血液肿瘤合并脓毒血症危险因素分析及HLA-DR和S100A12联合检测对其预后的价值
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摘要
目的探讨单核细胞人白细胞抗原-DR(human leukocyte antigen DR,HLA-DR)和S100A12在血液肿瘤脓毒血症的诊断和预后的价值及相关危险因素。方法选取ICU住院的血液肿瘤合并脓毒血症患者为脓毒血症组,感染患者为非脓毒血症组,流式细胞仪和ELISA检测HLA-DR和S100A12,将脓毒血症组依结局分为死亡和生存组,分析HLA-DR和S100A12对血液肿瘤合并脓毒血症预后的相关性。结果脓毒血症组APACHEⅡ、死亡率、S100A12、PCT和CRP均高于非脓毒血症组,而HLA-DR则相反;S100A12、PCT、CRP、APACHEⅡ、WBC和HLA-DR均和血液肿瘤脓毒血症预后有关(P <0.05);S100A12和HLADR是血液肿瘤脓毒血症死亡的危险因素;HLA-DR和S100A12联合检测诊断血液肿瘤脓毒血症敏感性高。结论血液肿瘤脓毒血症患者HLA-DR降低和S100A12升高是患者预后的危险因素,联合检测为预后提供价值。
Objective To evaluate monocyte human leukocyte antigen DR(HLA-DR)and serum S100 A12 in diagnosis and prognosis of ematological tumor with sepsis,and to analyze the related risk factors. Methods Patients with hematological tumor with sepsis and without sepsis were enrolled in Qinghai Provincial People′sHospital. The clinical and laboratory characteristics were collected. Levels of HLA-DR and S100 A12 were detectedby flow cytometry and ELISA,respectively. The clinical and laboratory data were analyzed by the independentsample t-test,chi-square test and binary Logistic regression analysis,respectively. According to the outcome ofhematological malignancy with sepsis,patients were divided into death and survival group,the correlation betweenHLA-DR,S100 A12 and prognosis of hematologic malignancies with sepsis was analyzed by Poisson correlationanalysis method. Results APACHEⅡ,mortality,S100 A12,PCT and CRP in sepsis patients were higher thanthose in non-sepsis patients,but HLA-DR was on the contrary. S100 A12,PCT,CRP,APACHEⅡ,WBC andHLA-DR were all associated with the prognosis of hematologic malignancies combined with sepsis. MultivariateLogistic regression analysis showed that S100 A12 and HLADR were risk factors of death in hematological tumorswith sepsis. The combined detection of HLA-DR and S100 A12 in hematologic malignancies of septic patients wasmore sensitive than the single test. Conclusions The low HLA-DR expression and high S100 A12 level are riskfactors for the prognosis of hematologic malignancies with sepsis. Combined detection of the HLA-DR and S100 A12 was valuable for prognosis of hematologic malignancies with sepsis.
Objective To evaluate monocyte human leukocyte antigen DR(HLA-DR)and serum S100 A12 in diagnosis and prognosis of ematological tumor with sepsis,and to analyze the related risk factors. Methods Patients with hematological tumor with sepsis and without sepsis were enrolled in Qinghai Provincial People′sHospital. The clinical and laboratory characteristics were collected. Levels of HLA-DR and S100 A12 were detectedby flow cytometry and ELISA,respectively. The clinical and laboratory data were analyzed by the independentsample t-test,chi-square test and binary Logistic regression analysis,respectively. According to the outcome ofhematological malignancy with sepsis,patients were divided into death and survival group,the correlation betweenHLA-DR,S100 A12 and prognosis of hematologic malignancies with sepsis was analyzed by Poisson correlationanalysis method. Results APACHEⅡ,mortality,S100 A12,PCT and CRP in sepsis patients were higher thanthose in non-sepsis patients,but HLA-DR was on the contrary. S100 A12,PCT,CRP,APACHEⅡ,WBC andHLA-DR were all associated with the prognosis of hematologic malignancies combined with sepsis. MultivariateLogistic regression analysis showed that S100 A12 and HLADR were risk factors of death in hematological tumorswith sepsis. The combined detection of HLA-DR and S100 A12 in hematologic malignancies of septic patients wasmore sensitive than the single test. Conclusions The low HLA-DR expression and high S100 A12 level are riskfactors for the prognosis of hematologic malignancies with sepsis. Combined detection of the HLA-DR and S100 A12 was valuable for prognosis of hematologic malignancies with sepsis.
引文
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[24] ACHOUITI A,F?LL D,VOGL T,et al. S100A12 and solublereceptor for advanced glycation end products levels during hu-man severe sepsis[J]. Shock,2013,40(3):188-194.
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[26] PAYEN D,LUKASZEWICZ AC,BELIKOVA I,et al. Geneprofiling in human blood leucocytes during recovery from septicshock[J]. Intensive Care Med,2008,34(8):1371-1376.
[27] RADICH R J,ALVAREZ Z C,VALENZUELA R A,et al.Role of surgery in Saprochaete capitata(S. capitata)sepsis in apatient with acute myeloid leukemia[J]. Rev Med Chill,2017,145(8):1067-1071.
[2] MALIK I A,CARDENAS-TURANZAS M,GAETA S,et al.Sepsis and acute myeloid leukemia:a population-level study ofcomparative outcomes of patients discharged from texas hospitals[J]. Clinical lymphoma,myeloma&leukemia,2017,17(12):e27-e32.
