«上一篇/Previous Article|本期目录/Table of Contents|下一篇/Next Article»

《天津医科大学学报》[ISSN:1006-8147/CN:12-1259/R]

卷:

25卷

期数:

2019年03期

页码:

229-233

栏目:

临床医学

出版日期:

2019-05-20

文章信息/Info

Title:

Predictive value of protein C activity combined with D-dimer in the evaluation of sepsis and septic shock

文章编号:

1006-8147(2019)03-0229-05

作者:

吴 枫; 李燕华; 高玉雷; 柴艳芬

（天津医科大学总医院急诊医学科，天津300052）

Author(s):

WU Feng;  LI Yan-Hua;  GAO Yu-Lei;  CHAI Yan-Feng

（Department of Emergency, General Hospital, Tianjin Medical University, Tianjin 300052, China）

关键词:

脓毒症; 脓毒性休克; 蛋白C活性; D-二聚体

Keywords:

sepsis; septic shock; protein C activity; D-dimer

分类号:

R631

DOI:

-

文献标志码:

A

摘要:

目的：探讨脓毒症患者血浆蛋白C（PC）活性和D-二聚体（D-dimer）浓度变化水平及二者联合对脓毒症与脓毒性休克患者病情评估的预测价值。方法：采用前瞻性研究方法，选择天津医科大学总医院急诊医学科2017年1月～2018年2月收治的200例重症感染患者。根据脓毒症sepsis 3.0 诊断标准将所有患者分为脓毒症组（157例）和非脓毒症组（43例），并进一步将脓毒症患者分为脓毒性休克组（63例）和一般脓毒症组（94例）。抽取外周血检测PC活性和D-dimer两种生物标志物，评估不同组别PC活性和D-dimer浓度差异；采用Logistic回归分析探讨二者与脓毒症的相关性；采用受试者工作特征曲线（ROC曲线）探讨PC活性联合D-dimer对脓毒症和脓毒性休克患者病情评估的预测能力。结果：与非脓毒症组比较，脓毒症和脓毒性休克组患者血浆PC活性均显著降低（P＜0.001），而D-dimer水平在两组患者血浆中均显著升高（P＜0.001）。经Logistic回归分析确定PC活性与D-dimer均为预测脓毒症及脓毒性休克患者病情的独立实验室指标（P＜0.05）。PC活性用于评估脓毒症患者时的ROC曲线下面积（AUC）为0.776，将PC活性与D-dimer联合使用评估脓毒症时的AUC为0.791，高于单独使用时的AUC（分别为0.776与0.666）。PC活性用于评估脓毒性休克时的AUC为0.757，PC活性与D-dimer联合使用评估脓毒性休克时的AUC为0.789，大于二者单独使用时的AUC（分别为0.757与0.679）。结论：PC活性和D-dimer测定对脓毒症与脓毒性休克患者病情评估有较强的预测能力，且PC活性与D-dimer联合使用能进一步提高对脓毒症与脓毒性休克患者病情评估的预测能力。

Abstract:

Objective: To assess the amount of protein C activity and D-dimer in patients with sepsis and septic shock and to explore its predictive value in patients with sepsis. Methods: A prospective study was conducted and we selected 200 patients with severe infection who were treated with emergency medicine in the General Hospital of Tianjin Medical University from January 2017 to February 2018.protein C activity, D-dimer ,white blood cell count(WBC) and other biomarker of sepsis were detected. All patients were divided into sepsis group(157 cases) and non-sepsis group(43 cases) according to sepsis 3.0 diagnostic criteria; then all these patients with sepsis were stratified into septic shock group(63 cases) and general sepsis group (94 cases) according to the diagnosis of sepsis 3.0. Differences in protein C activity between different groups were evaluated; the receiver operating characteristic curve(ROC curve) was used to evaluate the predictive ability of protein C activity when used independently as well as when used in combination with D-dimer. Results:Protein C activity levels were decreased in plasma of patients with sepsis and septic shock(P﹤0.001). D-dimer levels were elevated in plasma of patients with sepsis and septic shock(P <0.001). Logistic analysis confirmed that PC activity level and D-dimer level were independent factors for predicting sepsis and septic shock(P<0.05). The area under the ROC curve (AUC) when protein C activity was used to predict sepsis was 0.776, and the AUC of protein C activity and D-dimer used in the prediction of sepsis was 0.791. AUC was higher than protein C activity and D-dimer when used alone(0.776, 0.666, respectively). The AUC of protein C activity for the prediction of septic shock was 0.757. The AUC of protein C activity and D-dimer used in the prediction of septic shock was 0.789, greater than protein C activity and D-dimer(0.757,0.674 respectively) when uesd alone. Conclusion: PC activity and D-dimer levels could have strong predictive power for the assessment of patients with sepsis and septic shock, and PC activity combined with D-dimer may further improve the assessment of patients with sepsis and septic shock predictive ability.

