摘要目的 探讨血清内皮细胞特异性分子-1(endocan)、降钙素原(PCT)对脓毒症早期诊断及预后评估的临床价值.方法 选择2014年12月至2016年12月河北医科大学第三医院重症加强治疗病房(ICU)收治的全身炎症反应综合征(SIRS,26例)和脓毒症(78例)患者.脓毒症患者再按病情严重程度分为一般脓毒症组(20例)、严重脓毒症组(24例)、脓毒性休克组(34例);根据28 d转归分为生存组(55例)和死亡组(23例).记录患者入ICU时的血清endocan、PCT、急性生理学与慢性健康状况评分系统Ⅱ(APACHEⅡ)评分、序贯器官衰竭评分(SOFA).比较SIRS组与脓毒症组以及脓毒症各亚组间endocan、PCT、APACHEⅡ评分、SOFA评分的差异;Spearman法分析脓毒症患者各指标间的相关性;受试者工作特征曲线(ROC)分析endocan、PCT对脓毒症早期诊断及预后预测的价值.结果 ① 脓毒症组endocan、PCT、APACHEⅡ评分、SOFA评分、28 d病死率均明显高于SIRS组〔endocan(μg/L):4.28(10.64)比1.03(0.69),PCT(μg/L):3.94(10.75)比0.43(0.39),APACHEⅡ(分):18.81±9.17比9.35±3.78,SOFA(分):9.00(7.20)比4.50(1.50),28 d病死率:29.49%比11.54%,均P<0.01〕;endocan、PCT、APACHEⅡ评分、SOFA评分诊断脓毒症的ROC曲线下面积(AUC)分别为0.887、0.842、0.822、0.835;endocan最佳临界值为1.26μg/L时诊断脓毒症的敏感度为87.2%,特异度为81.8%;PCT最佳临界值为0.75μg/L时诊断脓毒症的敏感度为85.9%,特异度为81.8%.② 随病情严重程度加重,脓毒症患者endocan、PCT、APACHEⅡ评分、SOFA评分、28 d病死率呈递增趋势,脓毒性休克组各指标显著高于严重脓毒症组和一般脓毒症组〔endocan(μg/L):13.02(6.70)比3.33(3.05)、1.60(0.98),PCT(μg/L):8.10(17.68)比5.47(8.92)、1.57(2.78),APACHEⅡ(分):25.00(9.50)比18.00(9.00)、9.50(5.75),SOFA(分):13.00(4.50)比8.00(3.00)、5.00(3.50),28 d病死率:52.94%比20.83%、0%,均P<0.01〕,且脓毒症患者endocan、PCT、APACHEⅡ、SOFA评分间均有良好的正相关性(均P<0.01),说明endocan、PCT可用于评估脓毒症严重程度.③ 脓毒症死亡组患者endocan、PCT、APACHEⅡ评分、SOFA评分均显著高于生存组〔endocan(μg/L):15.05(9.23)比2.32(4.81),PCT(μg/L):18.40(16.99)比3.10(6.67),APACHEⅡ(分):28.13±7.56比14.91±6.64,SOFA(分):14.70±3.65比7.38±3.26,均P<0.01〕;用endocan、PCT、APACHEⅡ评分、SOFA评分预测脓毒症死亡的AUC分别为0.915、0.763、0.899、0.930;endocan最佳临界值为4.37μg/L时预测脓毒症死亡的敏感度为95.7%,特异度为70.9%;PCT最佳临界值为7.68μg/L时预测脓毒症死亡的敏感度为65.2%,特异度为78.2%.结论 血清endocan水平对脓毒症早期诊断和预后评估的临床价值比PCT更好.

abstractsObjective To investigate the clinical value of serum endocan and procalcitonin (PCT) in early diagnosis and prognosis evaluation of sepsis.Methods The patients with systemic inflammatory response syndrome (SIRS,n = 26) and sepsis (n = 78) admitted to intensive care unit (ICU) of the Third Hospital of Hebei Medical University from December 2014 to December 2016 were enrolled. According to the severity of disease, the sepsis patients were divided into general sepsis group (n = 20), severe sepsis group (n = 24), and septic shock group (n = 34). The cases were divided into survival group (n = 55) and non-survival group (n = 23) according to 28-day mortality. The serum endocan, PCT, acute physiology and chronic health evaluation Ⅱ (APACHE Ⅱ) score, and sequential organ failure assessment (SOFA) score were recorded when the patients were admitted into ICU. The differences in endocan, PCT, APACHE Ⅱ, SOFA score between SIRS and sepsis groups and within sepsis subgroups were compared. Spearman correlation analysis was used to analyze the correlation between the indexes of sepsis patients. Receiver operation characteristic curve (ROC) was used to evaluate the value of endocan and PCT for the diagnosis and prognosis of sepsis.Results ① Serum endocan, PCT, APACHE Ⅱ, SOFA score and 28-day mortality in the sepsis group were significantly higher than those in the SIRS group [endocan (μg/L): 4.28 (10.64) vs. 1.03 (0.69), PCT (μg/L): 3.94 (10.75) vs. 0.43 (0.39), APACHE Ⅱ:18.81±9.17 vs. 9.35±3.78, SOFA: 9.00 (7.20) vs. 4.50 (1.50), 28-day mortality: 29.49% vs. 11.54%, allP < 0.01]. The area under the ROC curve (AUC) of endocan, PCT, APACHE Ⅱ, SOFA score for sepsis diagnosis were 0.887, 0.842, 0.822, 0.835, respectively. When the cut-off value of endocan was 1.26μg/L, the sepsis diagnostic sensitivity was 87.2% and specificity was 81.8%. When the cut-off value of PCT was 0.75μg/L, the sepsis diagnostic sensitivity was 85.9% and specificity was 81.8%. ② With the severity of the disease increased, the index showed an increasing trend in patients with sepsis. Serum endocan, PCT, APACHE Ⅱ, SOFA score and 28-day mortality in septic shock group were significantly higher than those in severe sepsis group or general sepsis group [endocan (μg/L): 13.02 (6.70) vs. 3.33 (3.05), 1.60 (0.98); PCT (μg/L): 8.10 (17.68) vs. 5.47 (8.92), 1.57 (2.78); APACHE Ⅱ: 25.00 (9.50) vs. 18.00 (9.00), 9.50 (5.75); SOFA: 13.00 (4.50) vs. 8.00 (3.00), 5.00 (3.50); 28-day mortality: 52.94% vs. 20.83%, 0%; allP < 0.01]. There was a significantly positive correlation between endocan, PCT, APACHE Ⅱ, SOFA, indicating that the endocan and PCT can be used to assess the severity of sepsis. ③ Serum endocan, PCT, APACHE Ⅱ and SOFA score in non-survival group were significantly higher than those in the survival group [endocan (μg/L): 15.05 (9.23) vs. 2.32 (4.81), PCT (μg/L):18.40 (16.99) vs. 3.10 (6.67), APACHE Ⅱ: 28.13±7.56 vs. 14.91±6.64, SOFA: 14.70±3.65 vs. 7.38±3.26, allP < 0.01]. The AUC of endocan, PCT, APACHE Ⅱ, SOFA score for the prediction of non-survival sepsis were 0.915, 0.763, 0.899, 0.930. When the cut-off value of endocan was 4.37μg/L, the septic death prediction sensitivity was 95.7% and specificity was 70.9%. When the cut-off value of PCT was 7.68μg/L, the septic death prediction sensitivity was 65.2% and specificity was 78.2%.Conclusions Serum endocan is more clinically valuable than PCT in early diagnosis and prognosis assessment of sepsis.