肝素结合蛋白浓度检测在脓毒症诊断中的应用价值
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摘要
目的探讨肝素结合蛋白(HBP)浓度检测在脓毒症诊断中的应用价值。方法选取2018年1月—12月成都市郫都区中医医院收治的52例脓毒症患者作为研究对象,根据疾病严重程度的不同分为脓毒症组(26例)和脓毒性休克组(26例);另选35例健康体检者作为健康对照组。采用酶联免疫吸附试验(ELISA法)检测所有受检者的HBP,采用酶联免疫荧光法检测降钙素原(PCT),采用免疫层析法检测超敏C-反应蛋白(hs-CRP),采用全自动血液分析仪检测白细胞计数(WBC),观察各组的HBP、PCT、hs-CRP和WBC检测结果进行比较,并绘制受试者工作特征曲线(ROC),评估HBP对脓毒症的诊断价值。结果健康对照组、脓毒症组、脓毒性休克组的HBP、PCT、hs-CRP和WBC均呈逐步上升趋势〔HBP(μg/L):2.85±0.76、8.55±1.27、96.72±21.35,PCT(μg/L):0.25±0.09、0.38±0.34、1.86±0.67,hs-CRP(g/L):2.63±1.33、3.17±1.53、10.91±6.21,WBC(×10~9/L):7.29±0.80、9.26±0.87、12.49±1.56〕,各组之间两两比较差异均有统计学意义(均P<0.05),其中脓毒性休克组的HBP升高最为明显(P<0.01)。HBP诊断脓毒症和脓毒性休克的敏感度和特异度均明显优于PCT、hs-CRP、WBC(均P<0.05)。ROC曲线分析结果显示,HBP预测脓毒症的ROC曲线下面积(AUC)为0.882〔95%可信区间(95%CI)=0.745～1.000,P=0.002〕,最佳临界值为7.295μg/L时,敏感度为0.625、特异度为1.000。结论在脓毒症诊断中,应用HBP浓度检测能够有效鉴别脓毒症的感染程度,使患者得到及时的治疗,提高预后疗效。
Objective To explore the value of heparin binding protein(HBP) concentration testing in the diagnosis of sepsis. Methods Fifty-two patients with sepsis admitted to Pidu District Hospital of Traditional Chinese Medicine from January to December 2018 were selected as the research subjects. According to the severity of the disease, the patients were divided into a sepsis group(26 cases) and a septic shock group(26 cases);in addition, 35 healthy subjects were selected as a healthy control group. HBP was detected by enzyme-linked immunosorbent assay(ELISA), procalcitonin(PCT) was detected by enzyme-linked immunofluorescence assay,hypersensitive C-reactive protein(hs-CRP) was detected by immunochromatography, and white blood cell count(WBC) was detected by automatic blood analyzer. The results of HBP、PCT、hs-CRP and WBC levels were observed and compared, and the receiver operation characteristic curve was drawn to evaluate the value of HBP in the diagnosis of sepsis. Results The levels of following indexes: HBP, PCT, hs-crp and WBC respectively showed a gradually increasing trend sequentially in the healthy control group, sepsis group and septic shock group [HBP(ug/L): 2.85±0.76, 8.55±1.27, 96.72±21.35; PCT(ug/L): 0.25±0.09, 0.38±0.34, 1.86±0.67; hs-CRP(g/L):2.63±1.33, 3.17±1.53, 10.91±6.21, WBC(×10~9/L): 7.29±0.80, 9.26±0.87, 12.49±1.56], the differences of pairwise comparisons between each of the two groups revealed statistically significant(all P < 0.05), and the septic shock group showed the most significant increase in HBP(P < 0.01). The sensitivity and the specificity of HBP in the diagnosis of sepsis and septic shock were significantly better than those of PCT, hs-CRP and WBC(all P < 0.05).The results of ROC curve analysis showed that the area under the ROC curve(AUC) predicted by HBP for sepsis was 0.882 [95% confidence interval(95%CI) = 0.745-1.000, P = 0.002]. When the optimal critical value was 7.295 μg/L,the sensitivity and specificity were 0.625 and 1.000 respectively. Conclusion In the diagnosis of sepsis, the application of HBP concentration detection can effectively identify the degree of infection of sepsis, so that the patients can receive timely treatment to improve their prognoses.
