摘要目的:探讨脓毒症患者血Toll样受体4(TLR4)、正五聚蛋白-3(PTX3)、Apelin的水平变化及其与病情、预后的关系。方法:回顾性选取2015年3月至2020年3月郴州市第一人民医院收治的82例脓毒症患者，其中脓毒症休克组22例、严重脓毒症组34例、普通脓毒症组26例，另选取同期健康体检者82例为对照组。测定对比各组血TLR4、PTX3、Apelin水平、序贯器官功能障碍评分(SOFA)、急性生理学与慢性健康状况评分系统Ⅱ(APACHEⅡ)评分。探究血TLR4、PTX3、Apelin水平与脓毒症患者SOFA、APACHEⅡ评分的关系，并统计不同预后(28 d生存、死亡患者)脓毒症患者的一般资料与血TLR4、PTX3、Apelin水平，观察脓毒症患者预后的影响因素，分析血TLR4、PTX3、Apelin水平对脓毒症患者预后的预测意义。结果:各组间血TLR4、PTX3、Apelin水平比较，脓毒症休克组>严重脓毒症组>普通脓毒症组>对照组( P<0.05)；高SOFA、APACHEⅡ评分脓毒症患者血TLR4、PTX3、Apelin水平高于低SOFA、APACHEⅡ评分患者( P<0.05)；Pearson相关性分析，血TLR4、PTX3、Apelin水平与脓毒症患者SOFA、APACHEⅡ评分呈正相关( P<0.05)；脓毒症死亡患者血TLR4、PTX3、Apelin水平及SOFA、APACHEⅡ评分高于生存患者( P<0.05)；经logistic回归分析发现，血TLR4、PTX3、Apelin水平及SOFA评分、APACHEⅡ评分均为脓毒症患者28 d死亡的重要危险因素( P<0.05)；绘制ROC曲线发现，血TLR4、PTX3、Apelin联合预测脓毒症患者预后的灵敏度为85.71%，特异度为85.25%。 结论:脓毒症患者血TLR4、PTX3、Apelin水平显著增高，且与患者病情、预后有关，可为临床诊治提供一定依据。

abstractsObjective:To investigate the changes in the expression of toll like receptor 4 (TLR4), pentamerin-3 (PTX3) and Apelin in the blood of patients with sepsis and their relationship with the condition and prognosis.Methods:From March 2015 to March 2020, 82 patients with sepsis in the First People′s Hospital of Chenzou were retrospectively selected, including 22 patients in septic shock group, 34 patients in severe sepsis group and 26 patients in general sepsis group. 82 healthy people in the same period were selected as the control group. The expression of serum TLR4, PTX3, Apelin, Sequential Organ Dysfunction Score (SOFA), Acute Physiology and Chronic Health Score System Ⅱ (APACHE Ⅱ) were measured and compared. The relationship between the expression of serum TLR4, PTX3 and Apelin and the scores of SOFA and APACHE Ⅱ in patients with sepsis were analyzed. The general data and the expression of serum TLR4, PTX3 and Apelin in patients with sepsis with different prognosis (28 day survival and death) were counted. The influencing factors of prognosis in patients with sepsis were observed, and the predictive significance of serum TLR4, PTX3 and Apelin on the prognosis of patients with sepsis was analyzed.Results:Comparison of serum TLR4, PTX3 and Apelin level in the groups: septic shock group>severe sepsis group>general sepsis group>control group ( P<0.05); The serum level of TLR4, PTX3 and Apelin in patients with high SOFA and APACHE Ⅱ scores were higher than those in patients with low SOFA and APACHE Ⅱ scores ( P<0.05); Pearson correlation showed that serum level of TLR4, PTX3 and Apelin was positively correlated with the SOFA and APACHE Ⅱ scores of sepsis patients ( P<0.05); The levels of serum TLR4, PTX3, Apelin and the scores of SOFA and APACHE Ⅱ in the dead patients with sepsis were higher than those in survival patients ( P<0.05); Logistic regression analysis found that serum level of TLR4, PTX3, Apelin, SOFA score, and APACHE Ⅱ score were all important risk factors for 28 day death of sepsis patients ( P<0.05); The receiver operating characteristic (ROC) curve showed that the sensitivity and specificity of combined blood indexes (TLR4, PTX3 and Apelin) in predicting the prognosis of patients with sepsis were 85.71% and 85.25%. Conclusions:The expression of serum TLR4, PTX3 and Apelin in patients with sepsis can be significantly increased, which is related to the patient′s condition and prognosis and can provide a certain basis for clinical diagnosis and treatment.