[1]伯 东,付 敏.感染性休克患者血清PAD2 表达水平与APACHE Ⅱ评分的相关性分析[J].现代检验医学杂志,2024,39(02):140-145.[doi:10.3969/j.issn.1671-7414.2024.02.026]
　BO dong,FU Min.Correlation Analysis between Serum PAD2 Expression Level and APACHE Ⅱ Scores in Patients with Septic Shock[J].Journal of Modern Laboratory Medicine,2024,39(02):140-145.[doi:10.3969/j.issn.1671-7414.2024.02.026]
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感染性休克患者血清PAD2 表达水平与APACHE Ⅱ评分的相关性分析()
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《现代检验医学杂志》[ISSN:/CN:]

卷:
第39卷
期数:
2024年02期
页码:
140-145
栏目:
论著
出版日期:
2024-03-31

文章信息/Info

Title:
Correlation Analysis between Serum PAD2 Expression Level and APACHE Ⅱ Scores in Patients with Septic Shock
文章编号:
1671-7414（2024）02-140-06
作者:
伯 东; 付 敏
（内江市第一人民医院急诊科，四川内江 641000）
Author(s):
BO dong;  FU Min
（Department of Emergency, the First People’s Hospital of Neijiang, Sichuan Neijiang 641000, China）
关键词:
肽酰基精氨酸脱亚胺酶2; 感染性休克; 急性生理学和慢性健康状况评价Ⅱ
分类号:
R631.4；R446
DOI:
10.3969/j.issn.1671-7414.2024.02.026
文献标志码:
A
摘要:
目的 探讨感染性休克患者血清肽酰基精氨酸脱亚胺酶2 (peptidylarginine deiminase type 2，PAD2) 表达水平与急性生理学和慢性健康状况评价Ⅱ（acute physiology and chronic health evaluation Ⅱ，APACHE Ⅱ）评分的相关性。方法 选取内江市第一人民医院2020 年6 月～ 2022 年6 月收治的103 例感染性休克患者作为研究组，采用APACHE Ⅱ评分根据患者病情严重程度将其分为轻度组（n=9）、中度组（n=51）和重度组（n=13），另外选取103 例同期在该院体检且一般资料与研究组患者相匹配的健康者作为对照组。采用酶联免疫吸附法测定感染性休克患者血清PAD2 表达水平；采用Spearman 法分析感染性休克患者血清PAD2 表达水平与APACHE Ⅱ评分的相关性；采用Logistic 回归分析影响感染性休克患者病情严重程度的相关因素；采用受试者工作特征（receiver operating characteristic，ROC）曲线分析血清PAD2 对中重度感染性休克的诊断价值。结果 研究组与对照组血肌酐（137.52±9.01μmol/L vs 112.22±8.67μmol/L）水平及血小板计数（74.58±5.19 vs 86.02±5.34）×109/L 比较，差异具有统计学意义（t=20.535，15.591，均P ＜ 0.05）；研究组患者血清PAD2 表达水平（42.47 ± 6.22 ng/ml）高于对照组（38.59 ± 5.31 ng/ml），差异具有统计学意义（t=4.815，P<0.05）；感染性休克患者血清PAD2 表达水平和APACHE Ⅱ评分均随病情严重程度的增加而逐渐升高（F=3.777，176.582，均P ＜ 0.05）；感染性休克患者血清PAD2 表达水平与APACHE Ⅱ评分呈正相关（r=0.859，P<0.05）；血肌酐（OR=1.927）、PAD2（OR=1.803）及APACHE Ⅱ评分（OR=1.657）均为发生中重度感染性休克的危险因素（均P<0.05），血小板计数（OR=0.781）则是发生中重度感染性休克的保护因素（P<0.05）。血清PAD2 诊断中重度感染性休克的曲线下面积（area under the curve，AUC）为0.880，敏感度、特异度分别为75.73%（95%CI：0.701 ～ 0.826）和90.29%（95%CI：0.851 ～ 0.935），对中重度感染性休克具有较高的诊断价值。结论 血清PAD2 表达水平与APACHEⅡ评分呈正相关，且对中重度感染性休克具有较好诊断价值。
Abstract:
Objective To explore the correlation between the expression level of serum peptidylarginine deiminase type 2 (PAD2) and acute physiology and chronic health evaluation Ⅱ (APACHE II) scores in patients with septic shock. Methods A total of 103 patients with septic shock admitted to the First People’s Hospital of Neijiang from June 2020 to June 22 were regarded as the study group. According to the severity of the condition, the APACHE II scores were used to classify study group into mild group (n=39), moderate group (n=51) and severe group (n=13). In addition, 103 healthy individuals who underwent physical examination in the hospital during the same period, whose general information matched the study group patients, were selected as the control group. Serum PAD2 expression level in patients with septic shock was determined by enzyme-linked immunosorbent assay. Spearman method was applied to analyze the correlation between serum PAD2 expression level and APACHE Ⅱ scores in patients with septic shock. Logistic regression was applied to analyze the factors affecting the severity of patients with septic shock. The diagnostic value of serum PAD2 in moderate and severe septic shock was evaluated using receiver operating characteristic (ROC) curve analysis. Results The differences in blood creatinine levels (137.52 ± 9.01μmol/L vs 112.22±8.67μmol/L ) and platelet counts(74.58±5.19 vs 86.02±5.34)×109/L between study group and control group were statistically significant (t=20.535, 15.591, all P<0.05). The expression level of PAD2 in the study group (42.47±6.62 ng/ml) was higher than that in the control group (38.59±5.31 ng/ml), with significant difference (t=4.815, P<0.05). The expression level of serum PAD2 and APACHE II scores in patients with septic shock gradually increased with the severity of the condition (F=3.777, 176.582, all P<0.05). The expression level of serum PAD2 in patients with septic shock was positively correlated with APACHE Ⅱ scores (r=0.859, P<0.05). Serum creatinine (OR=1.927)，PAD2 (OR=1.803) and APACHE Ⅱ scores (OR=1.657) were risk factors for moderate and severe septic shock (P<0.05), while platelet count (OR=0.781) was a protective factor (P<0.05). The area under the curve (AUC) of serum PAD2 in the diagnosis of moderate and severe septic shock was 0.880, and the sensitivity and specificity were 75.73% (95%CI:0.701 ～ 0.826) and 90.29% (95%CI:0.851 ～ 0.935), respectively, indicating it had high diagnostic value for moderate and severe septic shock. Conclusion The expression level of serum PAD2 was positively correlated with APACHE II scores, and may have a good diagnostic value for moderate and severe septic shock.