[3] GREEN R S,GORMAN S K. Emergency department antimicro-bial considerations in severe sepsis[J]. Emerg Med Clin NorthAm,2014,32(4):835-849.
[4] PIERRAKOS C,VINCENT J L. Sepsis biomarkers:a review[J].Crit Care,2010,14(1):R15.
[5] VINCENT J L,BEUMIER M. Diagnostic and prognostic mark-ers in sepsis[J]. Expert Rev Anti Infect Ther,2013,11(3):265-275.
[6] DREWRY A M,ABLORDEPPEY E A,MURRAY E T,et al.Comparison of monocyte human leukocyte antigen-DR expres-sion and stimulated tumor necrosis factor alpha production asoutcome predictors in severe sepsis:aprospective observationalstudy[J]. Crit Care,2016,20(1):334.
[7] HUANG H,TU L. Expression of S100 family proteins in neona-tal rats with sepsis and its significance[J]. Int J Clin ExpPathol,2015,8(2):1631-1639.
[8] WARD P A. New approaches to the study of sepsis[J]. EMBOMol Med,2012,4(12):1234-1243.
[9] CHO S Y,CHOI J H. Biomarkers of sepsis[J]. Infect Chemoth-er,2014,46(1):1-12.
[10] REID V L,WEBSTER N R. Role of microparticles in sepsis[J]. Br J Anaesth,2012,109(4):503-513.
[11] KITAMURA Y,HASHIMOTO S,MIZUTA N,et al. Fas/FasL-dependent apoptosis of alveolar cells after lipopolysaccharide-in-duced lunginjury in mice[J]. Am J Respir Crit Care Med,2001,63(3 Pt1):762-769.
[12] GUINEE D J R,BRAMBILLA E,FLEMING M,et al. The po-tential role of BAX and BCL-2 expression in diffuse alveolardamage[J]. Am J Pathol,1997,151(4):999-1007.
[13] BROWN K A,BRAIN S D,PEARSON J D,et al. Neutrophilsin development of multiple organ failure in sepsis[J]. Lancet,2006,368(9530):157-169.
[14] STOMA I,KARPOV I,USS A,RUMMO O,et al. Diagnosticvalue of sepsis biomarkers in hematopoietic stem cell transplantrecipients in a condition of high prevalence of gram-negativepathogens[J]. Hematol Oncol Stem Cell Ther,2017,10(1):15-21.
[15] HEIZMANN C W,ACKERMANN G E,GALICHET A. Pathol-ogies involving the S100 protein and RAGE[J]. Subcell Bio-chem,2007,45:93-138.
[16]夏誉,叶素贞. EICU脓毒血症患者预后评估及相关因素[J].实用医学杂志,2017,33(11):1822-1825.
[17] TANG B M,ESLICK G D,CRAIG J C,et al. Accuracy of pro-calcitonin for sepsis diagnosis in critically ill patients:a system-atic review and meta-analysis[J]. Lancet Infect Dis,2007,7(3):210-217.
[18] UHEL F,AZZAOUI I,GREGOIRE M,et al. Early expansionof circulating granulocytic myeloid-derived suppressor cells pre-dicts development of nosocomial infections in patients with sepsis[J]. Am J Respir Crit Care Med,2017,196(3):315-327.
[19] PAYEN D,LUKASZEWICZ A C,BELIKOVA I,et al. Geneprofiling in human blood leucocytes during recovery from septicshock[J]. Intensive Care Med,2008,34(8):1371-1376.
[20] KNAUS W A,DRAPER E A,WAGNER D P,et al. APACHEⅡa severity of disease classification system[J]. Crit Care Med,1985,13(10):818-829.
[21] WANG J,GAO P,GUO S,et al. Analysis of death risk factorsfor nosocomial infection patients in an ICU:a retrospective re-view of 864 patients from 2009 to 2015[J]. Zhonghua Wei Zhong Bing Ji Jiu Yi Xue,2016,28(8):704-708.
[22] HOFMANN M A,DRURY S,FU C,et al. RAGE mediates anovel proinflammatory axis:a central cell surface receptor forS100/calgranulin polypeptides[J]. Cell,1999,97(7):889-901.
[23] INGELS C,DERESE I,WOUTERS P J,et al. Soluble RAGEand the RAGE ligands HMGB1 and S100A12 in critical illness:impact of glycemic control with insulin and relation with clinicaloutcome[J]. Shock,2015,43(2):109-116.
[24] ACHOUITI A,F?LL D,VOGL T,et al. S100A12 and solublereceptor for advanced glycation end products levels during hu-man severe sepsis[J]. Shock,2013,40(3):188-194.
[25] FOELL D,WITTKOWSKI H,KESSEL C,et al. Proinflamma-tory S100A12 can activate human monocytes via Toll-like recep-tor 4[J]. Am J Respir Crit Care Med,2013,187(12):1324-1334.
[26] PAYEN D,LUKASZEWICZ AC,BELIKOVA I,et al. Geneprofiling in human blood leucocytes during recovery from septicshock[J]. Intensive Care Med,2008,34(8):1371-1376.
[27] RADICH R J,ALVAREZ Z C,VALENZUELA R A,et al.Role of surgery in Saprochaete capitata(S. capitata)sepsis in apatient with acute myeloid leukemia[J]. Rev Med Chill,2017,145(8):1067-1071.