脓毒症患者血清VEGF-A与sFLT-1水平变化的临床意义

目的观察脓毒症患者血清中VEGF-A、sFLT-1水平变化,以及VEGF-A活性指数(VEGF-A/sFLT-1)变化,探讨其对脓毒症患者的病情评估和预后的预测价值。方法研究对象脓毒症组为2010年1月-2011年6月期间入住安徽医科大学第一附属医院急诊医学科符合脓毒症诊断标准的59例患者,根据28 d存活情况分为脓毒症存活和死亡组;对照组为20例健康者。采用酶联免疫吸附法测定脓毒症患者和对照组血清中VEGF-A及sFLT-1水平,计算VEGF-A活性指数,分别进行三者与APACHEⅡ评分、脓毒症预后的相关性分析。结果脓毒症组血清VEGF-A、sFLT-1水平均明显高于对照组(P0.05);脓毒症死亡组血清VEGF-A、sFLT-1水平及VEGF-A活性指数均明显高于存活组(P0.05);脓毒症组血清VEGF-A、sFLT-1水平及VEGF-A活性指数与APACHEⅡ评分均呈正相关性(r=0.754,P=0;r=0.655,P=0;r=0.497,P=0);使用ROC曲线分析血清VEGF-A、sFLT-1浓度和VEGF-A活性指数对脓毒症发生的预测价值,其曲线下面积分别为76.3%、76.4%和58.1%;评估血清VEGF-A、sFLT-1浓度和VEGF-A活性指数对脓毒症预后的预测价值,其ROC曲线下面积分别为91.2%、86.2%和85.5%。结论脓毒症组血清VEGF-A、sFLT-1水平及VEGF-A活性指数均明显升高,且与病情严重程度以及不良预后呈正相关;血清VEGF-A、sFLT-1水平及VEGF-A活性指数对临床预测脓毒症发生及预后有一定价值。

Clinical significance of the levels of VEGF and sFlt-1 in sepsis patients

Objective To investigate the changes of serum VEGF-A, sFLT-1 levels and activity VEGF-A index （ VEGF-A/sFLT-1 ）, and to analyze their clinical significance of evaluation and prognosis prediction in sepsis patients. Methods Fifty-nine sepsis patients were studied after admitted to the I cu of First Affiliated Hospital of Anhui Medical University from March 2008 to August 2010 ,and 20 healthy people were involved in control group. The sepsis patients were divided into the survival group and the death group further according to the suival status at 28 days. Serum VEGF-A and sFLT-1 levels were assayed by ELISA in all patients, furthermore, activity indices of VEGF-A was calculated. Next, we created a Spearman-rank correlation matrix showihg the association with each of the markers with APACHE II. Finally,to determine the diagnostic and predictive accuracy of all the biomarkers, ROC curves were constructed, and AUCs were calculated. We used SPSS17.0 package for data processing. Results In sepsis group, the VEGF-A, sFLT-1 levels in serum were higher than those in the control group （P 〈0. 05） ;In sepsis death group, the serum VEGF-A, sFLT-1 levels and activity indices of VEGF-A were higher than those in the sepsis survival group（ P 〈 0.05 ） ; Further more, the serum VEGF-A and sFLT-I levels and activity indices of VEGF-A in sepsis patients showed positive relationship with the APACHE II score （ r = 0. 754, P = 0 ; r= 0. 655, P = 0 ; r = 0. 497,P = 0）. The AUCs of serum VEGF-A, sFLT-1 levels and activity indices of VEGF-A to predict and diagnose sepsis were 0. 763, 0.764 and 0.581 respectively;The AUCs of serum VEGF-A, sFLT-1 levels and activity indices of VEGF-A predicting 28-day mortality were 0. 912,0.862 and 0. 855 respectively. Conclusion Serum VEGF-A and sFLT-1 levels and the activity indices of VEGF-A of sipsis patients were higher than those in control group. Further more, serum VEGF-A and sFLT-1 levels and the activity indices of VEGF-A showed positive relationship with APACHE II score;Elevated serum levels of VEGF-A, sFLT-1 and the activity indices of VEGF-A can predict sepsis diagnosis and outcome.