Objective To explore the value of heparin binding protein(HBP) concentration testing in the diagnosis of sepsis. Methods Fifty-two patients with sepsis admitted to Pidu District Hospital of Traditional Chinese Medicine from January to December 2018 were selected as the research subjects. According to the severity of the disease, the patients were divided into a sepsis group(26 cases) and a septic shock group(26 cases);in addition, 35 healthy subjects were selected as a healthy control group. HBP was detected by enzyme-linked immunosorbent assay(ELISA), procalcitonin(PCT) was detected by enzyme-linked immunofluorescence assay,hypersensitive C-reactive protein(hs-CRP) was detected by immunochromatography, and white blood cell count(WBC) was detected by automatic blood analyzer. The results of HBP、PCT、hs-CRP and WBC levels were observed and compared, and the receiver operation characteristic curve was drawn to evaluate the value of HBP in the diagnosis of sepsis. Results The levels of following indexes: HBP, PCT, hs-crp and WBC respectively showed a gradually increasing trend sequentially in the healthy control group, sepsis group and septic shock group [HBP(ug/L): 2.85±0.76, 8.55±1.27, 96.72±21.35; PCT(ug/L): 0.25±0.09, 0.38±0.34, 1.86±0.67; hs-CRP(g/L):2.63±1.33, 3.17±1.53, 10.91±6.21, WBC(×10~9/L): 7.29±0.80, 9.26±0.87, 12.49±1.56], the differences of pairwise comparisons between each of the two groups revealed statistically significant(all P < 0.05), and the septic shock group showed the most significant increase in HBP(P < 0.01). The sensitivity and the specificity of HBP in the diagnosis of sepsis and septic shock were significantly better than those of PCT, hs-CRP and WBC(all P < 0.05).The results of ROC curve analysis showed that the area under the ROC curve(AUC) predicted by HBP for sepsis was 0.882 [95% confidence interval(95%CI) = 0.745-1.000, P = 0.002]. When the optimal critical value was 7.295 μg/L,the sensitivity and specificity were 0.625 and 1.000 respectively. Conclusion In the diagnosis of sepsis, the application of HBP concentration detection can effectively identify the degree of infection of sepsis, so that the patients can receive timely treatment to improve their prognoses.
引文
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5刘晓,徐芳萍.康妇消炎栓与妇科千金胶囊和抗菌药物联用对产妇产后子宫感染性疾病的临床疗效评价[J].抗感染药学,2017,14(8):1582-1584.
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7修桂英.降钙素原和C-反应蛋白检测与小儿发热性疾病的相关性分析[J].中国妇幼保健,2013,28(21):3545-3546.DOI:10.7620/zgfybj.j.issn.1001-4411.2013.28.61.
8 Matwiyoff GN,Prahl JD,Miller RJ,et al.Immune regulation of procalcitonin:a biomarker and mediator of infection[J].Inflamm Res,2012,61(5):401-409.DOI:10.1007/s00011-012-0439-5.
9孔丽蕊,黄深华,黄亨建.HBP表达水平对脓毒症的预警评估作用研究进展[J].邵阳学院学报(自然科学版),2018,15(5):104-110.
10袁雪.慢性心力衰竭患者血清半乳糖凝集素-3和心型脂肪酸结合蛋白表达水平及其诊断和预后价值[J/CD].中国医学前沿杂志(电子版),2017,9(8):82-85.DOI:10.12037/YXQY.2017.08-18.
11王亮,马晓春.肝素结合蛋白的结构和功能特点及其在脓毒症中的作用[J].中华危重病急救医学,2014,26(3):200-203.DOI:10.3760/cma.j.issn.2095-4352.2014.03.018.
12张伟杰,刘杏萍,许新劲.普通肝素与低分子肝素对脓毒血症患者肝素结合蛋白浓度的影响对比[J].黑龙江医学,2017,41(4):341-342.DOI:10.3969/j.issn.1004-5775.2017.04.027.
13赵雪峰,孟庆玲.小剂量普通肝素对老年感染性休克患者血清降钙素原及肝素结合蛋白的影响[J].实用医学杂志,2016,32(22):3731-3734.DOI:10.3969/j.issn.1006-5725.2016.22.028.
14邓宽国,韩相卿,王立民.血清肝素结合蛋白检测对ICU危重患者细菌感染的评价价值研究[J].中国临床医生杂志,2018,46(2):169-171.DOI:10.3969/j.issn.2095-8552.2018.02.013.
15易晓榕,桂晓美.肝素结合蛋白用于诊断脓毒血症的研究[J].实验与检验医学,2017,35(5):654-657.DOI:10.3969/j.issn.1674-1129.2017.05.006.
16张团结,韩来新,王伟,等.肝素结合蛋白对脓毒症相关急性呼吸窘迫综合征的预测价值研究[J].传染病信息,2018,31(1):41-42,47.DOI:10.3969/j.issn.1007-8134.2018.01.010.
