60岁以上脓毒症患者单核细胞活化标志物sCD14、sCD163与新发心功能障碍和短期预后相关

叶文.60岁以上脓毒症患者单核细胞活化标志物sCD14、sCD163与新发心功能障碍和短期预后相关[J].内科急危重症杂志,2023,29(4):304-309

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DOI：10.11768/nkjwzzzz20230411

中文关键词: 脓毒症心功能障碍 ≥60岁预后可溶性分化簇14 可溶性分化簇163

英文关键词:

基金项目:海南省卫生健康行业科研项目（No：20A200365）

作者	单位	E-mail
叶文	中南大学湘雅医学院附属海口医院	fushuyiyuan86@outlook.com

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中文摘要:

摘要目的：探讨60岁以上脓毒症患者血清可溶性分化簇（sCD）14、sCD163水平与新发心功能障碍（SICD）和短期预后的关系。方法：选取年龄≥60岁脓毒症患者98例为脓毒症组，另选取100例健康志愿者为对照组。采用酶联免疫吸附法（ELISA）检测2组血清sCD14、sCD163水平。根据心功能情况（新发左室射血分数＜50%和/或二尖瓣血流最大流速/心房收缩期二尖瓣血流最大流速比值＜0.8诊断为SICD）将患者分为SICD组（59例）和非SICD组（39例）。采用多因素Logistic回归分析影响脓毒症患者继发SICD的危险因素。绘制受试者工作特征（ROC）曲线，分析血清sCD14、sCD163水平对老年脓毒症患者SICD风险及院内28d死亡的预测价值。结果：脓毒症组患者血清sCD14、sCD163水平高于对照组（P均＜0.05），且治疗后逐渐降低（P均＜0.01）；各时间点SICD组患者血清sCD14、sCD163水平高于非SICD组（P均＜0.01）。经多因素Logistic回归分析，序贯器官衰竭评分（SOFA）、血清N末端B型利钠肽原（NT-proBNP）、sCD14、sCD163水平是脓毒症患者继发SICD的独立危险因素（P均＜0.05）。经ROC曲线分析，联合检测血清sCD14、sCD163水平预测年龄≥60岁脓毒症患者SICD发生风险或院内28d死亡的曲线下面积分别为0.920（95%CI：0.860~0.979）、0.940（95%CI：0.884~0.995），较SOFA或NT-proBNP值单独预测更优（P均＜0.05）。结论：血清sCD14、sCD163水平可作为预测≥60岁脓毒症患者发生SICD的生物标志物，对于短期预后不良亦有预测价值。

英文摘要:

Abstract Objective: To analyze the association of monocyte activation markers soluble cluster of differentiation (sCD)14 and sCD163 with new cardiac dysfunction (SICD) and short-term prognosis in sepsis patients over 60 years old. Methods: A total of 98 sepsis patients aged ≥60 years were selected as the sepsis group, and 100 healthy volunteers served as the control group. The serum sCD14 and sCD163 levels were detected by ELISA. The patients were divided into SICD group (59 cases) and non-SICD group (39 cases) according to the cardiac function (newly diagnosed left ventricular ejection fraction <50% and/or the ratio of maximum mitral flow velocity to maximum mitral flow velocity in atrial systole <0.8). The independent risk factors of SICD secondary to sepsis were analyzed by multivariate Logistic regression. Receiver operating characteristic (ROC) curve was used to analyze the efficacy of serum sCD14 and sCD163 baseline levels in predicting SICD and death within 28 days in patients with sepsis. Results: Serum sCD14 and sCD163 levels in sepsis group was significantly higher than those in healthy control group (P<0.05). Serum sCD14 and sCD163 levels in SICD group and non-SICD group were decreased after treatment (P<0.001). The serum sCD14 and sCD163 levels in SICD group were higher than those in non-SICD group (P<0.001). According to multivariate Logistic regression analysis, Sequential Organ Failure Assessment (SOFA) baseline score, increased serum N-terminal pro-brain natriuretic peptide (NT-proBNP), sCD14 and sCD163 baseline levels were independent risk factors for SICD secondary to sepsis. The ROC curve analysis showed that the area under curve of serum sCD14 combined with sCD163 was 0.920 (95% CI: 0.860-0.979) and 0.940 (95% CI: 0.884-0.995), which were better than SOFA or NT-proBNP alone(P< 0.05). Conclusion: Serum sCD14 and sCD163 can be used as candidate biomarkers for predicting SICD in sepsis patients aged ≥60 years old, and have reference value for predicting poor short-term prognosis.