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中华老年病研究电子杂志 ›› 2023, Vol. 10 ›› Issue (01) : 8 -13. doi: 10.3877/cma.j.issn.2095-8757.2023.01.002

临床研究

肝素结合蛋白水平对老年脓毒症患者疾病严重程度的早期诊断和预后预测价值
吕晓春, 蔡国龙, 许强宏(), 胡才宝   
  1. 310010 杭州,浙江医院重症医学科
  • 收稿日期:2022-04-21 出版日期:2023-02-28
  • 通信作者: 许强宏
  • 基金资助:
    浙江省重点科技创新团队项目(2011R50018-13)

The value of heparin binding protein level in early diagnosis of disease severity and prognosis prediction in elderly sepsis patients

Xiaochun Lyu, Guolong Cai, Qianghong Xu(), Caibao Hu   

  1. Intensive Care Unit, Zhejiang Hospital, Hangzhou 310010, China
  • Received:2022-04-21 Published:2023-02-28
  • Corresponding author: Qianghong Xu
引用本文:

吕晓春, 蔡国龙, 许强宏, 胡才宝. 肝素结合蛋白水平对老年脓毒症患者疾病严重程度的早期诊断和预后预测价值[J/OL]. 中华老年病研究电子杂志, 2023, 10(01): 8-13.

Xiaochun Lyu, Guolong Cai, Qianghong Xu, Caibao Hu. The value of heparin binding protein level in early diagnosis of disease severity and prognosis prediction in elderly sepsis patients[J/OL]. Chinese Journal of Geriatrics Research(Electronic Edition), 2023, 10(01): 8-13.

目的

探讨肝素结合蛋白(HBP)对老年脓毒症患者疾病严重程度的早期诊断和预后预测作用。

方法

采用多中心前瞻性设计,纳入2014年7月至2015年3月全国18家三级甲等医院重症监护病房(ICU)收治的患者,所有患者一旦纳入研究即参照指南按需进行液体复苏及积极治疗。抽取患者入选当日、入选24 h时的静脉血,检测血浆HBP、降钙素原(PCT)、C反应蛋白(CRP)水平。根据脓毒症2.0诊断标准将患者分为脓毒症组、严重脓毒症组、脓毒症休克组、非感染的全身炎症反应综合征(SIRS)组,比较各组患者性别、年龄、基础疾病、纳入时的急性生理学与慢性健康状况评分Ⅱ(APACHEⅡ)评分、28 d病死率及各时间点HBP、PCT、CRP水平;采用Spearman非参数相关系数分析HBP、PCT、CRP水平与APACHEⅡ评分的相关性;采用生存函数分析HBP对患者预后的预测价值。

结果

共纳入295例患者,其中脓毒症组124例,严重脓毒症组58例,脓毒性休克组73例,SIRS组40例。4组患者APACHEⅡ评分以及基线HBP、PCT、CRP水平的差异均有统计学意义(F=3.841,H=14.470、44.298、14.778;P<0.01),且入组次日HBP水平与次日APACHEⅡ评分存在相关性(r=-0.196,P<0.05)。SIRS组、脓毒症组、严重脓毒症组、脓毒性休克组28 d病死率分别为2.50%、2.42%、18.97%、20.55%,其中基线HBP<15 μg/L的患者生存率更高(χ2=0.020,P<0.05)。

结论

HBP水平与老年脓毒症患者的疾病严重程度相关,基线HBP可用于预测老年脓毒症患者的预后,基线HBP>15 ng/mL的患者死亡风险增加。

Objective

To investigate the value of heparin binding protein (HBP) level in early diagnosis of disease severity and prognosis prediction in elderly sepsis patients.

Methods

A multi-center prospective study was used. Patients admitted to the intensive care unit (ICU) of 18 tertiary A hospitals across the country during July 2014 and March 2015 were enrolled in the study. Once patients were included in the study, they received fluid resuscitation and active treatment immediately according to the guidelines as needed. Venous blood was collected on the day of enrollment and 24 hours after enrollment, and the levels of plasma HBP, procalcitonin (PCT), and C-reactive protein (CRP) were detected. According to the sepsis 2.0 diagnostic criteria, the patients were divided into sepsis group, severe sepsis group, septic shock group and non-infectious systemic inflammatory response syndrome (SIRS) group. The gender, age, underlying diseases, acute physiology and chronic health scoreⅡ (APACHEⅡ) score, 28-day mortality, and the levels of HBP, PCT, CRP were compared among the groups. The correlation between HBP, PCT, CRP levels and APACHEⅡ score were analyzed using Spearman non parametric correlation coefficient, and the predictive value of HBP for the prognosis of patients was evaluated using survival function.

Results

A total of 295 patients were included in the study, including 124 patients with sepsis, 58 patients with severe sepsis, 73 patients with septic shock, and 40 patients with SIRS. There were differences in APACHEⅡ scores, baseline HBP, PCT and CRP levels among the groups (F=3.841; H=14.470, 44.298, 14.778; P < 0.01), and only HBP was correlated with APACHEⅡscore on the day after enrollment (r=-0.196, P < 0.05). The 28-day mortality rates in the SIRS group, sepsis group, severe sepsis group, and septic shock group were 2.50%, 2.42%, 18.97%, and 20.55%, respectively, and the survival rate of patients with HBP≥15 μg/L was higher (χ2=0.020, P < 0.05).

Conclusion

The level of HBP is correlated with the severity of disease in elderly sepsis patients. Baseline HBP can be used to predict the prognosis, and patients with baseline HBP >15 ng/mL have an increased risk of death.

表1 4组患者基本情况的比较[±s或例(%)]
表2 4组患者基线HBP、CRP及PCT水平的比较[MQ1Q3)]
图1 不同基线血清HBP水平患者28 d生存率的比较注:HBP指肝素结合蛋白
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