17朱宏坤.血清肝素结合蛋白在脓毒症患者中的表达与临床意义[J].中国中西医结合急救杂志,2015,22(1):75-78.DOI:10.3969/j.issn.1008-9691.2015.01.018.
18邹艳花,杨录波,邱淑妍,等.肝素结合蛋白在脓毒症诊断及分级中的应用[J].深圳中西医结合杂志,2018,28(20):58-59.DOI:10.16458/j.cnki.1007-0893.2018.20.029.
2 Ilboudo CM,Jackson MA.Early onset neonatal sepsis and meningitis[J].J Pediatric Infect Dis Soc,2014,3(4):354-357.DOI:10.1093/jpids/piu003.
3 Cankaya S,Demir B,Aksakal SE,et al.Insulin resistance and its relationship with high molecular weight adiponectin in adolescents with polycystic ovary syndrome and a maternal history of polycystic ovary syndrome[J].Fertil Steril,2014,102(3):826-830.DOI:10.1016/j.fertnstert.2014.05.032.
4邹艳花,杨录波,邱淑妍,等.肝素结合蛋白在脓毒症诊断及分级中的应用[J].深圳中西医结合杂志,2018,28(20):58-59.DOI:10.16458/j.cnki.1007-0893.2018.20.029.
5刘晓,徐芳萍.康妇消炎栓与妇科千金胶囊和抗菌药物联用对产妇产后子宫感染性疾病的临床疗效评价[J].抗感染药学,2017,14(8):1582-1584.
6王翔.脓毒血症相关新型生物标志物研究进展[J].中华实用诊断与治疗杂志,2015,29(8):736-738.DOI:10.13507/j.issn.1674-3474.2015.08.004.
7修桂英.降钙素原和C-反应蛋白检测与小儿发热性疾病的相关性分析[J].中国妇幼保健,2013,28(21):3545-3546.DOI:10.7620/zgfybj.j.issn.1001-4411.2013.28.61.
8 Matwiyoff GN,Prahl JD,Miller RJ,et al.Immune regulation of procalcitonin:a biomarker and mediator of infection[J].Inflamm Res,2012,61(5):401-409.DOI:10.1007/s00011-012-0439-5.
9孔丽蕊,黄深华,黄亨建.HBP表达水平对脓毒症的预警评估作用研究进展[J].邵阳学院学报(自然科学版),2018,15(5):104-110.
10袁雪.慢性心力衰竭患者血清半乳糖凝集素-3和心型脂肪酸结合蛋白表达水平及其诊断和预后价值[J/CD].中国医学前沿杂志(电子版),2017,9(8):82-85.DOI:10.12037/YXQY.2017.08-18.
11王亮,马晓春.肝素结合蛋白的结构和功能特点及其在脓毒症中的作用[J].中华危重病急救医学,2014,26(3):200-203.DOI:10.3760/cma.j.issn.2095-4352.2014.03.018.
12张伟杰,刘杏萍,许新劲.普通肝素与低分子肝素对脓毒血症患者肝素结合蛋白浓度的影响对比[J].黑龙江医学,2017,41(4):341-342.DOI:10.3969/j.issn.1004-5775.2017.04.027.
13赵雪峰,孟庆玲.小剂量普通肝素对老年感染性休克患者血清降钙素原及肝素结合蛋白的影响[J].实用医学杂志,2016,32(22):3731-3734.DOI:10.3969/j.issn.1006-5725.2016.22.028.
14邓宽国,韩相卿,王立民.血清肝素结合蛋白检测对ICU危重患者细菌感染的评价价值研究[J].中国临床医生杂志,2018,46(2):169-171.DOI:10.3969/j.issn.2095-8552.2018.02.013.
15易晓榕,桂晓美.肝素结合蛋白用于诊断脓毒血症的研究[J].实验与检验医学,2017,35(5):654-657.DOI:10.3969/j.issn.1674-1129.2017.05.006.
16张团结,韩来新,王伟,等.肝素结合蛋白对脓毒症相关急性呼吸窘迫综合征的预测价值研究[J].传染病信息,2018,31(1):41-42,47.DOI:10.3969/j.issn.1007-8134.2018.01.010.
17朱宏坤.血清肝素结合蛋白在脓毒症患者中的表达与临床意义[J].中国中西医结合急救杂志,2015,22(1):75-78.DOI:10.3969/j.issn.1008-9691.2015.01.018.
18邹艳花,杨录波,邱淑妍,等.肝素结合蛋白在脓毒症诊断及分级中的应用[J].深圳中西医结合杂志,2018,28(20):58-59.DOI:10.16458/j.cnki.1007-0893.2018.20.029.