参考文献/References:

[1] Arishima T, Ito T, Yasuda T, et al. Circulating activated protein C levels are not increased in septic patients treated with recombinant human soluble thrombomodulin[J].Thromb J, 2018,16(1): 24
[2] Biron B, Ayala A, Lomas-Neira J, et al. Biodmarikers for sepsis:What is and what might be?[J].Biomarker insights, 2015, 10(S4):7
[3] Vasileiadis I, Politou M, Dimopoulos S, et al. Variation of endothelium-related hemostatic factors during sepsis[J]. Microcirculation,2018, 25(8): e12500
[4] Chapelet A, Foucher Y, Gerard N, et al. An early increase in endothelial protein C receptor is associated with excess mortality in pneumococcal pneumonia with septic shock in the ICU[J]. Crit Care,2018, 22(1): 251
[5] Faix J. Established and novel biomarkers of sepsis[J]. Biomarkers， Med, 2011, 5(2):177
[6] Da Silva F, Cataldi T, Da Lima T, et al. Proteomic profiling identifies N-acetylmuramoyl-l-alanine amidase as a novel biomarker of sepsis[J]. Biomark Med, 2016, 10(12):1225
[7] Mecatti G, Messias M, Paiola R, et al. Lipidomic profiling of plasma and erythrocytes from septic patients reveals potential biomarker candidates[J]. Biom Ins, 2018,13(1):13
[8] Takamitsu M, Tomohisa S, Yoshizumi D. Cilinical investigation of coagulation. markers for early detection of sepsis-induced disseminated intravascular coagulation:A Single-Center, Prospective observational study[J]. Clin Appl Thromb Hemost, 2018, 1(6):10
[9] Becher T, Muller J, Akin I, et al. The evolution of activated protein C plasma. levels in septic shock and its association with mortality: A prospective observational study[J]. J crit care, 2018, 47(41): 48
[10] Gustafsson A, Ljunggren L, Bodelsson M, et al.The prognostic value of. suPAR compared to other inflammatory markers in patients with severe sepsis[J].Biomark Insights, 2012, 7(39): 44
[11] Schwameis M, Steiner M M, Schoergenhofer C, et al. D-dimer and histamine.in early stage bacteremia: A prospective controlled cohort study[J].Eur J Intern Med, 2015, 26(10): 782
[12] Xing L Y, Yin J, Shao M, et al. Clinical characteristics and prognosis of serous.body cavity effusions in patients with sepsis: a retrospective observational study[J]. BMC Anesthesiol, 2018, 18(1):169
[13] Rello J, Valenzuela-Sanchez F, Ruiz-Rodriguez M, et al. Sepsis :a review of advances in management[J].Adv Ther, 2017, 34(2393):2411
[14] Keeley A, Hine P, Nsutebu E, et al. The recognition and management of sepsis and septic shock:a guide for non-intensivists[J]. Postgrad Med J, 2017, 93(8): 624
[15] Angus C, Poll T, Finfer S, et al.Severe sepsis and septic shock[J].N Eng J Med, 2013, 369(840):51

相似文献/References:

