摘要
目的 探讨T细胞表面程序性死亡受体-1(PD-1)表达水平与脓毒症患者28 d预后的关系。方法 将2020年1月—2023年4月上海市第八人民医院住院治疗的脓毒症患者作为研究对象,患者根据入院28 d后预后情况分为死亡组(41例)和生存组(78例)。采用倾向性得分匹配(PSM)按1∶1的比例对死亡患者进行匹配,每组41例,比较患者的临床资料,分析影响患者预后的独立危险因素。分析PD-1表达水平与脓毒症患者预后的剂量反应关系及诊断价值。构建列线图模型,并对模型效能进行验证。结果 匹配后两组患者除PD-1水平外,其余指标比较差异均无统计学意义(P>0.05)。多因素分析结果显示,合并慢性肝病、APACHEⅡ评分、SOFA评分、CRP、乳酸、PCT、PD-1水平均是影响脓毒症患者预后的独立危险因素(P<0.05)。剂量反应关系分析结果显示,当PD-1≤22 ng/mL时,脓毒症患者死亡的风险几乎不随PD-1水平升高而升高(HR=1.002,95%CI:1.000~1.005,P=0.623);但当PD-1>22 ng/mL时,脓毒症患者死亡的风险随PD-1水平升高而明显升高(HR=1.006,95%CI:1.003~1.008,P<0.001)。PD-1表达水平对脓毒症患者预后具有较高的诊断价值(AUC=0.803)。线图模型的ROC曲线下面积为0.817,C-index为0.806,校准曲线拟合度良好,临床决策曲线阈值概率在0.04~0.95范围内有较高的净获益值,表明列线图模型的区分度较高、准确度良好、有效性较好。结论 T细胞表面PD-1表达水平是影响脓毒症患者预后的重要因素,对患者预后评估具有积极意义。
Objective Explore the relationship between the expression level of programmed death receptor-1(PD-1)on T cell surface and the prognosis and benefits of sepsis patients.Methods Sepsis patients hospitalized in our hospital from January 2020 to April 2023 were selected as the research subjects.Patients were divided into a death group(41 cases)and a survival group(78 cases)based on the prognosis after 28 days of admission.Match the deceased patients in a 1∶1 ratio using propensity score matching(PSM),with 41 patients in each group,compare clinical data of patients and analyze independent risk factors that affect their prognosis.Analyze the dose-response relationship between the expression level of PD-1 and the prognosis of sepsis patients and the diagnostic value.Build a column chart model and verify its effectiveness.Results After matching,there was no statistically significant difference in other indicators between the two groups of patients except for the PD-1 level(P>0.05).The results of multivariate analysis showed that the combination of chronic liver disease,APACHE II score,SOFA score,CRP,lactate,PCT,and PD-1 levels were independent risk factors affecting the prognosis of sepsis patients(P<0.05).The dose-response relationship analysis results showed that when PD-1≤22 ng/mL,the risk of death in sepsis patients almost did not increase with the increase of PD-1 levels(HR=1.002,95%CI:1.000-1.005,P=0.623);But when PD-1>22ng/mL,the risk of death in sepsis patients increases with the increase of PD-1 levels(HR=1.006,95%CI:1.003-1.008,P<0.001).The expression level of PD-1 has high diagnostic value for the prognosis of sepsis patients(AUC=0.803).The area under the ROC curve of the line graph model is 0.817,with a C-index of 0.806.The calibration curve has a good fit,and the clinical decision curve threshold probability has a high net benefit value in the range of 0.04-0.95.This indicates that the line graph model has high discrimination,good accuracy,good effectiveness,and is safe and reliable.Conclusion The expression level of PD-1 on the surface of T cells is an important factor affecting the prognosis of patients with sepsis,and has positive significance for evaluating the prognosis of patients.
作者
王敏鹏
孙梦涵
李沈振
张东明
李亚明
周鑫健
WANG Minpeng;SUN Menghan;LI Shenzhen;ZHANG Dongming;LI Yaming;ZHOU Xinjian(Department of Critical Care Medicine,the Eighth People's Hospital of Shanghai,Shanghai 200235,China)
出处
《中国急救复苏与灾害医学杂志》
2024年第8期1072-1076,共5页
China Journal of Emergency Resuscitation and Disaster Medicine
作者简介
通信作者:周鑫健,E-mail:13801898707@163.com。
