单核细胞趋化蛋白-1对67例全身炎症反应综合征患者的诊断价值

目的 评估单核细胞趋化蛋白-1(MCP-1)在全身炎症反应综合征(SIRS)中的诊断价值。 方法 前瞻性研究。收集天津医科大学第二医院重症监护病房(ICU)、泌尿外科及胃肠外科于2020年8月至2021年4月收住院的67例经诊断符合SIRS的患者作为病例组,对照组为同期体检人员44例。采用酶联免疫吸附法(ELISA)检测病例组与对照组血清中的MCP-1浓度并比较其差异。将病例组按是否存在多器官功能障碍(MODS)分为MODS组(n=26)和非MODS组(n=41),比较血清MCP-1浓度,绘制受试者工作曲线,评价血清MCP-1对SIRS伴MODS的诊断效能。根据患者临床表现及检测结果,将患者分为脓毒症组(n=15)和非脓毒症组(n=52),比较两组间血清MCP-1浓度。 结果 SIRS患者血清MCP-1中位水平为180.2(90.9~407.4)pg/mL,对照组血清中位水平为53.4(40.2~83.7)pg/mL(P<0.001)。SIRS患者中MODS组血清MCP-1中位水平为426.2(150.1~733.6)pg/mL,非MODS组血清MCP-1中位水平为135.0(55.6~236.1)pg/mL(P<0.001),以血清MCP-1为变量对SIRS伴MODS诊断效能的ROC曲线下面积为0.74,最大约登指数对应的血清MCP-1临界值为176.0 pg/mL,敏感度为76.9%,特异性为65.9%。脓毒症组与非脓毒症组血清MCP-1比较差异无统计学意义(P=0.832)。 结论 SIRS患者血清MCP-1检测对MODS具有辅助诊断价值,但不能作为SIRS进展为脓毒症的预测指标。

Detection of serum MCP-1 in 67 patients with systemic inflammatory response syndrome

Objective To evaluate the diagnostic value of monocyte chemo-attractant protein-1(MCP-1)in systemic inflammatory response syndrome(SIRS). Methods In this prospective study, 67 SIRS patients who were admitted to the Intensive Care Unit(ICU), Department of Urology, and Department of Gastrointestinal Surgery in the Second Hospital of Tianjin Medical University during Aug. 2020 and Apr. 2021 were enrolled in the case group, and 44 people who came for physical examination were included in the control group. Enzyme-linked immunosorbent assay(ELISA)was used to detect the serum concentration of MCP-1 and the difference was compared. According to the presence of multiple organ dysfunction(MODS), the case group was subdivided into MODS group(n=26)and non-MODS group(n=41), and the serum concentration of MCP-1 was compared. The receiver operating characteristic(ROC)curve was drawn to evaluate the diagnostic efficacy of serum MCP-1 for SIRS with MODS. According to the clinical symptoms and test results, the patients were divided into the sepsis group(n=15)and non-sepsis group(n=52), and the serum concentration of MCP-1 was compared. Results The median serum MCP-1 level was 180.2(90.9-407.4)pg/mL in SIRS patients and 53.4(40.2-83.7)pg/mL in controls(P<0.001), 426.2(150.1-733.6)pg/mL in MODS group and 135.0(55.6-236.1)pg/mL in non-MODS group(P<0.001). When serum MCP-1 served as the variable, the area under the ROC curve(AUC)for the diagnostic efficacy of SIRS with MODS was 0.74, the cut-off value of serum MCP-1 corresponding to the maximum Youden index was 176.0 pg/mL, the sensitivity was 76.9% and the specificity was 65.9%. There was no significant difference in serum MCP-1 level between sepsis group and non-sepsis group(P=0.832). Conclusion Detection of serum MCP-1 level in SIRS patients has an auxiliary diagnostic value for MODS, but it cannot be used as a predictor of sepsis in SIRS patients.