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| 细菌性血流感染所致脓毒症患者血清PCT、APOM、sTREM-1与预后的关系研究 |
| Study on the Relationship Between Serum PCT, APOM, sTREM-1 and Prognosis in Patients With Sepsis Due to Bacterial Bloodstream Infection |
| 投稿时间：2023-12-25 修订日期：2023-12-25 |
| DOI： |
| 中文关键词: 细菌性血流感染 脓毒症 降钙素原 载脂蛋白M 可溶性髓系细胞触发受体-1 预后 |
| 英文关键词: Bacterial bloodstream infection Sepsis Procalcitonin Apolipoprotein M Soluble triggering receptor expressed on myeloid cells-1 Prognosis |
| 基金项目:北京市自然科学基金项目（7162071） |
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| 中文摘要: |
| 目的 探讨细菌性血流感染（BSI）所致脓毒症患者血清降钙素原（PCT）、载脂蛋白M（APOM）、可溶性髓系细胞触发受体-1（sTREM-1）与预后的关系。方法 选取2021年1月～2023年10月首都医科大学附属北京朝阳医院收治的细菌性BSI所致脓毒症患者185例（脓毒症组），根据28d内预后情况分为死亡组（61例）和存活组（124例），另选取同期体检健康志愿者87例（对照组）。采用电化学发光法检测血清PCT水平，酶联免疫吸附法检测血清APOM、sTREM-1水平。单因素及多因素Logistic回归模型分析影响细菌性BSI所致脓毒症患者预后的因素。受试者工作特征（ROC）曲线分析血清PCT、APOM、sTREM-1对细菌性BSI所致脓毒症患者预后的预测价值。结果 与对照组比较，脓毒症组血清PCT、sTREM-1水平升高，APOM水平降低（P＜0.05）。185例细菌性BSI所致脓毒症患者28d死亡死亡率为32.97%（61/185）。与存活组比较，死亡组血清PCT、sTREM-1水平升高，APOM水平降低（P＜0.05）。多因素分析结果显示：革兰阴性菌感染、脓毒性休克、中性粒细胞/淋巴细胞比值（NLR）升高、序贯器官衰竭评估（SOFA）评分增加、急性生理和慢性健康评估Ⅱ（APACHEⅡ）评分增加、血清PCT升高和sTREM-1升高为细菌性BSI所致脓毒症患者死亡的独立危险因素，血清APOM升高为独立保护因素（P＜0.05）。血清PCT、APOM、sTREM-1联合检测预测细菌性BSI所致脓毒症患者死亡的曲线下面积为0.908，大于血清PCT、APOM、sTREM-1单独检测预测的0.785、0.779、0.783。结论 细菌性BSI所致脓毒症患者血清PCT、sTREM-1水平升高和APOM水平降低与预后不良的发生有关，血清PCT、APOM、sTREM-1联合检测对细菌性BSI所致脓毒症患者死亡有较高的预测价值。 |
| 英文摘要: |
| Objective To investigate the relationship between serum procalcitonin (PCT), apolipoprotein M (APOM), soluble triggering receptor expressed on myeloid cells-1 (sTREM-1) and prognosis in patients with sepsis due to bacterial bloodstream infection (BSI). Methods 185 patients with sepsis due to bacterial BSI (sepsis group) were selected in Beijing Chaoyang Hospital Affiliated to Capital Medical University from January 2021 to October 2023, patients were divided into death group (61 cases) and survival group (124 cases) according to the prognosis within 28 days, and 87 healthy volunteers (control group) were selected from our hospital during the same period. Serum PCT level was detected by electrochemiluminescence, and serum APOM and sTREM-1 levels were detected by enzyme-linked immunosorbent assay. The factors affecting the prognosis of patients with sepsis due to bacterial BSI were analyzed by univariate and multivariate Logistic regression models. The predictive value of serum PCT, APOM and sTREM-1 on the prognosis of patients with sepsis due to bacterial BSI were analyzed by receiver operating characteristic (ROC) curve. Results Compared with control group, the levels of serum PCT and sTREM-1 in sepsis group were increased, and the level of APOM was decreased (P<0.05). The 28-day mortality rate of 185 patients with sepsis due to bacterial BSI was 32.97% (61/185). Compared with survival group, the levels of serum PCT and sTREM-1 in death group increased, and the level of APOM decreased (P<0.05). The results of the multifactor analysis show that gram-negative bacterial infection, septic shock, increased neutrophil/lymphocyte ratio (NLR), increased sequential organ failure assessment (SOFA) score, increased acute physiology and chronic health evaluation II (APACHE II) score, increased serum PCT and sTREM-1 were independent risk factors for death in patients with sepsis due to bacterial BSI, and increased serum APOM was an independent protective factor (P<0.05). The area under the curve of combined detection of serum PCT, APOM and sTREM-1 in predicting the death of patients with sepsis due to bacterial BSI was 0.908, which was greater than 0.785, 0.779 and 0.783 predicted by serum PCT, APOM and sTREM-1 alone. Conclusion The increase of serum PCT and sTREM-1 levels and the decrease of APOM level in patients with sepsis due to bacterial BSI are relate to the occurrence of poor prognosis, the combine detection of serum PCT, APOM and sTREM-1 has a high predictive value for the death of patients with sepsis due to bacterial BSI. |
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