| 贺外信,白娟.血清 γ干扰素、软骨组织糖蛋白水平对脓毒症休克不良预后的预测价值[J].安徽医药,2025,29(2):363-367. |
| 血清 γ干扰素、软骨组织糖蛋白水平对脓毒症休克不良预后的预测价值 |
| The predictive value of serum IFN-γ and YKL-40 levels for poor prognosis in septic shock patients |
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| DOI：10.3969/j.issn.1009-6469.2025.02.031 |
| 中文关键词: 休克，脓毒性 γ干扰素 软骨组织糖蛋白 预后 |
| 英文关键词: Shock,septic Interferon-γ Cartilage tissue glycoprotein Prognosis |
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| 中文摘要: |
| 目的分析血清 γ干扰素( IFN-γ)、软骨组织糖蛋白( YKL-40)水平对脓毒症休克病人不良预后的预测价值。方法前瞻性选取 2020年 12月至 2022年 12月在延安市人民医院就诊的 86例脓毒症休克病人，另选取同期脓毒症病人 80例，同期体检健康者 90例为对照，酶联免疫法检测血清 IFN-γ、YKL-40水平，比较病人血清 IFN-γ、YKL-40水平和临床资料。 Pearson法对血清 IFN-γ、YKL-40水平及其与血清乳酸、血清白蛋白、 SOFA评分、 APACHE Ⅱ评分相关性进行分析； Cox回归分析脓毒症休克病人死亡的影响因素； ROC曲线分析 IFN-γ、YKL-40对脓毒症休克病人预后预测价值。结果脓毒症休克病人、脓毒症病人和体检健康者血清 IFN-γ［(30.26±3.85)ng/L、(22.87±3.76)ng/L、(10.75±3.51)ng/L］、 YKL-40［(217.58±40.03)μg/L、(178.43±39.25) μg/L、(119.02±38.76)μg/L］水平依次降低，生存组脓毒症休克病人血清 IFN-γ［( 28.67±3.84)ng/L比( 34.38±3.88)ng/L］、 YKL-40［(201.76±40.02)μg/L比(258.45±40.06)μg/L］水平显著低于死亡组病人(P<0.05)。生存组和死亡组脓毒症休克病人呼吸频率、血清白蛋白、 SOFA评分、血清乳酸、 APACHE Ⅱ评分比较，差异有统计学意义( P<0.05)。血清 IFN-γ与 YKL-40水平呈正相关(r=0.41，P<0.001)血清 IFN-γ、YKL-40水平与血清乳酸、 SOFA评分、 APACHE Ⅱ评分呈正相关，与血清白蛋白呈负相关( P<0.05)。 Cox回归结果显示， IFN-γ［HR=1.03，95%CI:(1.02，1.04)］、 YKL-40［HR=1.12，95%CI:(1.06，1.18)］、血清乳酸［HR=分析，1.21，95%CI:(1.11，1.33)］、血清白蛋白［HR=0.96，95%CI:(0.94，0.98)］、 SOFA评分［HR=1.30，95%CI:(1.18，1.45)］、 APACHE Ⅱ评分［HR=1.35，95%CI:(1.16，1.58)］是脓毒症休克病人死亡的影响因素( P<0.001)。 IFN-γ、YKL-40水平联合检测评估脓毒症休克病人死亡的 AUC显著高于单项检测( ZIFN-γ-联合 =2.47，P=0.014；ZYKL-40-联合 =3.55，P<0.001)，特异度和灵敏度为 91.67%和 91.94%。结论脓毒症休克病人血清 IFN-γ、YKL-40水平较高，与脓毒症休克病人死亡密切相关，可能作为脓毒症休克病人不良预后的潜在标志物。 |
| 英文摘要: |
| Objective To analyze the predictive value of serum interferon-γ (IFN-γ) and cartilage tissue glycoprotein (YKL-40) lev-els on the poor prognosis of septic shock patients.Methods From December 2020 to December 2022, 86 patients with Septic shock‐who visited Yan'an People's Hospital were prospectively selected, while 80 patients with sepsis and 90 healthy individuals were select-ed as controls, serum IFN-γ and YKL-40 levels were detected by enzyme-linked immunoassay, and serum IFN-γ and YKL-40 levels and clinical data were compared. Serum IFN-γ and YKL-40 levels and their correlation with serum lactate, serum albumin, SOFAscore, and APACHE Ⅱ score were analyzed by Pearson method. Cox regression was applied to analyze the influencing factors of mortal-ity in Septic shock patients. ROC was applied to analyze the prognostic value of serum IFN-γ and YKL-40 levels in patients with Septic shock. Results The serum IFN-γ [(30.26±3.85)ng/L, (22.87±3.76)ng/L, (10.75±3.51)ng/L] and YKL-40 levels[(217.58±40.03)μg/L,(178.43±39.25)μg/L, (119.02±38.76)μg/L] in Septic shock patients, pyemia patients, and healthy individuals decreased sequentially,the serum IFN-γ [(28.67±3.84)ng/L vs. (34.38±3.88)ng/L] and YKL-40 levels [(201.76±40.02)μg/L vs. (258.45±40.06)μg/L] in Septic shock patients in the survival group were obviously lower than those in the death group (P<0.05). There was a statistically obvious dif-ference in respiratory rate, serum lactate, serum albumin, SOFA score, and APACHE Ⅱ score between the survival group and thedeath group (P<0.05). Pearson analysis showed a positive correlation between serum IFN-γ and YKL-40 levels (r=0.41, P<0.001), while serum IFN-γ and YKL-40 levels were positively correlated with serum lactate, SOFA score, APACHE Ⅱ score, and negatively correlated with serum albumin (P<0.05). Cox regression analysis showed that IFN-γ[HR=1.03, 95%CI:(1.02,1.04)], YKL-40 [HR=1.12, 95%CI:(1.06,1.18)], serum lactate [HR=1.21,95%CI:(1.11,1.33)], serum albumin [HR=0.96,95%CI:(0.94,0.98)], SOFA score [HR=1.30, 95%CI:(1.18,1.45)], and APACHE Ⅱ score [HR=1.35,95%CI: (1.16,1.58)] were influencing factors for mortality in patients with Septic shock (P<0.001). The AUC of combined detection of IFN-γ and YKL-40 levels in evaluating mortality of sepsis shock patients was obvi-ously higher than that of single detection (ZIFN-γ-combination=2.47, P=0.014;ZYKL-40-combination=3.55, P<0.001), with specificity and sensitivity of 91.67% and 91.94%.Conclusion The serum levels of IFN-γ and YKL-40 in Septic shock patients are high, which are closely relatedto the prognosis of patients and may serve as potential biomarkers for the prognosis of Septic shock patients. |
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