您的账号已在其他设备登录,您当前账号已强迫下线,
如非您本人操作,建议您在会员中心进行密码修改

确定

线粒体相关蛋白FAHD1和GDF-15在脓毒症诊断中的价值

Study on the value of mitochondrial associated protein fumarylacetoacetate domain containing protein 1 and growth differentiation factor-15 in the diagnosis of sepsis: test results from the patients of a multicenter study

摘要:

目的:探讨线粒体相关蛋白延胡索酰乙酰乙酸酯水解酶结构域含蛋白1(FAHD1)和生长分化因子15(GDF-15)在脓毒症诊断中的价值。方法:从一项基于脓毒症的早期预警及规范化诊疗体系建立的"脓毒症全过程预警及诊治管理数据库"中,收集2014年5月至2015年10月浙江医院、浙江大学医学院附属第二医院、中山大学附属第一医院、四川大学华西医院、宁波市第一医院纳入的疑似感染的成人患者。分析脓毒症和非脓毒症患者基础生命体征信息及确诊时主要血常规指标、肝肾功能指标、血气指标、急性生理学与慢性健康状况评分Ⅱ(APACHEⅡ)和序贯器官衰竭评分(SOFA)等。利用保存的血清样本,用电化学发光法检测降钙素原(PCT)水平,用免疫比浊法检测C-反应蛋白(CRP)水平,用酶联免疫吸附试验(ELISA)检测FAHD1和GDF-15水平。采用单因素和多因素Logistic回归分析脓毒症诊断中的危险因素,并应用受试者工作特征曲线(ROC曲线)分析各指标对脓毒症的诊断效能。结果:共入选132例患者,其中脓毒症76例,非脓毒症56例。与非脓毒症组相比,脓毒症组心率加快(次/min:116.4±17.8比97.4±19.1),平均动脉压(MAP)、血小板计数(PLT)、动脉血氧分压(PaO 2)显著降低〔MAP(mmHg,1 mmHg=0.133 kPa):65.8±9.7比74.7±10.3,PLT(×10 9/L):120(69,204)比163(117,239),PaO 2(mmHg):83.0(66.6,108.0)比108.0(84.4,130.0),均 P<0.05〕,直接胆红素(DBil)、血肌酐(SCr)、血乳酸(Lac)、APACHEⅡ评分和SOFA评分均显著升高〔DBil(μmol/L):13.00(5.55,55.31)比6.20(2.20,21.90),SCr(μmol/L):118.00(70.00,191.73)比77.20(59.65,110.86),Lac(mmol/L):2.90(1.50,4.10)比1.90(1.20,2.80),APACHEⅡ(分):20.0(16.0,25.0)比16.0(10.0,21.0),SOFA(分):12.0(8.0,16.0)比8.0(5.0,13.0),均 P<0.05〕。此外,脓毒症组血清FAHD1、GDF-15、PCT、CRP水平均显著高于非脓毒症组〔FAHD1(μg/L):3.96(2.25,5.92)比2.47(1.03,3.54),GDF-15(μg/L):8.46(4.37,19.68)比4.32(1.74,10.39),PCT(μg/L):3.79(1.37,11.32)比0.42(0.12,2.14),CRP(mg/L):154.43(61.33,283.20)比65.95(28.15,144.69),均 P<0.01〕。多因素Logistic回归分析显示,血清FAHD1〔优势比( OR)=1.135,95%可信区间(95% CI)为1.045~1.234〕、GDF-15( OR=1.090,95% CI为1.029~1.155)和CRP( OR=1.007,95% CI为1.002~1.011)均是脓毒症诊断的风险因素(均 P<0.05)。ROC曲线分析显示,在脓毒症诊断中,血清线粒体相关蛋白FAHD1和GDF-15的ROC曲线下面积(AUC)分别为0.727(95% CI为0.641~0.802)、0.677(95% CI为0.588~0.757),经典感染指标PCT和CRP的AUC分别为0.767(95% CI为0.683~0.837)、0.680(95% CI为0.591~0.760),线粒体相关蛋白与经典感染指标的AUC差异无统计学意义。FAHD1、GDF-15、PCT与CRP联合诊断的AUC最大,为0.809(95% CI为0.730~0.874),其敏感度为75.00%,特异度为80.00%。 结论:线粒体相关蛋白FAHD1和GDF-15在脓毒症诊断中具有一定作用,与PCT、CRP指标联合诊断效能会提高,可为脓毒症诊断标志物的筛查提供试验依据。

更多
abstracts:

Objective:To investigate the diagnostic value of mitochondrial associated protein fumarylacetoacetate domain containing protein 1 (FAHD1) and growth differentiation factor-15 (GDF-15) in sepsis.Methods:Based on the database of the whole process of sepsis early warning, diagnosis and treatment management, which was established on the study of sepsis early warning and standardized diagnosis and treatment system, adult patients with suspected infection admitted to the department of critical care medicine of Zhejiang Hospital, Second Affiliated Hospital of Zhejiang University, the First Affiliated Hospital of Sun Yat-Sen University, West China Hospital of Sichuan University, Ningbo First Hospital from May 2014 to October 2015 were enrolled. The basic vital signs, and the main blood routine results, liver and kidney function, blood gas, acute physiology and chronic health evaluation Ⅱ (APACHEⅡ) and sequential organ failure assessment (SOFA) score at the time of diagnosis of patients with or without sepsis were analyzed. The preserved serum samples were taken, the levels of procalcitonin (PCT), C-reactive protein (CRP) were detected by electrochemiluminescence method, immunoturbidimetry respectively, and FAHD1 and GDF-15 were detected by enzyme linked immunosorbent assay (ELISA). Univariate and multivariate Logistic regression were used to analyze the risk factors for sepsis diagnose. The indexes' diagnostic efficacy in sepsis were analyzed by receiver operating characteristics curve (ROC curve).Results:A total of 132 patients were enrolled, including 76 cases of sepsis and 56 cases of non-sepsis. Compared with the non-sepsis group, the heart rate in the sepsis group was increased (bpm: 116.4±17.8 vs. 97.4±19.1), while the mean arterial pressure (MAP), platelet count (PLT), arterial partial pressure of oxygen (PaO 2) were significantly decreased [MAP (mmHg, 1 mmHg = 0.133 kPa): 65.8±9.7 vs. 74.7±10.3, PLT (×10 9/L): 120 (69, 204) vs. 163 (117, 239), PaO 2 (mmHg): 83.0 (66.6, 108.0) vs. 108.0 (84.4, 130.0), all P < 0.05], direct bilirubin (DBil), serum creatinine (SCr), lactic acid (Lac), APACHEⅡ score and SOFA score were significantly increased [DBil (μmol/L): 13.00 (5.55, 55.31) vs. 6.20 (2.20, 21.90), SCr (μmol/L): 118.00 (70.00, 191.73) vs. 77.20 (59.65, 110.86), Lac (mmol/L): 2.90 (1.50, 4.10) vs. 1.90 (1.20, 2.80), APACHEⅡ score: 20.0 (16.0, 25.0) vs. 16.0 (10.0, 21.0), SOFA score: 12.0 (8.0, 16.0) vs. 8.0 (5.0, 13.0), all P < 0.05]. In addition, the serum levels of FAHD1, GDF-15, PCT and CRP in sepsis group were significantly higher than those in non-sepsis group [FAHD1 (μg/L): 3.96 (2.25, 5.92) vs. 2.47 (1.03, 3.54), GDF-15 (μg/L): 8.46 (4.37, 19.68) vs. 4.32 (1.74, 10.39), PCT (μg/L): 3.79 (1.37, 11.32) vs. 0.42 (0.12, 2.14), CRP (mg/L): 154.43 (61.33, 283.20) vs. 65.95 (28.15, 144.69), all P < 0.01]. Multivariate Logistic regression showed that serum FAHD1 [odds ratio ( OR) = 1.135, 95% confidence interval (95% CI) was 1.045-1.234], GDF-15 ( OR = 1.090, 95% CI was 1.029-1.155) and CRP ( OR = 1.007, 95% CI was 1.002-1.011) were risk factors for sepsis (all P < 0.05). ROC curve analysis of sepsis showed that the areas under ROC curve (AUC) of serum mitochondrial associated proteins FAHD1 and GDF-15 were 0.727 (95% CI was 0.641-0.802) and 0.677 (95% CI was 0.588-0.757), respectively; and the AUC of classical infection indexes PCT and CRP were 0.767 (95% CI was 0.683-0.837) and 0.680 (95% CI was 0.59-0.760), respectively. There was no significant difference between the AUC of mitochondrial associated proteins and classical infection indexes. The combination of FAHD1, GDF-15, PCT and CRP had the largest AUC, which was 0.809 (95% CI was 0.730-0.874), and the sensitivity was 75.00%, and the specificity was 80.00%. Conclusion:Mitochondrial associated protein FAHD1 and GDF-15 are associated with sepsis, and the diagnostic efficiency is improved when combined with PCT and CRP, which might provide experimental basis for screening diagnostic markers of sepsis.

More
作者: 李萌 任蓉蓉 陈上仲 陈琛 严静
期刊: 《中华危重病急救医学》2021年33卷2期 180-185页 MEDLINEISTICPKUCSCD
栏目名称: 论著·重症感染与脓毒症(临床研究)
DOI: 10.3760/cma.j.cn121430-20200813-00575
发布时间: 2021-04-06
  • 浏览:27
  • 下载:2

加载中!

相似文献

  • 中文期刊
  • 外文期刊
  • 学位论文
  • 会议论文
  • 更多内容

加载中!

加载中!

加载中!

加载中!