脓毒性休克患者抗菌肽LL-37与降钙素原联合检测价值

Value of combined detection of antibacterial peptide LL-37 and procalcitonin in patients with septic shock

  • 摘要:
      目的  分析血清抗菌肽LL-37和降钙素原(PCT)水平与脓毒性休克患者病情及近期预后的相关性。
      方法  选择90例全身炎症反应综合征(SIRS)患者作为研究对象,根据病情程度的不同分为脓毒性休克组44例和脓毒症组46例,另选择同期轻度感染患者50例设为对照组。比较3组患者外周血清抗菌肽LL-37、PCT、超敏C反应蛋白(hs-CRP)、白细胞介素-6(IL-6)水平以及急性生理学与慢性健康状况评分系统Ⅱ(APACHE Ⅱ)、序贯器官衰竭评估(SOFA)评分的差异。应用Pearson相关分析评估血清抗菌肽LL-37、PCT与APACHE Ⅱ评分、SOFA评分的相关性。随访28 d,根据预后的不同将脓毒性休克患者分为生存组与死亡组,比较2组血清抗菌肽LL-37、PCT水平差异。应用多元Logistic回归分析法分析脓毒性休克患者预后的影响因素,并绘制受试者工作特征(ROC)曲线评估血清抗菌肽LL-37联合PCT水平对脓毒性休克患者预后的预测价值。
      结果  脓毒性休克组血清抗菌肽LL-37、PCT、hs-CRP、IL-6水平以及APACHE Ⅱ评分、SOFA评分高于脓毒症组,且脓毒症组高于对照组,差异有统计学意义(P < 0.05)。脓毒性休克患者血清抗菌肽LL-37、PCT分别与SOFA评分呈正相关(r=0.803、0.826,P=0.024、0.019),也分别与APACHE Ⅱ评分呈正相关(r=0.784、0.811,P=0.029、0.022)。死亡组血清抗菌肽LL-37、PCT水平高于生存组,差异有统计学意义(P < 0.05)。血清抗菌肽LL-37、PCT和SOFA评分均为脓毒性休克患者预后的影响因素(OR=2.913、2.887、2.457,P=0.029、0.036、0.045)。ROC曲线显示,血清抗菌肽LL-37联合PCT预测脓毒性休克患者随访28 d死亡的曲线下面积(AUC)为0.806,灵敏度为89.6%,特异度为82.4%。
      结论  血清抗菌肽LL-37与PCT水平联合检测能有效评估脓毒性休克患者病情并预测近期预后。

     

    Abstract:
      Objective  To analyze the correlations between levels of antibacterial peptide LL-37 as well as procalcitonin (PCT) and disease condition as well as short-term prognosis in patients with septic shock.
      Methods  A total of 90 patients with systemic inflammatory response syndrome (SIRS) were collected as study objects, and were divided into septic shock group (44 cases) and sepsis group (46 cases) according to severity of the sepsis. Another 50 patients with mild infection were chosen as control group. The serum levels of antibacterial peptide LL-37, PCT, hypersensitive C-reactive protein (hs-CRP), interleukin-6 (IL-6) and the scores of APACHE Ⅱ as well as Sequential Organ Failure Assessment (SOFA) score were detected and compared between two groups. The correlations of serum levels of antibacterial peptide LL-37, PCT and APACHE Ⅱ as well as SOFA scores were confirmed by Pearson linear correlation analysis. Follow-up 28 days, the patients with septic shock were divided into survival group and death group according to the prognosis, and levels of antibacterial peptide LL-37 and PCT were compared. The risk factors of survival prognosis were confirmed by multivariate Logistic analysis. The diagnostic value of the serum levels of antibacterial peptide LL-37 and PCT to the prognosis of the patients with septic shock were analyzed by receiver operating characteristic curves (ROC).
      Results  The levels of antibacterial peptide LL-37, PCT, hs-CRP, IL-6, APACHE Ⅱ scores and SOFA scores in the septic shock group were higher than that of the sepsis group, and the above indexes in the sepsis group were higher than that in the control group (P < 0.05). The antibacterial peptide LL-37 and PCT were positively correlated with SOFA scores (r=0.803, P=0.024; r=0.826, P=0.019) and APACHE Ⅱ scores (r=0.784, P=0.029; r=0.811, P=0.022). Serum levels of antibacterial peptide LL-37 and PCT in the death group were significantly higher than those in the survival group (P < 0.05). Serum antibacterial peptide LL-37, PCT and SOFA score were all influencing factors for the prognosis of patients with septic shock (OR=2.913, 2.887, 2.457, P=0.029, 0.036, 0.045). The ROC curve showed that the area under the curve (AUC) of serum antibacterial peptide LL-37 combined with PCT in predicting the death of patients with septic shock after 28 days follow-up was 0.806, the sensitivity was 89.6% and specificity was 82.4%.
      Conclusion  The combination of the serum levels of antibacterial peptide LL-37 and PCT can effectively assess the ill-condition and short-term prognosis of patients with septic shock.

     

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