[1]于大勇a,卢　新b,任平香b,等.老年脓毒症患者血清循环Netrin-1表达水平对发生脑损伤风险的预测价值研究[J].现代检验医学杂志,2022,37(02):76-79.[doi:10.3969/j.issn.1671-7414.2022.02.016]
　YU Da-yonga,LU Xinb,REN Ping-xiangb,et al.Study on the Value of Serum Circulating Netrin-1 Expression Level in Predicting the Risk of Brain Injury in Elderly Patients with Sepsis[J].Journal of Modern Laboratory Medicine,2022,37(02):76-79.[doi:10.3969/j.issn.1671-7414.2022.02.016]
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老年脓毒症患者血清循环Netrin-1表达水平对发生脑损伤风险的预测价值研究()
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《现代检验医学杂志》[ISSN:/CN:]

卷:
第37卷
期数:
2022年02期
页码:
76-79
栏目:
论　著
出版日期:
2022-03-15

文章信息/Info

Title:
Study on the Value of Serum Circulating Netrin-1 Expression Level in Predicting the Risk of Brain Injury in Elderly Patients with Sepsis
文章编号:
1671-7414（2022）02-076-05
作者:
于大勇a; 卢　新b; 任平香b; 刘海芳b; 李志祥a
（唐山市丰润区人民医院a. 重症加强护理病房;b. 神经内科, 河北唐山064000）
Author(s):
YU Da-yonga;  LU Xinb;  REN Ping-xiangb;  LIU Hai-fangb;  LI Zhi-xianga
(a.Intensive Care Unit;b.Department of Neurology, Fengrun District People’s Hospital of Tangshan City,Hebei Tangshan 064000, China)
关键词:
脓毒症; 脑损伤; 神经导向因子-1
分类号:
R631，R651.15；R446.11
DOI:
10.3969/j.issn.1671-7414.2022.02.016
文献标志码:
A
摘要:
目的　探讨神经导向因子-1(Netrin-1) 在老年脓毒症并发脑损伤（sepsis-associated encephalopathy，SAE）患者血清中表达情况及临床意义。方法　选择2017 年1 月～ 2020 年12 月在唐山市丰润区人民医院就诊的老年脓毒症患者162例为观察对象，其中并发脑损伤患者67 例作为SAE 组，未并发脑损伤患者95 例作为对照组；根据患者28 天内死亡情况，将SAE 患者分为存活组35 例和死亡组32 例。酶联免疫吸附法（enzyme-linked immunosorbent assay，ELISA）检测血清中Netrin-1 和神经元特异性烯醇化酶（neuron specific enolase，NSE）表达水平，免疫层析法检测中枢神经特异蛋白（S100β）表达水平，对患者进行急性生理健康与慢性疾病（acute physical health and chronic diseases，APACHE Ⅱ）评分、序贯器官衰竭估计（Sequential Organ Failure Assessment, SOFA）评分，Pearson 分析血清 Netrin-1 水平与NSE，S100β，APACHE Ⅱ和SOFA 评分相关性，受试者工作特征（receiver operating characteristic，ROC）曲线分析血清Netrin-1 对SAE 的预测价值。结果　SAE 患者住重症加强护理病房（intensive care unit, ICU）时间8.72±1.81 天, APACHE Ⅱ为20.10±6.46分和SOFA 为11.57±4.83 分，显著高于对照组的ICU 时间4.52±1.34 天，APACHE Ⅱ 14.20±5.31 分和SOFA 8.41±3.56 分，差异均有统计学意义（t=4.794~16.971，均P ＜ 0.001）。SAE 患者血清Netrin-1 水平为114.57±30.21 ng/ml，显著低于对照组（162.81±35.43 ng/ml）的表达水平；NSE 和S100β 分别为9.62±1.76 ng/ml 和1.03±0.32μg/ml，显著高于对照组（7.32±1.35ng/ml 与0.75±0.21μg/ml），差异均有统计学意义（t=6.723~9.408，均P ＜ 0.001）。死亡组SAE 患者血清 Netrin-1 水平为93.78±25.62ng/ml，显著低于存活组的134.26±28.05ng/ml；NSE 和S100β 高于存活组（13.01±1.81 ng/ml vs 7.23±1.14 ng/ml；1.29±0.35μg/ml vs 0.81±0.19μg/ml），其APACHE Ⅱ和SOFA 显著高于对照组（22.15±6.21 分vs 18.23±5.64 分；13.25±3.42 分vs 10.45±2.95 分），差异具有统计学意义（t=2.708~15.782，均P ＜ 0.05）。相关性分析结果显示，SAE 患者血清 Netrin-1 水平与NSE，S100β，APACHE Ⅱ和SOFA 评分呈负相关性（r=-0.451，-0.503，-0.514，-0.409，均P ＜ 0.001）。血清Netrin-1 联合NSE 和S100β 预测老年脓毒症患者发生脑损伤风险敏感度和特异度分别为95.52% 和89.47%（AUC=0.969，95%CI：0.942~0.996，P ＜ 0.001），联合诊断优于血清Netrin-1 单独检测（AUC=0.873，95%CI：0.819~0.928，P ＜ 0.001）。结论　老年SAE 患者血清Netrin-1 水平降低。血清Netrin-1 单独或联合NSE 和S100β 检测对预测老年脓毒症患者发生脑损伤风险具有一定临床应用价值。
Abstract:
Objective　To explore the expression and clinical significance of neural guidance factor-1 (Netrin-1) in the serum of elderly sepsis patients with brain injury (SAE). Methods　A total of 162 elderly patients with sepsis in Tangshan Fengrun People’s Hospital from January 2017 to December 2020 were selected as the observation objects, including 67 patients with brain injury as SAE group and 95 patients without brain injury as control group. Aaccording to the death within 28 days, the patients were divided into survival group (n=35) and death group (n=32). The expression levels of Netrin-1 and neuron specific enolase (NSE) in serum were detected by enzyme-linked immunosorbent assay (ELISA), the expression level of central nerve specific protein (S100 β) was detected by immunochromatography, acute physiology chronic health evaluation (APACHE Ⅱ ) score and sequential organ failure assessment (SOFA) score were performed, the correlation between serum level of Netrin-1 and NSE, S100 β, APACHE Ⅱ and SOFA scores were analyzed by Pearson analysis, and the predictive value of serum Netrin-1 for SAE was analyzed by receiver operating characteristic(ROC) curve. Results　SAE patients stayed in ICU for 8.72±1.81days, APACHE Ⅱ 20.10±6.46 points and SOFA 11.57±4.83 points，and they were all significantly higher than the control group ICU time 4.52±1.34 days, APACHE Ⅱ 14.20±5.31 points and SOFA 8.41±3.56 points，the differences were statistically significant(t=4.794~16.971, all P ＜ 0.001).The serum Netrin-1 level of SAE patients was 114.57±30.21 ng/ml, which was significantly lower than that of the control group （162.81±35.43 ng/ml）, and the NSE level and the S100β expression level were 9.62±1.76 ng/ml and 1.03± 0.32 μg/ml,respectively,with significantly higher than the control group （7.32±1.35 ng/ml and 0.75±0.21 μg/ml）, the differences were statistically significant（t=6.723~9.408, all P ＜ 0.001）. The serum Netrin-1 level of SAE patients in the death group was 93.78±25.62 ng/ml, which was significantly lower than that of the survival group(134.26±28.05 ng/ml), and NSE ,S100β, APACHE Ⅱ and SOFA were 13.01±1.81 ng/ml vs 7.23±1.14 ng/ ml,1.29±0.35μg/ml vs 0.81±0.19μg/ml, 22.15±6.21 vs 18.23±5.64 points and 13.25±3.42 vs 10.45±2.95 scores ,with significantly higher than the control group，the differences were statistically significant (t=2.708~15.7827, all P ＜ 0.05).The results of correlation analysis showed that the level of serum Netrin-1 was negatively correlated with NSE, S100 β, APACHE Ⅱ and SOFA scores (r=-0.451, -0.503, -0.514 ，-0.409, all P<0.001). The sensitivity, the specificity and the area under the curve of serum Netrin-1 combined with NSE and S100β to predict the risk of brain injury in elderly patients with sepsis were 95.52% and 89.47%（AUC=0.969，95%CI：0.942~0.996, P ＜ 0.001）,respectively. The combined diagnosis was better than the detection of serum Netrin-1 alone（AUC=0.873，95%CI=0.819~0.928, P ＜ 0.001）. Conclusion　The expression level of serum Netrin-1 in elderly SAE patients decreased.Serum Netrin-1 alone or in combination with NSE and S100β have a certain value in predicting the risk of brain injury in elderly patients with sepsis, and has certain clinical application significance.

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备注/Memo

备注/Memo:
基金项目：河北省2020 年度医学科学研究课题计划（编号：20200400）。
作者简介：于大勇（1975-），男，硕士研究生，副主任医师，研究方向：危重症病人的应激性高血糖，E-mail:ydy8890@163.com。
更新日期/Last Update: 1900-01-01