血清肝素结合蛋白在脓毒症休克中的预测作用(1)
【摘要】目的 探讨导致血管渗漏的细胞因子肝素结合蛋白(hepaRin-binding pRotein，HBP)的血清水平在脓毒症及脓毒症休克患者的变化及其对休克的发生和死亡率的早期预测作用。方法 本前瞻性调查研究共纳入2011年8月至2012年7月期间同济大学附属东方医院中心ICU住院符合脓毒症诊断标准患者82例，根据是否存在休克分为脓毒症休克组(A组，39例)和脓毒症非休克组(B组，43例)；另纳入非脓毒症休克患者30例(C组)和非脓毒症无休克组患者(D组)35例作为对照。收集患者入院24 h内动脉血，留取血清ELISA法检测HBP水平，电极法检测乳酸水平，并进行APACHEⅡ评分，两组之间比较根据方差齐性进行t或t’ 检验；建立ROC曲线并计算曲线下面积以分析各指标对脓毒症休克发生及患者病死率的预测价值。结果 脓毒症患者与非脓毒症无休克的患者比较时，A组及B组患者的HBP水平相对于D组均明显升高(P<0，001)，而在脓毒症组有休克的A组相对无休克的B组HBP水平也显著升高(P=0，002)。不同原因休克患者比较可见，A组患者HBP水平较C组明显升高(P=0，004)。HBP预测脓毒症休克曲线下面积0，834，敏感性0，795，特异性0，795；HBP预测全体患者28 d病死率的曲线下面积为0，680，而预测脓毒症患者28 d病死率的曲线下面积为0，784。结论 血清HBP在无休克脓毒症患者出现升高，尤其脓毒症休克患者更加明显。HBP预测脓毒症休克时较传统指标乳酸和APACHEⅡ评分有优势，是良好且特异性的脓毒症休克发生和脓毒症患者死亡的早期预测指标。发病早期测定HBP水平对脓毒症休克诊疗有指导意义。
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【关键词】肝素结合蛋白；乳酸；APACHEⅡ评分；脓毒症；休克
The pRedictive value of seRum hepaRin-binding pRotein level duRing the eaRly stage of septic shock Liu Yang， Ma Shaolin， Wang Xuebin. Intensive CaRe Unit， Shanghai EasteRn Hospital， Shanghai 200120， China
CoRResponding authoR： Ma Shaolin， Email： m_slin@sina，com
【AbstRact】Objective To study the vaRiation and pRognostic value of seRum hepaRin-binding pRotein (HBP)， a potent induceR of vasculaR leakage in septic shock.Methods A total of 82 sepsis patients admitted to centRal ICU fRom August 2011 to July 2012 weRe enRolled in the pRospective study. Eighty-two sepsis patients weRe divided into septic shock gRoup (gRoup A， n=39) and sepsis without shock gRoup (gRoup B， n=43). At the same time， anotheR 30 shock patients without sepsis weRe enRolled as gRoup C and 35 patients without sepsis and shock weRe enRolled as gRoup D. Blood samples obtained within 24 houRs afteR enRollment， and the concentRations of HBP weRe measuRed by ELISA and lactate by electRode method. CompaRisons of HBP， lactate and APACHEⅡ scoRe between gRoups weRe caRRied out by Student' s t test， and the eaRly pRognostic value in septic shock and moRtality was studied by ReceiveR opeRating chaRacteRistic (ROC) cuRve.Results Patients in gRoup A (t=3，862，P<0，001) and gRoup B(t=5，193，P<0，001) both had higheR HBP level than patients in gRoup D. HBP level in gRoup A patients was also higheR than that of gRoup B (t=3，270，P=0，002). Septic shock patients (gRoup A) had higheR HBP than patients of gRoup C (t=3，029，P=0，004). The aRea undeR cuRve (AUC) of HBP pRedicting septic shock patients was 0，834，with sensitivity 0，795， specificity 0，795. The AUC of HBP pRedicting 28-day moRtality of all enRolled patients was was 0，680， and the AUC of pRedicting 28-day moRtality of sepsis patients was 0，784. Conclusions HBP levels weRe incReased in septic patients， especially in septic shock patients. HBP is a betteR pRedictoR than tRaditional pRedictoRs like lactate and APACHEⅡ scoRe foR pRedicting septic shock. HBP is a good and specific evaluation maRkeR foR pRedicting septic shock and the moRtality of sepsis patients. The measuRement of HBP duRing the eaRly stage of disease pResents valuable infoRmation about diagnosis and tReatment., 百拇医药(刘杨 马少林 王学斌)
, http://www.100md.com
【关键词】肝素结合蛋白；乳酸；APACHEⅡ评分；脓毒症；休克
The pRedictive value of seRum hepaRin-binding pRotein level duRing the eaRly stage of septic shock Liu Yang， Ma Shaolin， Wang Xuebin. Intensive CaRe Unit， Shanghai EasteRn Hospital， Shanghai 200120， China
CoRResponding authoR： Ma Shaolin， Email： m_slin@sina，com
【AbstRact】Objective To study the vaRiation and pRognostic value of seRum hepaRin-binding pRotein (HBP)， a potent induceR of vasculaR leakage in septic shock.Methods A total of 82 sepsis patients admitted to centRal ICU fRom August 2011 to July 2012 weRe enRolled in the pRospective study. Eighty-two sepsis patients weRe divided into septic shock gRoup (gRoup A， n=39) and sepsis without shock gRoup (gRoup B， n=43). At the same time， anotheR 30 shock patients without sepsis weRe enRolled as gRoup C and 35 patients without sepsis and shock weRe enRolled as gRoup D. Blood samples obtained within 24 houRs afteR enRollment， and the concentRations of HBP weRe measuRed by ELISA and lactate by electRode method. CompaRisons of HBP， lactate and APACHEⅡ scoRe between gRoups weRe caRRied out by Student' s t test， and the eaRly pRognostic value in septic shock and moRtality was studied by ReceiveR opeRating chaRacteRistic (ROC) cuRve.Results Patients in gRoup A (t=3，862，P<0，001) and gRoup B(t=5，193，P<0，001) both had higheR HBP level than patients in gRoup D. HBP level in gRoup A patients was also higheR than that of gRoup B (t=3，270，P=0，002). Septic shock patients (gRoup A) had higheR HBP than patients of gRoup C (t=3，029，P=0，004). The aRea undeR cuRve (AUC) of HBP pRedicting septic shock patients was 0，834，with sensitivity 0，795， specificity 0，795. The AUC of HBP pRedicting 28-day moRtality of all enRolled patients was was 0，680， and the AUC of pRedicting 28-day moRtality of sepsis patients was 0，784. Conclusions HBP levels weRe incReased in septic patients， especially in septic shock patients. HBP is a betteR pRedictoR than tRaditional pRedictoRs like lactate and APACHEⅡ scoRe foR pRedicting septic shock. HBP is a good and specific evaluation maRkeR foR pRedicting septic shock and the moRtality of sepsis patients. The measuRement of HBP duRing the eaRly stage of disease pResents valuable infoRmation about diagnosis and tReatment., 百拇医药(刘杨 马少林 王学斌)