MCP-1和mHLA-DR检测对脓毒症患者病情危重程度及预后评估的临床意义

目的探讨单核细胞趋化蛋白1（MCP-1）表达量和单核细胞人类白细胞抗原-DR（mHLA-DR）表达率对脓毒症患者病情危重程度及预后的临床意义。 方法选取2014年12月至2016年2月在聊城市人民医院重症医学科就诊的脓毒症患者104例，根据预后分为生存组（63例）和死亡组（41例），所有患者发病后12 h内采集静脉血，收集评估脏器功能的指标，并进行序贯器官衰竭估计（SOFA）评分和急性生理与慢性健康状况评分系统Ⅱ（APACHEⅡ）评分，应用酶联免疫吸附测定法（ELISA）检测血清MCP-1的表达量，流式细胞仪检测外周血mHLA-DR的表达率，比较2组患者之间各项指标的差异，并分析其对病情危重程度及临床预后的评估价值及相关性。 结果入组的脓毒症患者，死亡组血清MCP-1表达量较生存组明显升高［（187.65±60.73）pg/ml vs（90.83±31.58）pg/ml，t=-10.65，P<0.01］，外周血mHLA-DR表达率较生存组明显降低［（29.41±8.78）% vs（54.70±12.21）%，t=11.47，P<0.05］，SOFA评分较生存组明显升高［（11.76±3.92）分vs（9.17±4.39）分，t=-3.28，P<0.01］，APACHEⅡ评分明显高于生存组［（25.76±6.27）分vs （18.83±4.65）分，t=-6.47，P<0.05］。血清MCP-1表达量评估脓毒症患者预后的受试者工作特征（ROC）曲线下面积（AUC）为0.950［95%可信区间（CI）=0.911~0.989，P<0.001］，根据ROC曲线确定MCP-1评估脓毒症患者死亡的最佳阈值为115.48 pg/ml时，其诊断敏感度为90.2%，特异度为87.3%。mHLA-DR表达率的ROC的AUC为0.952（95%CI=0.915~0.990，P<0.001），根据ROC曲线确定mHLA-DR评估脓毒症患者生存的最佳阈值为39.3%时，其诊断敏感度为88.9%，特异度为87.8%。SOFA评分的ROC的AUC为0.690（95%CI=0.591~0.790，P<0.002），根据ROC曲线确定SOFA评分评估脓毒症患者死亡的最佳阈值为8.5分时，其诊断敏感度为80.5%，特异度为57.1%。APACHEⅡ评分的ROC的AUC为0.805（95%CI=0.711~0.898，P<0.001），根据ROC曲线确定APACHEⅡ评分评估脓毒症患者死亡的最佳阈值为22.5分时，其诊断敏感度为75.6%，特异度为76.2%。所有入组患者血清MCP-1表达量与mHLA-DR表达率呈负相关（r=-0.872，P<0.001）。 结论MCP-1和mHLA-DR的表达水平可以反映脓毒症患者的病情危重程度，对评估预后具有一定的指导意义。

Clinical significance of the MCP-1 and the monocyte human leukocyte antigen-DR in patients with sepsis

ObjectiveTo investigate the clinical value of t MCP-1 and monocyte human leukocyte antigen-DR (mHLA-DR) in severity and the prognosis of sepsis patients. Method104 patients with sepsis were selected. Patients were classified into two groups (survival group (63 cases) and non-survival group (41 cases). Venous blood was collected in all patients within 12 hours after admission, and sequential organ failure assessment (SOFA) score and acute physiology and chronic health evaluation Ⅱ (APACHEⅡ) score were documented. Serum MCP-1 was detected by ELISA method and peripheral blood mHLA-DR by flow cytometer. We compared the differences between the two groups, and drew the receiver-operating characteristic curve (ROC) to investigate the clinical value of different indicators for the prognosis of sepsis patients. And we further analyzed the relationship between the MCP-1 and the mHLA-DR. ResultFor all the enrolled sepsis patients, the expression of serum MCP-1 in non-survival group was significantly higher than in survival group (187.65±60.73) pg/ml vs (90.83±31.58) pg/ml, t=-10.65, P<0.01]. The level of the mHLA-DR in survival group was higher than non-survival group (54.70±12.21) % vs (29.41±8.78)% t=11.47, P<0.05]. The SOFA score in non-survival group was higher than in survival group (11.76±3.92) vs (9.17±4.39), t=-3.28, P<0.01]. The APACHEⅡ score in non-survival group was significantly higher than in survival group (25.76±6.27) vs (18.83±4.65), t=-6.47, P<0.05]. The MCP-1 death area under the curve (AUC) was 0.950 (P<0.001, 95%CI: 0.911-0.989), and the cut-off point was 115.48pg/ml, the sensitivity was 90.2%, the specificity was 87.3%. The mHLA-DR survival area under the curve (AUC) was 0.952 (P<0.001, 95%CI: 0.915-0.990), and the cut-off point was 39.3%, the sensitivity was 88.9%, the specificity was 87.8%. The SOFA score death area under the curve (AUC) was 0.690 (P<0.002, 95%CI: 0.591-0, 790), and the cut-off point was 8.5 points, the sensitivity was 80.5%, the specificity was 57.1%. The APACHEⅡ score death area under the curve (AUC) was 0.805 (P<0.001, 95%CI: 0.711-0.898), and the cut-off point was 22.5 points, the sensitivity was 75.6%, the specificity was 76.2%. The MCP-1 expression was negatively correlated with the mHLA-DR level (r=-0.872, P<0.01). ConclusionThe expression of serum MCP-1 and peripheral blood mHLA-DR in sepsis patients can reflect the degree of disease, and help assess patients′ prognosis.