[1]殷晓英,崔海涛,刘 凡.革兰阴性菌感染性脓毒症患者血清SAA/CRP动态变化对多黏菌素类药物治疗的预后预测价值[J].现代检验医学杂志,2026,41(03):92-97.[doi:10.3969/j.issn.1671-7414.2026.03.017]
　YIN Xiaoying,CUI Haitao,LIU Fan.Prognostic Predictive Value of Dynamic Changes in Serum SAA/CRP Levels in Patients with Gram-Negative Bacterial Sepsis for Polymyxin Treatment[J].Journal of Modern Laboratory Medicine,2026,41(03):92-97.[doi:10.3969/j.issn.1671-7414.2026.03.017]
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革兰阴性菌感染性脓毒症患者血清SAA/CRP动态变化对多黏菌素类药物治疗的预后预测价值()

《现代检验医学杂志》[ISSN:/CN:]

卷:
第41卷
期数:
2026年03期
页码:
92-97
栏目:
论著
出版日期:
2026-05-13

文章信息/Info

Title:
Prognostic Predictive Value of Dynamic Changes in Serum SAA/CRP Levels in Patients with Gram-Negative Bacterial Sepsis for Polymyxin Treatment
文章编号:
1671-7414（2026）03-092-06
作者:
殷晓英a，崔海涛b，刘 凡c
青岛市胶州中心医院 a.药剂科；b.检验科；c.重症医学科，山东青岛 266300
Author(s):
YIN Xiaoyinga，CUI Haitaob，LIU Fanc
a. Department of Pharmacy; b. Department of Clinical Laboratory; c. Depart-ment of Critical Care Medicine, Qingdao Jiaozhou Central Hospital, Shandong Qingdao 266300, China
关键词:
脓毒症; 革兰阴性菌感染; 多黏菌素; 淀粉样蛋白A; C-反应蛋白
分类号:
R631；R446.5
DOI:
10.3969/j.issn.1671-7414.2026.03.017
文献标志码:
A
摘要:
目的?探讨革兰阴性菌（G-菌）感染性脓毒症患者血清淀粉样蛋白A/C-反应蛋白（SAA/CRP）动态变化对多黏菌素类药物治疗的预后预测价值。方法收集2024年1～12月青岛市胶州中心医院136例G-菌感染性脓毒症患者临床资料进行回顾性研究，均接受多黏菌素类药物治疗，于治疗前、治疗后24、72h测定SAA/CRP。利用潜类别轨迹模型（LCTM）筛选出SAA/CRP动态变化轨迹并分组，统计三个轨迹组临床资料、预后，采用COX回归方程和卡普兰-迈耶（K-M）生存曲线分析SAA/CRP动态变化轨迹与预后关系，采用受试者操作特征（ROC）曲线下面积（AUC）分析SAA/CRP动态变化轨迹对预后的预测价值。结果136例G-菌感染性脓毒症患者治疗前、治疗后24、72h时SAA/CRP呈逐渐降低趋势（3.02±0.44、2.68±0.39、2.41±0.35），差异具有统计学意义（F=81.419，P＜0.05）。经过LCTM筛选确定3个分类轨迹为最优模型，具体分组为：T1组（最低水平）、T2组（中等水平）、T3组（最高水平）；治疗前、治疗后24、72h时，T3组SAA/CRP水平＞T2组＞T1组，差异具有统计学意义（F=14.754、127.332、395.242，均P＜0.05）；三个轨迹组年龄、APACHEⅡ评分、脏器功能衰竭＞2个、28天病死率比较，差异具有统计学意义（F/χ2=7.774～146.351，均P＜0.05）。校正混杂因素后，与T1组比较，T2组、T3组患者28天死亡率呈线性升高。SAA/CRP呈现初始值最高并持续升高的变化轨迹时，预测G-菌感染性脓毒症患者预后的AUC为0.860，敏感度和特异度分别为72.97%、98.98%。结论SAA/CRP动态变化轨迹与多黏菌素类药物治疗G-菌感染性脓毒症患者预后存在强关联性，具备预后预测价值，控制SAA/CRP在参考范围波动将有助于控制病情进展，促进疾病良好转归。
Abstract:
Objective To investigate the prognostic predictive value of dynamic changes in serum amyloid A protein/C-reactive protein (SAA/CRP) levels in patients with Gram-negative bacterial sepsis (G-bacteria) for polymyxin treatment. Methods Clini-cal data from 136 patients with G-bacteria-induced sepsis treated at Qingdao Jiaozhou Central Hospital from January 2024 to De-cember 2024 were retrospectively analyzed. All patients received polymyxin treatment. SAA/CRP was measured before treatment at 24 and 72 hours post-treatment. The latent class trajectory modeling (LCTM) was used to identify SAA/CRP dynamic trajecto-ry groups. The clinical data and prognosis of the three trajectory groups were statistically analyzed. The relationship between the dynamic changes of SAA/CRP and prognosis was analyzed using COX regression equations and Kaplan-Meier (K-M) survival curves. The predictive value of the dynamic changes of SAA/CRP for prognosis was analyzed using receiver operating character-istic (ROC) curves and area under the curve (AUC). Results Among 136 patients with G-bacterial sepsis, the SAA/CRP ratio ex-hibited a gradual decrease at baseline (3.02±0.44), 24 hours (2.68±0.39) and 72 hours (2.41±0.35) post-treatment, with statis-tically significant differences (F=81.419, P<0.05). After screening with LCTM, three classification trajectories were identified as the optimal models: Group T1 (lowest level), Group T2 (intermediate level), and Group T3 (highest level). At baseline and 24/72 hours post-treatment, the level of SAA/CRP ratio was significantly higher in Group T3 than in Group T2 and T1 (F=14.754, 127.332, 395.242, all P<0.05). There were statistically significant differences in age, APACHE Ⅱscore, mumber of organs with dysfunction> 2, and 28-day mortality rate among the threc trajectories groups (F/χ2=7.774~146.351, all P<0.05). After adjusting for confounding factors, the 28-day mortality rates in Groups T2 and T3 remained significantly higher than that in Group T1, showing a linear increase. When the SAA/CRP ratio exhibited a trajectory of initial peak followed by sustained elevation, the AUC for predicting the prognosis of patients with G-bacterial septicemia was 0.860, with sensitivity and specificity of 72.97% and 98.98%, respectively. Conclusions The dynamic trajectory of SAA/CRP levels are strongly correlated with the prognosis of polymyxin-treated patients with G-bacterial sepsis, demonstrating prognostic predictive value. Controlling SAA/CRP fluctuations within the reference range will help to control disease progression and promote favorable outcomes.

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备注/Memo

备注/Memo:
基金项目：中国海洋大学教育部重点实验室，2024年度开放基金（项目编号：MDME2501-01）。
作者简介：殷晓英（1978-），女，本科，主管药师，研究方向：药学，E-mail：xiaoying1128x@163.com。
通讯作者：崔海涛（1984-），男，本科，副主任技师，研究方向：临床医学检验，E-mail：cuihaitao1583686@126.com。
更新日期/Last Update: 2026-05-15