王丹丹.血清骨形态发生蛋白9与生长分化因子15水平在脓毒症诊断及预后评估中的价值[J].内科急危重症杂志,2024,30(4):308-312
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| DOI：10.11768/nkjwzzzz20240405 |
| 中文关键词: 脓毒症 血清骨形态发生蛋白9 生长分化因子15 |
| 英文关键词: |
| 基金项目:山西省留学人员科技活动择优资助项目（20200030） |
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| 摘要点击次数: 250 |
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| 中文摘要: |
| 摘要 目的：探讨血清骨形态发生蛋白9（BMP9）与生长分化因子15（GDF15）表达在脓毒症诊断和预后评估中的价值。方法：收集脓毒症患者30例作为脓毒症组，非脓毒症重症患者31例为非脓毒症组，同期体检的健康成人23例为对照组。追踪随访脓毒症组患者28d转归，分为存活组16例和死亡组14例。分析比较3组一般资料、临床指标及血清BMP9与GDF15水平。采用Logistic回归分析脓毒症发病及预后的危险因素。通过受试者工作特征曲线（ROC）的曲线下面积（AUC）评估血BMP9及GDF15在脓毒症诊断及预后预测中的价值。结果：与非脓毒症组和对照组比较，脓毒症组血清BMP9表达明显增高（P均< 0.05）。与对照组比较，脓毒症组血清GDF15表达明显增高（P< 0.05）。脓毒症死亡组患者血清BMP9、GDF15水平显著高于存活组（P均< 0.05）。Logistic回归示血BMP9、C反应蛋白（CRP)、序贯器官衰竭评分（SOFA)是脓毒症发病的独立危险因素，GDF15是脓毒症患者死亡的独立影响因素。BMP9联合CRP诊断脓毒症的AUC为0.845，特异性83.9%，灵敏度73.3%，诊断效能与序贯器官衰竭评分相当（AUC 0.809，特异性83.9%，灵敏度70.0%）。GDF15联合中性粒细胞与淋巴细胞的比值（NLR）对脓毒症患者预后预测的AUC为0.898，特异性80%，灵敏度100%，预测效能与急性生理与慢性健康状况评估（APACHE II）评分相当（AUC 0.687，特异性93.9%，灵敏度53.3%）。结论：脓毒症患者BMP9和GDF15表达明显增高，BMP9联合CRP对脓毒症诊断价值较高。GDF15联合NLR对脓毒症患者预后预测效能较高。 |
| 英文摘要: |
| Abstract Objective: To explore the expression of serum bone morphogenetic protein 9 (BMP9) and growth differentiation factor 15 (GDF15) in the sepsis patients and their value in the diagnosis and prognosis evaluation of sepsis. Methods: Totally, 30 patients with sepsis were selected as the sepsis group, 31 severe non-septic patients were selected as the non-septic group, and 23 adults undergoing physical examination during the same period were selected as the healthy control group. The outcome of sepsis patients was followed up for 28 days. Sepsis patients were divided into the survival group (16 cases) and the death group (14 cases). The general data, clinical indicators and BMP9 and GDF15 levels were analyzed and compared. The risk factors of sepsis onset and prognosis were analyzed by Logistic regression. The value of BMP9 and GDF15 in the diagnosis and prognosis of sepsis was evaluated by the area under the receiver operating characteristic (ROC) cure. Results: There were statistically significant differences in the levels of BMP9 and GDF15 among the three groups (P<0.05). Compared with the non-sepsis and control groups, BMP 9 expression was significantly increased in the sepsis group (P<0.05). Compared with the control group, the GDF 15 expression was significantly increased in the sepsis group. The levels of BMP9 and GDF15 were significantly higher in the death group than those in the survival group (P<0.05). BMP9 was an independent risk factor for sepsis onset, and GDF15 was an independent influencing factor for death in sepsis patients.The AUC of BMP9 combined with C reactive protein (CRP) for the diagnosis of sepsis was 0.845, specificity 83.9%, sensitivity 73.3%,the diagnostic efficacy was comparable to the sequential organ failure (SOFA) score (AUC 0.809, specificity 83.9%, sensitivity 70.0%). The AUC of GDF15 combined with NLR for the prognosis of sepsis patients was 0.898, specificity 80%, sensitivity 100%, the predictive efficacy was comparable to the Acute Physical and Chronic Health Status Assessment (APACHE II) score(AUC 0.687, specificity 93.9%, sensitivity 53.3%). Conclusion: The expression of BMP9 and GDF15 is significantly increased in sepsis patients. BMP 9 combined with CRP has a high value in sepsis diagnosis evaluation. GDF 15 combined with NLR has a high prognosis prediction efficacy in patients with sepsis. |
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