蛋白C活性联合D-二聚体在脓毒症和脓毒性休克患者病情评估中的预测价值研究

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。

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

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.