肝素结合蛋白评估老年感染性疾病病情及预后的应用价值

doi:10.3969/j.issn.1003-9198.2021.11.007

摘要/Abstract

摘要： 目的探讨肝素结合蛋白(heparine-binding protein,HBP)评估老年感染性疾病病情及预后的价值。方法选取我院急诊科2018年8月至2020年12月符合标准的老年病人168例,根据是否存在感染及器官功能衰竭分为脓毒症组(A组)81例、轻度感染组(B组)48例、非感染组(C组)39例。收集病人入院24 h内的HBP、降钙素原(PCT)、CRP、WBC水平及最高体温,并进行序贯器官衰竭评分(SOFA)。建立ROC曲线评价各指标对病人预后的预测意义并计算约登指数确定最佳截断值。结果 A组病人HBP、PCT、CRP水平升高,与B、C组相比,差异有统计学意义(P＜0.05);B组病人HBP、CRP和WBC水平高于C组病人,差异有统计学意义(P＜0.05);B组病人PCT水平与C组相比,差异无统计学意义(P＞0.05)。A组病人24 h最高体温显著高于B、C组,差异有统计学意义(P＜0.001)。在对所有入选病人进行死亡风险预测时,HBP、PCT、CRP的AUC分别为0.802、0.777、0.711;在对脓毒症组死亡风险进行预测时,HBP、PCT的AUC分别为0.724、0.648。结论 HBP可作为评估老年感染性疾病病情及预后的有效生物标记物。

关键词: 肝素结合蛋白, 老年人, 感染性疾病, 脓毒症, 序贯器官衰竭评分, 预后

Abstract: Objective To investigate the value of heparin binding protein(HBP) in assessing the condition and prognosis of elderly patients with infectious diseases. Methods From August 2018 to December 2020, 168 elderly patients in the Emergency Department of our hospital were selected. According to the presence of infection and organ failure, they were divided into in the sepsis group (group A, n=81), the mild infection group (group B, n=48) and the non-infection group (group C, n=39). The levels of HBP, procalcitonin(PCT), C-reaction protein(CRP), white blood cell count (WBC) and the highest body temperature were collected within 24 h after admission, and sequential organ failure score was assessed. Receiver operating characteristic (ROC) curve was established to evaluate the prognostic significance of each index, and Youden index was calculated to determine the best cut-off value. Results The levels of HBP, PCT and CRP in group A were significantly higher than those in group B and group C (P<0.05). The levels of HBP, CRP and WBC in group B were higher than those in group C (P<0.05). There was no significant difference in the level of PCT between group B and group C (P>0.05). The highest 24 h body temperature in group A was significantly higher than that in group B and group C (P<0.001). In predicting the risk of death of all selected patients, the areas under the ROC curve (AUC) of HBP, PCT and CRP were 0.802, 0.777 and 0.711, respectively. In predicting the risk of death in sepsis patients, the AUC of HBP and PCT were 0.724 and 0.648, respectively. Conclusions HBP can be used as an effective biomarker to evaluate the condition and prognosis of infectious diseases in the elderly.

Key words: heparin binding protein, aged, infectious diseases, sepsis, sequential organ failure assessment, prognosis

中图分类号:

R 446

沈华, 冯倩茹, 张铮, 孙才智, 郭磊, 秦海东. 肝素结合蛋白评估老年感染性疾病病情及预后的应用价值[J]. 实用老年医学, 2021, 35(11): 1131-1135.

SHEN Hua, FENG Qian-ru, ZHANG Zheng, SUN Cai-zhi, GUO Lei, QIN Hai-dong. Application value of heparin-binding protein in evaluating the condition and prognosis of elderly patients with infectious diseases[J]. Practical Geriatrics, 2021, 35(11): 1131-1135.

