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目的：研究血清肝素结合蛋白（HBP）、新喋呤（neopterin）联合泛素特异性蛋白酶13（USP13）预测脓毒症患者临床转归的临床价值。方法：选取2021年6月~2023年6月我院收治的157例脓毒症患者，根据是否发生脓毒性休克分组为未休克组（n=93）和休克组（n=64），比较两组血清HBP、neopterin、USP13水平。统计157例脓毒症患者入院28 d死亡情况，比较死亡组和生存组资料及血清HBP、neopterin、USP13水平，采用多因素Logistic回归模型分析脓毒症患者入院28 d死亡的影响因素，采用受试者工作特征（ROC）曲线分析血清HBP、neopterin、USP13对脓毒症患者入院28 d死亡的预测价值。结果：与未休克组相比，休克组血清HBP、neopterin显著升高（P＜0.05），血清USP13显著降低（P＜0.05）。157例脓毒症患者入院28 d死亡47例，发生率为29.94%。与生存组相比，死亡组急性生理与慢性健康状况评分Ⅱ（APACHE-Ⅱ）、合并糖尿病比例、序贯器官衰竭评估评分（SOFA）、HBP、neopterin显著升高（P＜0.05），血清USP13显著降低（P＜0.05）。多因素Logistic回归分析显示，APACHEⅡ评分升高、SOFA评分升高、合并糖尿病、HBP升高、neopterin升高及USP13降低是脓毒症患者入院28 d死亡的危险因素（P＜0.05）。ROC曲线显示，血清HBP、neopterin、USP13、HBP+neopterin、neopterin+USP13、HBP+USP13、HBP+neopterin+USP13预测脓毒症患者入院28 d死亡的曲线下面积（AUC）（95%CI）分别为0.722（0.627~0.818）、0.768（0.691~0.844）、0.647（0.547~0.747）、0.849（0.779~0.919）、0.845（0.780~0.910）、0.832（0.755~0.910）、0.923（0.876~0.969），HBP+neopterin+USP13联合预测的效能显著优于单项或两项检测（P＜0.05）。结论：血清HBP、neopterin高水平、血清USP13低水平与脓毒症患者入院28 d死亡及脓毒性休克有关，血清HBP、neopterin联合USP13检测可有效预测脓毒症患者入院28 d死亡。

英文摘要:

Objective: To study the clinical value of serum heparin binding protein (HBP), neopterin (neopterin) and ubiquitin specific protease 13 (USP13) in predicting the clinical outcome of patients with sepsis. Methods: 157 patients with sepsis who were admitted to our hospital from June 2021 to June 2023 were selected, and patients were divided into non-shock group (n=93) and shock group (n=64) according to whether septic shock occurred, the levels of serum HBP, neopterin and USP13 were compared between two groups. The 28 d mortality of 157 patients with sepsis were counted, the data of death group and survival group and the levels of serum HBP, neopterin and USP13 were compared, the influencing factors of 28 d death in patients with sepsis upon admission were analyzed by multivariate Logistic regression model, the predictive value of serum HBP, neopterin and USP13 of 28 d death in patients with sepsis upon admission were analyzed by receiver operating characteristic (ROC) curve. Results: Compared with non-shock group, the serum HBP and neopterin in shock group were significantly increased (P<0.05), and the serum USP13 was significantly decreased (P<0.05). 157 patients with sepsis admitted for 28 d and 47 deaths, with an incidence of 29.94%. Compared with survival group, the acute physiology and chronic health status score II (APACHE-II), the proportion of complicated with diabetes mellitus, sequential organ failure assessment score (SOFA), HBP and neopterin in death group were significantly increased (P<0.05), and serum USP13 was significantly decreased (P<0.05). Multivariate Logistic regression analysis showed that, elevated APACHE II score, elevated SOFA score, complicated with diabetes mellitus, elevated HBP, elevated neopterin and decreased USP13 were risk factors for 28 d death in patients with sepsis upon admission (P<0.05). ROC curve showed that, the area under the curve (AUC) (95%CI) of serum HBP, neopterin, USP13, HBP+neopterin, neopterin+USP13, HBP+USP13, HBP+neopterin+USP13 for predicting 28 d death in patients with sepsis upon admission were 0.722（0.627~0.818）, 0.768（0.691~0.844）, 0.647（0.547~0.747）, 0.849（0.779~0.919）, 0.845（0.780~0.910）, 0.832（0.755~0.910）, 0.923（0.876~0.969）, the combined prediction efficiency of HBP+neopterin+USP13 was significantly better than that of single or two tests (P<0.05). Conclusion: High levels of serum HBP, neopterin, and low levels of serum USP13 are associate with 28 d death and septic shock in patients with sepsis, Detection of serum HBP, neopterin combine with USP13 can effectively predict 28 d death in patients with sepsis upon admission.

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