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投稿时间：2023-07-17 网络发布日期：2023-10-20
投稿时间：2023-07-17 网络发布日期：2023-10-20
中文摘要: 目的 对脓毒症相关性脑病（SAE）患者血清可溶性髓样细胞触发受体-1（sTREM-1）、正五聚蛋白-3（PTX3）水平以及脑电双频指数（BIS）进行测定，并探讨三者在SAE早期诊断中的应用价值。
方法 回顾性选取2020年6月至2022年6月成都市妇女儿童中心医院收治的120例脓毒症患者为研究对象。根据是否发生SAE，将患者分为SAE组（n=50）与非SAE组（n=70），根据格拉斯哥昏迷评分（GCS）将50例SAE患者分为轻度组（25例）、中度组（16例）与重度组（9例）。检测患者血清sTREM-1、PTX3及降钙素原（PCT）、C-反应蛋白（CRP）、肿瘤坏死因子-α（TNF-α）水平，测定BIS，计算序贯性器官衰竭（SOFA）、急性生理学及慢性健康状况Ⅱ（APACHEⅡ）评分。分析血清sTREM-1、PTX3水平及BIS对SAE的诊断价值和影响SAE发生的因素。
结果 SAE组血清sTREM-1、PTX3、PCT、CRP、TNF-α水平及SOFA评分、APACHEⅡ评分高于非SAE组，BIS水平低于非SAE组（P＜0.05）。SAE组中，依轻度组、中度组、重度组之序，血清sTREM-1、PTX3水平递升，BIS水平递降（P＜0.05）。ROC曲线分析显示，血清sTREM-1、PTX3水平及BIS辅助早期诊断SAE的曲线下面积（AUC）分别为0.787、0.829、0.821，三者联合诊断的AUC为0.921，优于各自单独检测（Z=2.652、2.154、2.251，P＜0.05）。多因素logistic回归分析显示，APACHEⅡ评分、SOFA评分、sTREM-1、PTX3升高是脓毒症患者发生SAE的危险因素，BIS升高为保护因素（P＜0.05）。
结论 SAE患者血清sTREM-1、PTX3水平升高，BIS降低，并与SAE患者病情的严重程度密切相关，且三者联合检测对SAE患者的早期诊断有一定价值。
中文关键词: 脓毒症 脓毒症相关性脑病 可溶性髓样细胞触发受体-1 正五聚蛋白-3 脑电双频指数
Abstract:ObjectiveTo determine the levels of serum soluble triggering receptor expressed on myeloid cells-1 (sTREM-1), pentraxin-3 (PTX3) and electroencephalogram bispectral index (BIS) in patients with sepsis-associated encephalopathy (SAE), and to explore their application value in the early diagnosis of SAE.
Methods A retrospective study was conducted on 120 patients with sepsis admitted to Chengdu Womens and Childrens Central Hospital from June 2020 to June 2022. According to the occurrence of SAE, patients were divided into SAE group (n=50) and non-SAE group (n=70). According to the Glasgow Coma Scale (GCS), 50 SAE patients were divided into mild group (25 cases), moderate group (16 cases), and severe group (9 cases). The levels of serum sTREM-1, PTX3, procalcitonin (PCT), C-reactive protein (CRP), and tumor necrosis factor-α (TNF-α） in patients were detected, BIS was measured; Sequential Organ Failure Assessment (SOFA), Acute Physiology and Chronic Health Evaluation Ⅱ (APACHE Ⅱ) scores were calculated. The serum levels of sTREM-1 and PTX3, as well as the diagnostic value of BIS for SAE, and the factors affecting the occurrence of SAE were analyzed.
Results The levels of serum sTREM-1, PTX3, PCT, CRP, TNF-α, SOFA score, and APACHE Ⅱ score in SAE group were higher than those in non-SAE group, while the BIS level was lower than that in non-SAE group (P＜0.05). In SAE group, in the order of mild, moderate, and severe groups, serum levels of sTREM-1 and PTX3 gradually increased, while BIS levels decreased (P＜0.05). ROC curve analysis showed that the serum levels of sTREM-1, PTX3, and the area under the curve (AUC) of BIS for early diagnosis of SAE were 0.787, 0.829 and 0.821, respectively. The AUC of the combined diagnosis of the three was 0.921, which was better than the individual detection (Z=2.652, 2.154, 2.251, P＜0.05). Multivariate logistic regression analysis showed that elevated APACHE Ⅱ score, SOFA score, sTREM-1 and PTX3 were risk factors affecting the occurrence of SAE, while elevated BIS was a protective factor (P＜0.05).
Conclusion The levels of serum sTREM-1 and PTX3 in SAE patients increase, while BIS decreases, which is closely related to the severity of the condition in SAE patients. The combined detection of the three has certain value for the early diagnosis of SAE patients.
keywords: Sepsis Sepsis-associated encephalopathy Soluble triggering receptor expressed on myeloid cells-1 Pentraxin-3 Electroencephalogram bispectral index
文章编号： 中图分类号：R631 文献标志码：A
基金项目:成都市科技项目（2022-YF05-01279-SN）
引用文本：
雷明雨,周杨,李琴,等.血清sTREM-1、PTX3联合脑电双频指数在脓毒症相关性脑病早期诊断中的应用价值[J].中国临床研究,2023,36(10):1469-1473.
雷明雨,周杨,李琴,等.血清sTREM-1、PTX3联合脑电双频指数在脓毒症相关性脑病早期诊断中的应用价值[J].中国临床研究,2023,36(10):1469-1473.