参考文献/References:

[1] PUTZU A, SCHORER R, LOPEZ-DELGADO J C,et al. Blood purification and mortality in sepsis and septic shock: a systematic review and meta-analysis of randomized trials[J]. Anesthesiology, 2019, 131(3):580-593.
[2] STRANDBERG G, WALTHER S, AGVALD ?HMAN C, et al. Mortality after severe sepsis and septic shock in swedish intensive care units 2008-2016-A nationwide observational study[J]. Acta Anaesthesiologica Scandinavica, 2020, 64(7): 967-975.
[3] DE BACKER D, CECCONI M, LIPMAN J, et al. Challenges in the management of septic shock: a narrative review[J]. Intensive Care Medicine, 2019,45(4): 420-433.
[4] 苏爱峰, 李云. 感染性休克患者血浆D- 乳酸、肝素结合蛋白水平与APACHE Ⅱ评分的相关性分析[J].医学理论与实践, 2022, 35(18): 3064-3067. SU Aifeng, LI Yun. Analysis of correlations between plasma D-lactic acid and heparin binding protein levels and APACHE Ⅱ score in patients with septic shock[J].Journal of Medical Theory and Practice, 2022, 35(18):3064-3067.
[5] 陈峰. 血清PCT，CRP 结合APACHE Ⅱ评分对感染性休克患者生存状况的评估效果[J]. 检验医学与临床, 2021, 18(1): 109-112. CHEN Feng. Evaluation effect of serum PCT, CRP and APACHE Ⅱ scores on survival status of patients with septic shock[J]. Laboratory Medicine and Clinic, 2021,18(1): 109-112.
[6] ZHOU Jing, BIESTERVELD B E, LI Yongqing, et al. Peptidylarginine deiminase 2 knockout improves survival in hemorrhagic shock[J]. Shock, 2020, 54(4):458-463.
[7] TIAN Yuzi, QU Shibin, ALAM H B, et al. Peptidylarginine deiminase 2 has potential as both a biomarker and therapeutic target of sepsis[J]. JCI Insight, 2020, 5(20): e138873.
[8] 中国医师协会急诊医师分会. 中国急诊感染性休克临床实践指南[J]. 中华急诊医学杂志, 2016, 25(3):274-287. Chinese Medical Doctor Association Emergency Physicians Branch. Chinese emergency septic shock clinical practice guidelines[J]. Chinese Journal of Emergency Medicine, 2016, 25(3): 274-287.
[9] 中华医学会重症医学分会. 成人严重感染与感染性休克血流动力学监测与支持指南[J]. 中华内科杂志,2007, 46(4): 344-349. Brnach of Critical Care Medicine, Chinese Medical Association. Guidelines of hemodynamic monitor and support in adult patients with severe sepsis and sepeic shock[J]. Chinese Journal of Internal Medicine, 2007,46(4): 344-349.
[10] EDEL Y, KLIMINSKI V, POKROY-SHAPIRA E, et al. Elevated plasma level of soluble triggering receptor expressed on myeloid cells-1 is associated with inflammation activity and is a potential biomarker of thrombosis in primary antiphospholipid syndrome[J].Arthritis Research & Therapy, 2019, 21(1): 10.
[11] HUANG Zhiwei, FU Zhaoyin, HUANG Wujun, et al. Prognostic value of neutrophil-to-lymphocyte ratio in sepsis: a meta-analysis[J]. American Journal of Emergency Medicine, 2020, 38(3): 641-647.
[12] SONG J, PARK D W, MOON S, et al. Diagnostic and prognostic value of interleukin-6, pentraxin 3, and procalcitonin levels among sepsis and septic shock patients: a prospective controlled study according to the Sepsis-3 definitions[J]. BMC Infectious Diseases, 2019,19(1): 968.
