摘要
目的 探讨早期测定脓毒症患者血小板CD63、CD42b及CD36表达水平在脓毒症预后评估中的价值.方法 选择2017年2月至2019年9月昆山市第一人民医院和昆山市花桥人民医院重症医学科收治的脓毒症患者139例及健康体检志愿者40例分为脓毒症组和健康对照组.根据28 d预后将脓毒症组分为生存组和死亡组,入院24 h内和第3天抽取血标本,用流式细胞仪检测患者血小板CD63、CD42b、CD36阳性表达率和平均荧光强度(MFI).检测患者入院后同时间段血常规、凝血功能、降钙素原(PCT)、C-反应蛋白(CRP)、血乳酸等.收集患者的基本临床资料以及入院24 h内指标最差时的急性生理与慢性健康状况Ⅱ评分(APACHEⅡ评分)和序贯器官衰竭评分(SOFA评分).比较各组患者的临床和实验室数据;研究各数据之间的相关性采用Pearson分析.对差异有统计学意义的变量进行二元Logistic回归分析,确定28 d死亡的独立危险因素.采用受试者工作特征曲线(ROC曲线)分析血小板CD63、CD42b、CD36对脓毒症患者预后的判断价值.结果 脓毒症组较健康对照组的CD63和CD36的表达水平显著增高[(8.35±0.82)%vs.(1.84±0.55)%,64.18±3.71 vs.48.54±8.36,P<0.01],CD42b表达水平显著下降(49.32±2.10 vs.59.67±5.10,P<0.01).死亡组较生存组的CD63和CD36表达水平显著增高[(11.84±1.35)% vs.(6.56±0.82)% ,72.49±6.21 vs.59.94±4.45,P<0.01],而CD42b表达水平显著下降(43.18±3.26 vs.52.56±2.46,P<0.01).Pearson相关分析显示,CD63、CD36与CD42b三者之间显著相关(P<0.01);APACHEⅡ评分、SOFA评分、乳酸与CD63、CD36呈正相关,与CD42b呈显著负相关(P<0.05或P<0.01);CD36与抗凝血酶Ⅲ(AT-Ⅲ)水平、血小板计数、PCT具有相关性(P<0.05或P<0.01);CD42b与PCT、凝血酶原时间(PT)呈负相关(P<0.05或P<0.01).二元Logistic回归分析显示:CD63[优势比(OR)=1.229,P<0.01]、CD42b(OR=0.947,P<0.05)、APACHEⅡ评分(OR=1.226,P<0.01)和AT-Ⅲ水平(OR=0.974,P<0.05)是影响脓毒症患者28 d死亡的独立危险因素.ROC曲线分析显示,检测入院第1天的CD63、CD42b表达水平及APACHEⅡ评分对脓毒症的预后判断均有价值[ROC曲线下面积(AUC)分别为0.8098、0.7358、0.8658],三者联合判断能力更好(AUC=0.8791,敏感度72.09%,特异度85.56%).结论 早期检测CD63、CD42b、CD36的表达水平可在一定程度上判断脓毒症患者的预后.
Objective This study was aimed to observe the early expression levels of platelet surface CD63,CD42b and CD36 in septic patients to explore their value for prognosis of sepsis.Methods The study selected 139 septic patients and 40 healthy adults as a control group.The patients were admitted to intensive care unit(ICU)of the First People's Hospital of Kunshan and the Peopled Hospital of Kunshan Huaqiao from February 2017 to September 2019.Moreover,they were divided into survival group and death group according to the 28-day prognosis.The positive rates and mean fluorescence intensity of platelet CD63,CD42b and CD36 were measured by flow cytometry on the first and third day of admission.Meanwhile,hemogram,coagulation indexes,procalcitonin(PCT),C-reaction protein(CRP)and lactate were measured.The primary clinical data of the patients were collected.APACHE II score and SOFA score were recorded according to the worst indicators within 24 hours.The clinical information and laboratory data of different groups were compared.Pearson correlation analyzed the correlation between the indicators.Moreover,the statistically significant variables were analyzed by binary Logistic regression analysis to identify the independent risk factors for death.Receiver operating characteristic curve(ROC)was used to evaluate the prognostic value of platelet CD63,CD42b and CD36 in patients with sepsis.Results The expression levels of CD63 and CD36 were significantly increased in the sepsis group compared with the control group[(8.35±0.82)%vs.(1.84±0.55)%,64.18±3.71 vs.48.54±8.36,P<0.01],while CD42b level was significantly decreased(49.32±2.10 vs.59.67±5.10,P<0.01).The expression of CD63 and CD36 in the death group were exhibited increased compared with the survival group[(11.84±1.35)%vs.(6.56±0.82)%,72.49±6.21 vs.59.94±4.45,P<0.01],while CD42b level was decreased significantly(43.18±3.26 vs.52.56±2.46,P<0.01).Pearson analysis showed that CD63,CD36 and CD42b were pairwise correlated(P<0.01).Compared with APACHE II score,SOFA score and Lac,the levels of CD63 and CD36 were significantly positively correlated while CD42b was negatively correlated(P<0.05 or P<0.01).CD36 was correlated with AT-IE activity,platelet count and PCT(P<0.05 or P<0.01),while CD42b was negatively correlated with PCT and Prothrombin time(P<0.05).Binary Logistic regression showed that the levels of CD63[odds ratio(OR)=1.229,P<0.01],CD42b(OR=0.947,P<0.05)and APACHE II score(OR=1.226,P<0.01)and AT-Ⅲ level(OR=0.974,P<0.05)were the independent risk factors for the death of 28d in sepsis.ROC curve analysis showed that the CD63,CD42b levels on the first day after admission and APACHE D score had higher prognostic value for the 28-day motality[the area under ROC curve(AUC)were 0.8098,0.7358 and 0.8658].The combination of CD63,CD42b and CD36 may have better judgment ability for sepsis prognosis(AUC=0.8791,sensitivity 72.09%,and specificity 85.56%).Conclusion Early detection of CD63,CD42b and CD36 can be used to predict the prognosis of patients with sepsis to a certain extent.
作者
陶涛
刘龙
陈阳
姚建英
彭媛
陆士奇
Tao Tao;Liu Long;Chen Yang;Yao Jian-ying;Peng Yuan;Lu Shi-qi(Intensive Care Unit,The First People's Hospital of Kunshan,Kunshan 215300,China)
出处
《中国急救医学》
CAS
CSCD
北大核心
2020年第1期58-64,共7页
Chinese Journal of Critical Care Medicine
基金
昆山市社会发展科技专项基金(KS18086)。
作者简介
陶涛(1988-),男,硕士研究生,主治医师,E-mail:kstt881206@126.com;通信作者:陆士奇(1959-),男,博士,博士生导师,E-mail:lushiqi2004@126.com。
