血清淀粉样蛋白A、肝素结合蛋白及降钙素原在胆道感染并发脓毒症病人中的预测价值

周子翔; 郑传明; 徐志鹏; 宋琦; 王振杰

doi:10.13898/j.cnki.issn.1000-2200.2023.11.008

血清淀粉样蛋白A、肝素结合蛋白及降钙素原在胆道感染并发脓毒症病人中的预测价值

Predictive value of the serum amyloid A, heparin-binding protein, and procalcitonin in patients with biliary infection complicated with sepsis

摘要

摘要:
目的探讨血清淀粉样蛋白A（serum amyloid a，SAA）、肝素结合蛋白（heparin-binding protein，HBP）、降钙素原（procalcitonin，PCT）在胆道感染并发脓毒症病人中的预测价值。
方法选择急诊外科收治的胆道感染病人117例，根据脓毒症诊断标准将病人分为胆道感染未并发脓毒症组（非脓毒症组）35例和胆道感染并发脓毒症组（脓毒症组）82例，其中，脓毒症组病人根据有无休克分为普通脓毒症组（普通组）55例和脓毒性休克组（休克组）27例。观察病人入科24 h内血清SAA、HBP、PCT、白细胞（WBC）以及急性生理与慢性健康评价（APACHE Ⅱ）评分和序贯性器官功能衰竭（SOFA）评分。另选择同期来我院体检的健康人群40名作为对照组。比较各组相关指标，并采用ROC曲线分析评价各指标对胆道感染并发脓毒症的诊断效能。
结果非脓毒症组和普通组、休克组病人血清HBP、PCT、SAA水平均高于对照组（P < 0.05）；非脓毒症组、普通组、休克组病人组间血清HBP、PCT、SAA水平均依次升高（P < 0.05）；各组WBC间差异无统计学意义（P>0.05）。脓毒症组病人HBP、PCT、SAA水平均与APACHEⅡ评分、SOFA评分呈明显正相关关系（P < 0.01）。按照随访结果，以28 d病人是否存活将脓毒症组病人分为生存组65例和死亡组17例，死亡组病人HBP、PCT、SAA水平和APACHEⅡ、SOFA评分均明显高于存活组（P < 0.01）；logistic回归分析显示，高水平HBP、PCT、SAA均为脓毒症病人生存结局的独立危险因素（P < 0.05）。ROC曲线分析显示，HBP、HBP+PCT诊断胆道感染并发脓毒症的敏感度较高，HBP+SAA诊断特异度较高。
结论SAA、HBP、PCT对胆道感染进展为脓毒症具有一定的辅助诊断价值，其中HBP具有较高敏感度，而HBP和SAA联合检测特异度较高。

Abstract:
ObjectiveTo explore the predictive value of the serum amyloid A(SAA), heparin-binding protein(HBP), and procalcitonin(PCT) in patients with biliary tract infection complicated with sepsis.
MethodsA total of 117 patients from the emergency surgery department were divided into the biliary tract infection complicated without sepsis group(non-sepsis group, 35 cases) and biliary tract infection complicated with sepsis group(sepsis group, 82 cases) according to the diagnostic criteria of sepsis, and the sepsis group was divided into the common sepsis group(common group, 55 cases) and septic shock group(shock group, 27 cases) according to the presence or absence of shock.The serum SAA, HBP, PCT, WBC, Acute Physiological and Chronic Health Assessment(APACHE Ⅱ) score and Sequential organ failure Estimate(SOFA) score were observed within 24h after admission.Another 40 healthy examination people during the same period were selected as the control group.The correlation indexes of each group were compared, and the diagnostic efficiency of each index in biliary tract infection complicated with sepsis was evaluated by ROC curve analysis.
ResultsThe serum levels of HBP, PCT and SAA in the non-sepsis group, general group and shock group were higher than those in control group (P < 0.05).The serum HBP, PCT and SAA levels in the non-sepsis group, general group and shock group increased successively(P < 0.05).There was no statistical significance in the WBC among all groups(P>0.05).The levels of HBP, PCT and SAA were positively correlated with APACHEⅡ score and SOFA score(P < 0.01).According to the follow-up results, the sepsis group was divided into the survival group(65 cases) and death group(17 cases) according to whether the patients survived at 28 days.The HBP, PCT, SAA levels and APACHE Ⅱ and SOFA scores in the death group were significantly higher than those in survival group (P < 0.01).The results of logistic regression analysis showed that high levels of HBP, PCT and SAA were the independent risk factors of survival outcome of sepsis patients (P < 0.05).The results of ROC curve analysis showed that the HBP and HBP+PCT had higher sensitivity in diagnosing biliary tract infection complicated with sepsis, and the HBP+SAA had higher specificity.
ConclusionsThe SAA, HBP and PCT have certain auxiliary diagnostic value in biliary tract infection progression to sepsis, the HBP has a high sensitivity, while the combined detection of HBP and SAA has a high specificity.

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