摘要目的 探讨中介素(IMD)对老年脓毒症患者病情程度及预后的评估价值.方法 采用回顾性研究方法,选择2015年4月至2016年12月航天中心医院老年医学科重症加强治疗病房(ICU)收治的年龄≥65岁的脓毒症患者为研究对象(41例),以同期年龄匹配的健康体检者作为健康对照组(30例).收集患者入院24 h内血清C-反应蛋白(CRP)、降钙素原(PCT)、IMD水平,急性生理学与慢性健康状况评分系统Ⅱ(APACHEⅡ)评分及预后.根据APACHEⅡ评分将患者分为10~20分、21~30分、>30分3组;根据住院期间预后将患者分成死亡组和生存组.分析各组间血清CRP、PCT和IMD水平的差异;Pearson法分析IMD与各感染指标的相关性;受试者工作特征曲线(ROC)评价CRP、PCT、IMD对老年脓毒症患者预后的预测价值.结果 与健康对照组比较,脓毒症组CRP、PCT、IMD水平均显著升高〔CRP(mg/L):114.71±40.08比4.03±2.68,PCT(μg/L):1.338±0.812比0.007±0.001,IMD(ng/L):43.03±9.67比16.77±2.06,均P<0.01〕.随APACHEⅡ评分的升高,PCT、IMD呈递增趋势,APACHEⅡ10~20分、21~30分、>30分3组PCT(μg/L)分别为0.397±0.129、1.164±0.326、1.999±0.888(F=19.392,P=0.000),IMD(ng/L)分别为29.12±5.60、40.48±4.40、52.75±4.73(F=33.310,P=0.000),而APACHEⅡ评分各组间CRP差异无统计学意义(F=2.137,P=0.132).老年脓毒症患者IMD与CRP、PCT均呈正相关(r1=0.351、P1=0.024,r2=0.617、P2=0.000),与体温、白细胞计数(WBC)无相关性(r1=0.063、P1=0.697,r2=0.064、P2=0.692).与生存组比较,死亡组PCT、IMD水平明显升高〔PCT(μg/L):1.547±0.883比1.043±0.608,IMD(ng/L):47.44±8.23比36.80±8.13,均P<0.05〕,而CRP升高差异无统计学意义.ROC曲线分析显示,IMD评估老年脓毒症患者住院期间死亡的ROC曲线下面积〔AUC(95%可信区间,95%CI)〕大于PCT和CRP〔0.809(0.675~0.943)比0.680(0.511~0.849)、0.664(0.490~0.838)〕;IMD最佳截断值为41.58 ng/L时预测老年脓毒症患者预后的敏感度为75.0%,特异度为82.4%.结论 老年脓毒症患者血清IMD、PCT、CRP水平可明显升高;IMD、PCT能更好地反映老年脓毒症患者的病情严重程度,且IMD对老年脓毒症患者的预后判断更有价值.

abstractsObjective To investigate the predicting value of intermedin (IMD) for the prognosis of elderly sepsis patients.Methods A retrospective analysis was conducted. Forty-one patients with sepsis, aged ≥65 years, and admitted to geriatrics intensive care unit of Aerospace Center Hospital from April 2015 to December 2016 were enrolled. Thirty healthy patients were studied as control during the same time. The expression of C-reactive protein (CRP), procalcitonin (PCT) and IMD were tested within 24 hours during hospitalization, and the acute physiology and chronic health evaluation Ⅱ(APACHE Ⅱ) score and prognosis was evaluated. According to APACHE Ⅱ score, patients were divided into 3 groups, 10-20 score, 21-30 score, and > 30 score group. And based on the prognosis, the patients were divided into death group and survival group. The differences of expression levels of CRP, PCT and IMD in each group were assessed. The relationship of IMD and infection index was analyzed by Pearson correlation. Receiver operating characteristic curve (ROC) was used to evaluate the prognostic value of CRP, PCT and IMD in patients with sepsis.Results Compared with the control group, the levels of CRP, PCT and IMD were significantly higher in the sepsis patients [CRP (mg/L): 114.71±40.08 vs. 4.03±2.68, PCT (μg/L): 1.338±0.812 vs. 0.007±0.001, IMD (ng/L):43.03±9.67 vs. 16.77±2.06, allP < 0.01]. With the increase of APACHE Ⅱ score, the levels of PCT and IMD were gradually increased. In APACHE Ⅱ 10-20 score, 21-30 score, > 30 score groups, PCT (μg/L) were 0.397±0.129, 1.164±0.326, and 1.999±0.888, respectively (F = 19.392,P = 0.000); IMD (ng/L) were 29.12±5.60, 40.48±4.40,52.75±4.73, respectively (F = 33.310,P = 0.000). There was no significant difference in CRP among APACHE Ⅱ score groups (F = 2.137,P = 0.132). The level of IMD was positively correlated with CRP and PCT (r1 = 0.351,P1 = 0.024;r2 = 0.617,P2 = 0.000), and there was no correlation with temperature and white blood cell count (r1 = 0.063,P1 = 0.697;r2 = 0.064,P2 = 0.692). The expression of PCT and IMD in the death groups were significantly higher than the survival group [PCT (μg/L): 1.547±0.883 vs. 1.043±0.608, IMD (ng/L): 47.44±8.23 vs. 36.80±8.13, bothP < 0.05], while CRP was not significantly different. The area under the ROC curve [AUC (95% confidence interval, 95%CI)] of IMD was larger than that of PCT and CRP [0.809 (0.675-0.943) vs. 0.680 (0.511-0.849), 0.664 (0.490-0.838)]; when cut-off value of IMD was 41.58 ng/L, the sensitivity was 75.0% and the specificity was 82.4%.Conclusions The levels of CRP, PCT and IMD were increased in elderly sepsis patients, and IMD and PCT can better reflect the severity of sepsis. IMD is more valuable in predicting the prognosis of sepsis patients.