[13] SILCOCK D J, CORFIELD A R, STAINES H, et al. Superior performance of National Early Warning Score compared with quick sepsis-related organ failure assessment score in predicting adverse outcomes: a retrospective observational study of patients in the prehospital setting[J]. European Journal of Emergency Medicine, 2019, 26(6): 433-439.
[14] 刘冰, 王国兴, 孙雪莲. 血清降钙素原和D- 二聚体检测在急诊脓毒症患者病情及预后评估中的应用价值[J]. 临床和实验医学杂志, 2020, 19(3): 310-313. LIU Bing, WANG Guoxing, SUN Xuelian. Application value of serum procalcitonin and D-dimer detection in the evaluation of the condition and prognosis of patients with emergency sepsis[J]. Journal of Clinical and Experimental Medicine, 2020, 19(3): 310-313.
[15] SUN Bo, TOMITA B, SALINGER A, et al. PAD2-mediated citrullination of Fibulin-5 promotes elastogenesis[J]. Matrix Biology, 2021, 102: 70-84.
[16] 詹明华, 鲍会漳, 陈家丽, 等. 抗PAD2 和抗PAD4自身抗体在类风湿关节炎中的临床应用价值探讨[J]. 中华检验医学杂志, 2021, 44(11): 1035-1042. ZHAN Minghua, BAO Huizhang, CHEN Jiali, et al. Clinical relevance of autoantibodies targeting peptidylarginine deiminases 2 and 4 in rheumatoid arthritis[J]. Chinese Journal of Laboratory Medicine,2021, 44(11): 1035-1042.
[17] 舒红斌, 刘利. 早期乳酸清除率、氧合指数在重症肺炎患儿病情判断及预后评估中的价值[J]. 临床肺科杂志, 2018, 23(2): 362-364. SHU Hongbin, LIU Li. The value of early lactate clearance rate and oxygenation index in the diagnosis and prognosis evaluation of children with severe pneumonia[J]. Journal of Clinical Pulmonary Medicine,2018, 23(2): 362-364.
[18] 郭战萍, 任静静, 王珊珊, 等. 血清ChE 和Ang-1 与IL-6 水平对感染性休克患者临床结局的预测价值[J].中华医院感染学杂志, 2022, 32(5): 689-692. GUO Zhanping, REN Jingjing, WANG Shanshan, et al. Values of serum ChE, Ang-1 and IL-6 in prediction of clinical outcomes of patients with septic shock[J].Chinese Journal of Nosocomiology, 2022, 32(5): 689-692.
[19] 付鹤鹏, 张玉想. 危重症患者血小板功能的评估及其临床意义[J]. 中华危重病急救医学, 2018, 30(3):284-288. FU Hepeng, ZHANG Yuxiang. Evaluation of platelet function in critically ill patients and its clinical significance[J]. Chinese Critical Care Medicine, 2018,30(3): 284-288.
[20] 张珍, 王新庄. 脓毒症患者血清YKL-40 水平检测与急性肾损伤早期诊断的相关性研究[J]. 现代检验医学杂志, 2021, 36(3): 148-150. ZHANG Zhen, WANG Xinzhuang. Correlation between serum YKL-40 level and early diagnosis of acute kidney injury in patients with sepsis[J]. Journal of Modern Laboratory Medicine, 2021, 36(3): 148-150.
[21] NGUYEN T C. Thrombocytopenia-associated multiple organ failure[J]. Critical Care Clinics, 2020, 36(2): 379-390.
[22] 易观群. 血小板在抵御细菌感染和增强免疫中的地位[J]. 中国感染控制杂志, 2021, 20(4): 374-380. YI Guanqun. The role of platelet in resisting bacterial infection and enhancing immunity[J]. Chinese Journal of Infection Control, 2021, 20(4): 374-380.

备注/Memo

备注/Memo:
作者简介：伯东（1990-），男，学士学位，主治医师，研究方向：急重症，E-mail：ddf1jxz@163.com。
更新日期/Last Update: 2024-03-15