| 脓毒症患者血液激活素 a，CRP，HMGB1和 vWF表达水平及临床意义 |
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| 引用本文： | 李炳奇,叶俊伟,梅喜平,冯辉斌.脓毒症患者血液激活素 a，CRP，HMGB1和 vWF表达水平及临床意义[J].现代检验医学杂志,2022,0(1):97-102. |
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| 作者姓名： | 李炳奇 叶俊伟 梅喜平 冯辉斌 |
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| 作者单位： | （鄂东医疗集团黄石市中心医院/ 湖北理工学院附属医院重症医学科，湖北黄石 435000） |
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| 摘 要： | 目的 探讨脓毒症患者血液激活素 a(Activin-A)、C反应蛋白 (C-reactive protein, CRP)、高迁移率族蛋白 B1(high mobility group protein B1, HMGB1)和血管性血友病因子 (von willebrand factor, vWF)水平变化及临床意义。方法 选取 2019年 1月～ 2020年 5月鄂东医疗集团黄石市中心医院收治的 87例脓毒症患者，根据病情严重程度分为脓毒症组 (n=29)和脓毒性休克组 (n=58)，根据 28天预后情况分为死亡组 (n=36)和存活组 (n=51)。另选取同期 53例健康体检者为对照组。比较各组血清 Activin-A，CRP，HMGB1和 vWF水平，分析血清 Activin-A，CRP，HMGB1和 vWF水平与脓毒症患者病情严重程度和不良预后的关系。结果 脓毒性休克组血清 Activin-A，CRP，HMGB-1和 vWF水平明显高于脓毒症组和对照组（ Z=-8.935~-3.558, 均 P<0.001），脓毒症组明显高于对照组 (Z=-7.347~-5.950，均 P＜ 0.05)，差异具有统计学意义。 Spearman相关性分析显示，脓毒症患者血清 Activin-A，CRP，HMGB1，vWF水平与急性生理与慢性健康评分系统Ⅱ (APACHE Ⅱ )评分、脓毒症相关的序贯器官衰竭评估 (SOFA)呈正相关，差异具有统计学意义 (rAPACHEⅡ=0.396~0.450，均 P<0.000；rSOFA=0.381~0.442，均 P<0.05)。多因素 Logistics回归分析显示， APACHE Ⅱ评分、 SOFA评分、 Activin-A，CRP，HMGB1，vWF为脓毒症患者不良预后独立影响因素 (P＜ 0.05)。Activin-A+CRP+HMGB1+vWF预测不良预后的 AUC明显大于 APACHEⅡ评分、 SOFA评分以及 Activin-A，CRP，HMGB1和 vWF单独与两两预测，差异具有统计学意义 (均 P＜ 0.05)。结论 脓毒症患者血清 Activin-A，CRP，HMGB1，vWF水平明显提升，与病情严重程度和不良预后相关，联合检测可提升不良预后预测价值。
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| 关 键 词： | 脓毒症 激活素 -a C反应蛋白 高迁移率族蛋白 B1 血管性血友病因子 |
Blood Activator A,CRP, HMGB1 and vWF Expression Levels and Clinical Significance in Patients with Sepsis |
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| LI Bing-qi,YE Jun-wei,MEI Xi-ping,FENG Hui-bin.Blood Activator A,CRP, HMGB1 and vWF Expression Levels and Clinical Significance in Patients with Sepsis[J].Journal of Modern Laboratory Medicine,2022,0(1):97-102. |
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| Authors: | LI Bing-qi YE Jun-wei MEI Xi-ping FENG Hui-bin |
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| Affiliation: | （Department of Intensive Care， Huangshi Central Hospital / Affiliated Hospital of Hubei Institute of Technology ofEastern Hubei Medical Group，Hubie Huangshi 435000，China） |
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| Abstract: | Objective To investigate the changes of blood Activin-A, C-reactive protein (CRP), high mobility group protein B1(HMGB1) and von willebrand factor (vWF) levels in sepsis patients and their clinical significance. Methods 87 patients withsepsis treated in Huangshi Central Hospital of Erdong Medical Group from January 2019 to May 2020 were selected and dividedinto sepsis group (n=29) and septic shock group (n=58) according to the severity of the disease. They were divided into deathgroup(n=36) and survival group(n=51) according to the 28d prognosis, and another 53 healthy medical examiners were selectedas the control group during the same period. The levels of serum activin-A, CRP, HMGB1 and vWF were compared, and therelationship between the levels of serum Activin-A, CRP, HMGB1 and the severity of sepsis and poor prognosis was analyzed.Results Serum Activin-A, CRP, HMGB-1 and vWF levels were significantly higher in the septic shock group than in the sepsisgroup and the control group(Z=-8.935~-3.558, all P<0.001), and the sepsis group was significantly higher than the control group,with statistically significant differences (Z=-7.347~-5.950，all P ＜ 0.05). Spearman correlation analysis showed that serumActivin-A, CRP, HMGB1 and vWF levels were positively correlated with acute physiology andchronic health evaluation scoringsystem Ⅱ (APACHE Ⅱ ) scores and sepsis-related organ failure assessment (SOFA) associated with sepsis in patients withsepsis, with statistically significant differences (rAPACHEⅡ=0.396~0.450，all P<0.000；rSOFA=0.381~0.442，all P ＜ 0.05).Multifactor Logistic regression analysis showed that APACHE Ⅱ score, SOFA score, Activin-A, CRP, HMGB1 and vWF wereindependent factors influencing poor prognosis in patients with sepsis (P ＜ 0.05). ROC curve showed that the AUC of Activin-A+CRP+HMGB1+vWF in predicting poor prognosis was significantly higher than APACHE II score and SOFA score, as well asActivin-A, CRP, HMGB1, vWF alone and two predictions, the difference was statistically significant(P ＜ 0.05). Conclusion The levels of serum Activin-A, CRP, HMGB1 and vWF in patients with sepsis were significantly increased, which was related tothe severity of the disease and poor prognosis. Combined detection can improve the predictive value of poor prognosis. |
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