05);HBP、NT-proBNP、β_(2)-MG水平及APACHEⅡ评分表现为一般脓毒血症组<严重脓毒血症组<脓毒血症休克组,任意两组间比较,差异均有统计学意义(P<0.05)。死亡组血清HBP、NT-proBNP、β_(2)-MG水平及APACHEⅡ评分均高于生存组(P<0.05)。Pearson相关分析结果显示,脓毒血症患者血清HBP、NT-proBNP、β_(2)-MG水平与APACHEⅡ评分呈正相关(r=0.645、0.776、0.593,P<0.05)。ROC曲线分析结果显示,HBP、NT-proBNP、β_(2)-MG联合检测预测脓毒血症患者死亡的AUC为0.870(95%CI:0.730~1.000),明显高于HBP、NT-proBNP、β_(2)-MG单独检测的AUC[0.768(95%CI:0.598~0.937)、0.792(95%CI:0.653~0.932)、0.814(95%CI:0.645~0.984)],差异均有统计学意义(Z=2.705,P=0.007;Z=2.496,P=0.013;Z=2.126,P=0.033)。结论检测血清HBP、NT-proBNP、β_(2)-MG水平有助于判断脓毒血症患者病情严重程度及评估患者预后,3项指标联合检测可预测患者死亡风险。

Objective To explore the correlation between heparin binding protein(HBP),N-terminal brain natriuretic peptide precursor(NT-proBNP)andβ_(2)-microglobulin(β_(2)-MG)with the severity of sepsis,and to analyze its prognostic evaluation value for the patients.Methods Sixty-nine patients with sepsis diagnosed and treated in Jinshan Branch Hospital of Shanghai Municipal Sixth People′s Hospital from September 2021 to June 2023 were selected as the research subjects and their clinical data were retrospectively analyzed.The patients were divided into the general sepsis group(23 cases),severe sepsis group(23 cases)and sepsis shock group(23 cases)according to the severity of their condition.Additionally,23 patients with non-sepsis hospitalized in Jinshan Branch Hospital of Shanghai Municipal Sixth People′s Hospital during the same period were selected as the control group.The patients with sepsis were divided into the survival group and death group based on the 28 d mortality rate.The serum HBP,NT-proBNP andβ_(2)-MG levels,and APACHEⅡscores were detected and compared among the groups.The Pearson correlation was used to analyze the correlation between serum HBP,NT-proBNP andβ_(2)-MG levels with the APACHEⅡscores.The receiver operating characteristic(ROC)curve was used to analyze their predictive value for the death of sepsis patients.Results The serum HBP,NT-proBNP andβ_(2)-MG levels and APACHEⅡscores in the general sepsis group,severe sepsis group and sepsis shock group were higher than those in the control group(P<0.05).The serum HBP,NT-proBNP andβ_(2)-MG levels and APACHEⅡscore were manifested as the general sepsis group<severe sepsis group<sepsis shock group,and the difference between any two groups was statistically significant(P<0.05).The serum HBP,NT-proBNP andβ_(2)-MG levels and APACHEⅡscore in the death group were higher than those in the survival group(P<0.05).The Pearson correlation analysis results showed that the serum HBP,NT-proBNP andβ_(2)-MG levels were positively correlated with the APACHEⅡscore(r=0.645,0.776,0.593,P<0.05).The ROC curve analysis results showed that the area under the curve(AUC)of serum HBP,NT-proBNP andβ_(2)-MG combined detection for predicting the death of the patients with sepsiswas 0.870(95%CI:0.730-1.000),which was significantly higher than that HBP,NT proBNP andβ_(2)-MG separate testing[0.768(95%CI:0.598—0.937),0.792(95%CI:0.653-0.932),0.814(95%CI:0.645—0.984)],and the differences were statistically significant(Z=2.705,P=0.007;Z=2.496,P=0.013;Z=2.126,P=0.033).Conclusio n Detecting serum HBP,NT-proBNP andβ_(2)-MG levels could help to judge the severity of sepsis patients,evaluate their prognosis,and the combined detection of the three indicators could predict the death risk of the patients.