[1]高秋文,谢克亮,王卫娜,等.氢气对脓毒症小鼠存活率和肝脏损伤的保护作用[J].天津医科大学学报,2013,19(06):449.
　GAO Qiu-wen,XIE Ke-liang,WANG Wei-na,et al.Protective effects of hydrogen gas on survival rate and liver injury in septic mice[J].Journal of Tianjin Medical University,2013,19(03):449.
[2]高秋文,谢克亮,陈红光,等.Nrf2在富氢液减轻小鼠脓毒症氧化损伤中的作用[J].天津医科大学学报,2014,20(05):354.
　GAO Qiu-wen,XIE Ke-liang,CHEN Hong-guang,et al.Effect of Nrf2 in hydrogen-rich saline to reduce the oxidative damage in septic mice[J].Journal of Tianjin Medical University,2014,20(03):354.
[3]王彦峰,白 洁,李光明,等.血清降钙素原与肾上腺髓质素前体中段肽在婴幼儿细菌性肺炎诊疗中的临床研究[J].天津医科大学学报,2017,23(04):314.
　WANG Yan-feng,BAI Jie,LI Guang-ming,et al.Clinical research of serum procalcitonin and MR-pro-adrenomedullin in the diagnosis and treatment of bacterial pneumonia in infants[J].Journal of Tianjin Medical University,2017,23(03):314.
[4]齐 颖,陈 兵.脓毒性休克限制性液体复苏的临床研究[J].天津医科大学学报,2017,23(04):324.
　QI Ying,CHEN Bing.Clinical study on limited fluid resuscitation in septic shock[J].Journal of Tianjin Medical University,2017,23(03):324.
[5]杨蕊,许华,王兵,等.IL-18在脓毒症及脓毒症休克中预测死亡的作用[J].天津医科大学学报,2018,24(02):142.
　YANG Rui,XU Hua,WANG Bing,et al.Role of IL-18 in predicting mortality of patients with sepsis and septic shock[J].Journal of Tianjin Medical University,2018,24(03):142.
[6]杨宏伟,牛文彦.探讨uKIM-1、IL-6、T细胞亚群在脓毒症急性肾损伤中早期检测的意义[J].天津医科大学学报,2018,24(02):145.
　YANG Hong-wei,NIU Wen-yan.Value of measuring uKIM，IL-6 and T-cell subsets in sepsis patients with acute kidney injury[J].Journal of Tianjin Medical University,2018,24(03):145.
[7]辛可可,庞锋,孙俊丽,等.适度液体负平衡在脓毒性休克机械通气患者撤机过程中的应用[J].天津医科大学学报,2018,24(02):148.
　XIN Ke -ke,PANG Feng,SUN Jun-li,et al.Application of moderate negative fluid balance in patients with septic shock during weaining from mechanical ventilation[J].Journal of Tianjin Medical University,2018,24(03):148.
[8]黄 颖,曹 超,王 军,等.TLR4在脓毒症中对调节性T细胞功能活性的影响[J].天津医科大学学报,2018,24(06):492.
　HUANG Ying,CAO Chao,WANG Jun,et al.The effects of TLR4 on regulating the function of Tregs in sepsis[J].Journal of Tianjin Medical University,2018,24(03):492.
[9]郭 菲,王力军,么 颖,等.血浆组蛋白H4与脓毒症患者严重程度及预后关系研究[J].天津医科大学学报,2019,25(05):475.
　GUO Fei,WANG Li-jun,YAO Ying,et al.Prognostic value of plasma histone H4 in septic patients[J].Journal of Tianjin Medical University,2019,25(03):475.
[10]余信,蒋佳维,许华,等.血小板联合D-二聚体对脓毒症预后的评估价值[J].天津医科大学学报,2020,26(02):145.
　YU Xin,JIANG Jia-wei,XU Hua,et al.Prognostic value of platelet combined with D-dimer in sepsis[J].Journal of Tianjin Medical University,2020,26(03):145.

备注/Memo

备注/Memo:

基金项目 国家自然科学基金青年项目（81701931， 81601714，81871593）；天津市科学技术委员会自然科学基金青年项目（18JCQNJC10500）；北京协和医学基金会“睿E（睿意）急诊医学研究专项基金”项目（201617）；天津医科大学总医院青年孵育基金项目（ZYYFY2015020）
作者简介 吴枫（1992-），男，硕士在读，研究方向：急诊医学；通信作者：柴艳芬，E-mail：chaiyanfen2012@126.com。

常用功能

更新日期/Last Update: 2019-07-03