参考文献

[1] WENG L, ZENG X Y, YIN P, et al. Sepsis-related mortality in China: a descriptive analysis[J]. Intensive Care Med, 2018, 44(7): 1071-1080.
[2] 刘杨, 马少林, 王学斌. 血清肝素结合蛋白在脓毒症休克中的预测作用[J]. 中华急诊医学杂志, 2014,23(1):79-83.
[3] LIU X W, MA T, LIU W, et al. Sustained increase in angiopoietin-2, heparin-binding protein, and procalcitonin is associated with severe sepsis[J]. J Crit Care, 2018,45:14-19.
[4] SHANKAR-HARI M, PHILLIPS G S, LEVY M L, et al. Developing a new definition and assessing new clinical criteria for septic shock: For the Third International Consensus Definitions for Sepsis and Septic Shock (Sepsis-3)[J]. JAMA, 2016, 315(8):775-787.
[5] RHODES A, EVANS L E, ALHAZZANI W, et al. Surviving sepsis campaign: International Guidelines for Management of Sepsis and Septic Shock: 2016[J]. Intensive Care Med, 2017, 43(3):304-377.
[6] ALAM N, OSKAM E, STASSEN P M, et al. Prehospital antibiotics in the ambulance for sepsis: a multicentre, open label, randomised trial[J]. Lancet Respir Med, 2018,6(1):40-50.
[7] LIU Y, MA S, WANG X, et al. The role of beta2 integrin associated heparin-binding protein release in ARDS[J]. Life Sci, 2018, 203:92-98.
[8] PERSSON B P, HALLDORSDOTTIR H, LINDBOM L, et al. Heparin-binding protein (HBP/CAP37) - a link to endothelin-1 in endotoxemia-induced pulmonary oedema?[J]. Acta Anaesthesiol Scand, 2014, 58(5):549-559.
[9] TYDEN J, HERWALD H, HULTIN M, et al. Heparin-binding protein as a biomarker of acute kidney injury in critical illness[J]. Acta Anaesthesiol Scand, 2017,61(7):797-803.
[10] LINDER A, CHRISTENSSON B, HERWALD H, et al. Heparin-binding protein: an early marker of circulatory failure in sepsis[J]. Clin Infect Dis, 2009,49(7):1044-1050.
[11] 夏勇,郭旭光,廖康.血清肝素结合蛋白对菌血症的诊断价值[J]. 暨南大学学报(自然科学与医学版),2014,35(5):484-489.
[12] EMAMI-RAZAVI S H, MOHAMMADI A, ALIBAKHSHI A, et al. Incidence of post-operative sepsis and role of charlson co-morbidity score for predicting postoperative sepsis[J]. Acta Med Iran, 2016, 54(5):318-322.
[13] HASHIMOTO H, KITAGAWA K, HOUGAKU H, et al. Relationship between C-reactive protein and progression of early carotid atherosclerosis in hypertensive subjects[J]. Stroke, 2004,35(7):1625-1630.
[14] 姚咏明, 栾樱译. 客观评价脓毒症生物标志物的临床意义[J]. 中国危重病急救医学, 2012, 24(9):517-519.
[15] 罗雪影, 黄杰清. 联合检测血清 PCT、CRP 及 NEU%早期预测细菌性血流感染的分析[J]. 临床和实验医学杂志, 2015,14(21):1830-1833.
[16] 孙萍, 王东强, 刘伟, 等. 脓毒症患者白细胞计数及血清降钙素原和C-反应蛋白的动态变化[J]. 中华危重病急救医学, 2014, 26(7):516-518.
[17] ENDO S, AIKAWA N, FUJISHIMA S, et al. Usefulness of procalcitonin serum level for the discrimination of severe sepsis from sepsis: a multicenter prospective study[J]. J Infect Chemother, 2008,14(3):244-249.
[18] 叶应妩, 王毓三, 申子瑜. 全国临床检验标准规程[M]. 3版. 南京: 东南大学出版社, 2006: 133-134.
[19] MCCABE D J, HARRISON P, MACKIE I J, et al. Increased platelet count and leucocyte-platelet complex formation in acute symptomatic compared with asymptomatic severe carotid stenosis[J]. J Neurol Neurosurg Psychiatry, 2005,76(9):1249-1254.
[20] 陈永健, 王毓. 联合肝素结合蛋白和降钙素原诊断脓毒症及分级的临床应用价值[J]. 浙江医学, 2016,38(20):1671-1674.