血清可溶性血管内皮生长因子受体-1水平有助于预测糖尿病合并脓毒症休克患者预后

惠辉.血清可溶性血管内皮生长因子受体-1水平有助于预测糖尿病合并脓毒症休克患者预后[J].内科急危重症杂志,2022,28(4):272-276

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DOI：10.11768/nkjwzzzz20220403

中文关键词: 可溶性血管内皮生长因子受体-1 2型糖尿病脓毒症休克预后影响因素

英文关键词:

基金项目:国家自然科学基金委员会资助项目（No:81701962）

作者	单位	E-mail
惠辉	郴州市第一人民医院中心医院内分泌科	pbyrnq@163.com

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中文摘要:

目的：探讨血清可溶性血管内皮生长因子受体-1（sFlt-1）水平预测糖尿病合并脓毒症休克患者预后的临床价值。方法：收集112例糖尿病合并脓毒症休克患者临床资料，根据患者预后分为死亡组48例和存活组64例。采用酶联免疫吸附法（ELISA）检测患者入院时血清sFlt-1水平，并检测血糖化血红蛋白和血糖水平，统计比较2组呼吸机和抗生素治疗时长、C -反应蛋白 (CRP)水平、凝血酶原时间 (PT) 、活化部分凝血活酶时间 (APTT) 和血清B型尿钠肽 (BNP) 水平，比较2组患者急性生理与慢性健康状况系统评估(APACHEⅡ) 评分。采用单因素和多因素Logistic回归分析影响患者预后的独立危险因素，并采用Pearson相关性分析患者入院后血清sFlt-1水平与入院时CRP水平之间的相关性。采用受试者工作特征曲线（ROC）分析血清sFlt-1水平对糖尿病合并脓毒症休克患者预后的预测价值。结果：死亡组患者血清sFlt-1水平、年龄≥60岁、糖化血红蛋白水平、真菌感染和肺部感染占比、两个以上脏器衰竭比例、呼吸机使用时长以及CRP、BNP、PT水平显著高于存活组（P均<0.05），死亡组和存活组感染发生地点比较，差异有统计学意义（P<0.05）。以生存情况（存活=0，死亡=1）为因变量，Logistic回归分析显示年龄（OR=1.950，95%CI:1.138~3.343）、肺部感染（OR=1.844，95%CI: 1.053~3.230）、糖化血红蛋白（OR=2.358，95%CI: 1.368~4.067）、血清sFlt-1水平（OR=2.519，95%CI: 1.119~5.671）、CRP（OR=2.259，95%CI: 1.250~4.083）、使用呼吸机时长（OR=2.782，95%CI: 1.138~6.799）是影响患者预后的独立危险因素（P均<0.05）。Pearson相关性分析显示入院后第1天的血清sFlt-1水平与入院时CRP呈明显正相关（r=0.647，P<0.05）。ROC曲线分析显示sFlt-1截断值为465.48ng/L时，诊断曲线下面积为0.836(95%CI: 0.829~0.906)，灵敏度为81.25%，特异性为78.13%，约登指数为0.594。结论：糖尿病合并脓毒症休克患者血清sFlt-1水平明显升高，血清sFlt-1水平是影响糖尿病合并脓毒症休克患者预后的独立危险因素。

英文摘要:

Objective: To investigate the clinical value of serum soluble fms-like tyrosine kinase-1 (sFlt-1) levels in predicting the prognosis of patients with diabetes complicated with septic shock. Methods: The clinical data of 112 patients with diabetes mellitus complicated with septic shock were prospectively studied. According to the prognosis of the patients, the patients were divided into death group (n=48) and survival group (n=64). The ELISA was used to detect the serum sFlt-1 level in all study subjects upon admission, and the glycated hemoglobin level and blood glucose level were determined. The ventilator and antibiotic treatment time, C-reactive protein (CRP), prothrombin time (PT), activated partial thromboplastin time (APTT) and B-type natriuretic peptide (BNP) were measured. The acute physiology and chronic health evaluation scoring system (APACHEⅡ) score was recorded. The univariate and multivariate Logistic regression was used to analyze independent risk factors influencing the prognosis of patients. In addition, the receiver operating characteristic (ROC) curve was used to analyze the prognostic value of serum sFlt-1 levels in diabetic patients with septic shock. Results: The serum sFlt-1 level in the death group was significantly higher than that in the survival group (P<0.001). The results of the univariate Logistic regression analysis showed that the age of patients in the death group was ≥60 years old, the levels of diabetic hemoglobin, the incidence of fungal and lung infections, the proportion of patients with two or more organ failures, the duration of ventilator use, and the levels of CRP, BNP, and PT were significantly increased as compared with those in the survival group (P<0.05). There was statistically significant difference in the locations of infection between the two groups (P<0.05). With survival (survival=0, death=1) as the dependent variable, the logistic regression analysis showed age (OR=1.950, 95% CI 1.138-3.343), lung infection (OR=1.844, 95% CI 1.053-3.230), glycosylated hemoglobin (OR=2.358, 95% CI 1.368-4.067), serum sFlt-1 level (OR=2.519, 95% CI 1.119-5.671), CRP (OR=2.259, 95% CI 1.250-4.083) and the duration of ventilator use (OR=2.782, 95% CI 1.138-6.799) were independent risk factors influencing the prognosis of patients (P<0.05). The Pearson correlation analysis showed that the serum sFlt-1 level on the first day after admission was significantly positively correlated with the CRP at admission (R=0.647, P<0.05). The ROC curve analysis results showed that when the cut-off value of sFlt-1 was 465.48ng/L, the area under the diagnostic curve was 0.836 (95% CI: 0.829-0.906), the sensitivity was 81.25%, the specificity was 78.13%, and the Youden index was 0.594. Conclusion: The level of serum sFlt-1 in diabetic patients with septic shock is significantly increased, and serum sFlt-1 is an independent risk factor influencing the prognosis of diabetic patients with septic shock, and has a high predictive value for the prognosis of patients.