| 王玉华,张国秀,胡莹莹,等.血浆淀粉样蛋白A和硫化氢水平对脓毒症休克病人诊断及预后价值[J].安徽医药,2020,24(6):1101-1105. |
| 血浆淀粉样蛋白A和硫化氢水平对脓毒症休克病人诊断及预后价值 |
| Value of serum amyloid A and hydrogen sulfide levels in diagnosis and prognosis of septic shock patients |
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| DOI：10.3969/j.issn.1009?6469.2020.06.010 |
| 中文关键词: 休克，脓毒性 血清淀粉样蛋白 A 硫化氢 预后 |
| 英文关键词: Shock,septic Serum amyloid A protein Hydrogen sulfide Prognosis |
| 基金项目:河南省医学科技攻关计划项目( 2018020283) |
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| 中文摘要: |
| 目的探讨血浆淀粉样蛋白 A(SAA)和硫化氢水平对脓毒症休克病人诊断及预后的评估价值。方法选取 2015年 3月至 2017年 4月在河南科技大学第一附属医院经医学确诊的 124例脓毒症休克病人作为研究组，同时选取在该院体检正常者 124例作为对照组。采用酶联免疫双抗体夹心法检测研究组和对照组血浆 SAA水平；利用分光光度法检测所有研究对象血浆硫化氢水平；术后 1个月，对脓毒症休克病人进行随访，根据病人生存情况分为预后良好组和预后不良组，比较两组血浆 SAA、硫化氢水平；绘制受试者工作特征曲线( ROC)评估血浆 SAA、硫化氢水平对脓毒症休克病人治疗预后不良的诊断价值；对不同预后脓毒症休克病人的临床资料进行比较； logistic回归分析脓毒症休克预后的影响因素。结果脓毒症休克组病人血浆 SAA、硫化氢水平明显高于对照组［(128.35±41.23)μmoL/L比( 7.82±2.24)μmoL/L，t＝32.505，P＜0.001；(104.47±31.98)μmoL/L比( 45.15±14.27)μmoL/L，t＝18.863，P＜0.001］；预后不良组血浆 SAA、硫化氢水平明显高于预后良好组［(158.97±42.23)μmoL/L比( 107.83±33.59)μmoL/L，t＝7.465，P＜0.001(127.35±34.99)μmoL/L比( 89.62±26.52)μmoL/L，t＝6.399，P＜0.001］；血浆 SAA、硫化氢水平预测病人系统治疗 1个月后不良预后的曲线下面积( AUC)分别为 0.812、0.788，其对应截断值分别为 132.45 μmoL/L、110.03 μmoL/L，其对应灵敏度分别为 75.0%、72.9%，对应特异度分别为 78.9%、81.6%；两者联合评估脓毒症休克的 AUC为 0.913，其灵敏度、特异度分别为 82.3%、93.4%；预后不良组脓毒症休克病人中具有肝硬化史、糖尿病史、白血病史、吸烟史者比例，急性生理学与慢性健康状况评分系统 Ⅱ(APACHEⅡ)评分，序贯器官功能衰竭评分( SOFA)及乳酸含量均明显高于预后良好组( P＜0.05)；肝硬化、白血病、 APACHEⅡ评分、 SOFA评分、 SAA、硫化氢为脓毒症休克预后的危，险因素( P＜0.05)。结论血浆 SAA、硫化氢水平在脓毒症休克病人中呈高表达，两者可能对脓毒症休克病人的早期诊断及预后有一定的评估价值。 |
| 英文摘要: |
| Objective To explore the value of serum amyloid A(SAA)and hydrogen sulfide levels in the diagnosis and prognosis of septic shock patients.Methods A total of 124 patients with septic shock diagnosed in The First Affiliated Hospital of Henan University of Science and Technology from March 2015 to April 2017 were selected as research group，and another 124 persons having health checkup in the hospital were selected as control group at the same time.The levels of SAA of research group and con?trol group were detected by enzyme linked immunoassay double antibody method and the levels of hydrogen sulfide were measured by spectrophotometry.One month after operation，the patients with septic shock were followed up and assigned into good prognosis group and poor prognosis group according to the survival status，and the levels of SAA and hydrogen sulfide of the two groups were compared.Receiver operating characteristic(ROC)was drawn to evaluate the diagnostic value of plasma SAA and hydrogen sulfide levels for poor prognosis of septic shock patients.Clinical data of septic shock patients with different prognoses were compared and the influencing factors of septic shock prognosis were analyzed by logistic regression.Results The plasma levels of SAA and hydro?gen sulfide in research group were significantly higher than those in control group［(128.35±41.23)μmoL/L vs.(7.82±2.24)μmoL/L，t＝32.505，P＜0.001；(104.47±31.98)μmoL/L vs.(45.15±14.27)μmoL/L，t＝18.863，P＜0.001］，and the plasma levels of SAA and hydrogen sulfide in poor prognosis group were significantly higher than those in good prognosis group［(158.97±42.23)μmoL/L vs.(107.83±33.59)μmoL/L，t＝7.465，P＜0.001；(127.35±34.99)μmoL/L vs.(89.62±26.52)μmoL/L，t＝6.399，P＜0.001］.The areas under the curve(AUC)for SAA and hydrogen sulfide levels predicting the poor prognosis of patients after 1 month of treat?ment were 0.812，0.788，respectively.The corresponding cut?off values，degrees of sensitivity and degrees of specificity were 132.45 μmoL/L and 110.03 μmoL/L，75.0% and 72.9%，and 78.9% and 81.6%，respectively.The AUC of combined assessment of septic shock was 0.913，and the degrees of sensitivity and specificity were 82.3% and 93.4%，respectively.The proportion of septic shock patients having history of cirrhosis，diabetes，leukemia，and smoking，score of acute physiology and chronic health status Ⅱ(APACHE Ⅱ)，score of sequential organ failure assessment(SOFA)，and lactate content were significantly higher in poor prognosis group than in good prognosis group(P＜0.05).Liver cirrhosis，leukemia，APACHE Ⅱ score，SOFA score，SAA and hydrogen sulfide were risk factors for prognosis of septic shock(P＜0.05).Conclusion The levels of SAA and hydrogen sulfide in plasma are high? ly expressed in septic shock patients，which may have some value in the early diagnosis and prognosis of septic shock patients. |
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