血清ESM-1、sTM、sE-selectin与革兰阴性菌血流感染患者预后关系研究OA
Relationship between serum ESM-1,sTM,sE-selectin and prognosis in patients with Gram-negative bacteria bloodstream infection
目的:探讨血清内皮细胞特异性分子-1(ESM-1)、可溶性血栓调节蛋白(sTM)、可溶性E-选择素(sE-selectin)与革兰阴性菌血流感染患者预后的关系.方法:选取193例革兰阴性菌血流感染患者,检测血清ESM-1、sTM及sE-selectin水平.统计28 d内患者存活情况,并分为死亡组和存活组.采用多因素Logistic回归分析革兰阴性菌血流感染患者预后的影响因素,受试者工作特征(ROC)曲线分析血清ESM-1、sTM、sE-selectin对革兰阴性菌血流感染患者预后的预测价值,决策曲线分析(DCA)验证联合预测的临床实用性.结果:随访193例患者中,死亡52例,存活141例.死亡组血清ESM-1、sTM及sE-selectin水平高于存活组(均P＜0.05).死亡组患者基线急性生理学与慢性健康状况评分系统Ⅱ(APACHE Ⅱ)、感染性休克比例、使用血管活性药物比例及C-反应蛋白(CRP)、降钙素原(PCT)水平高于存活组,基线收缩压低于存活组(均P＜0.05).高基线APACHE Ⅱ评分、发生感染性休克及高血清ESM-1、sTM、sE-selectin水平是革兰阴性菌血流感染患者预后的独立危险因素(均P＜0.05).血清ESM-1、sTM、sE-selectin预测革兰阴性菌血流感染患者预后不良的曲线下面积(AUC)分别为0.712、0.709、0.712,三者联合预测的AUC为0.847,高于单独预测的AUC(均P＜0.05).DCA曲线显示,当风险阈值为0.05～0.55时,联合预测的净获益率优于单独预测.结论:血清ESM-1、sTM、sE-selectin是革兰阴性菌血流感染患者预后的影响因素,三者联合检测对患者预后具有较好的预测价值.
Objective:To investigate the relationship between serum endothelial cell-specific molecule 1(ESM-1),soluble thrombomodulin(sTM),soluble E-selectin(sE-selectin)and prognosis in patients with Gram-negative bacte-rial bloodstream infection.Methods:A total of 193 patients with Gram-negative bacterial bloodstream infection were enrolled,and serum levels of ESM-1,sTM and sE-selectin were detected.The 28-day survival status of patients was recorded,and they were divided into a death group and a survival group.Multivariate logistic regression analysis was used to analyze the prognostic factors in patients with Gram-negative bacterial bloodstream infection.ROC curve was applied to evaluate the predictive value of serum ESM-1,sTM and sE-selectin for prognosis of these patients.DCA was performed to verify the clinical utility of combined prediction.Results:Among the 193 followed-up patients,52 died and 141 survived.Serum levels of ESM-1,sTM and sE-selectin in the death group were significantly higher than those in the survival group(all P＜0.05).The baseline APACHE Ⅱ score,proportion of septic shock,propor-tion of vasoactive drug use,and levels of C-reactive protein(CRP)and procalcitonin(PCT)in the death group were higher than those in the survival group,while baseline systolic blood pressure was lower(all P＜0.05).High baseline APACHE Ⅱ score,septic shock,and high serum levels of ESM-1,sTM and sE-selectin were independent risk factors for prognosis in patients with Gram-negative bacterial bloodstream infection(all P＜0.05).The AUC of serum ESM-1,sTM and sE-selectin in predicting poor prognosis was 0.712,0.709 and 0.712,respectively,and the AUC of the combined prediction was 0.847,which was higher than that of single indicator(all P＜0.05).DCA showed that the net benefit rate of combined prediction was better than that of single prediction when the risk threshold ranged from 0.05 to 0.55.Conclusion:Serum ESM-1,sTM and sE-selectin are influencing factors for prognosis in patients with Gram-negative bacterial bloodstream infection,and combined detection of the three indicators has favorable pre-dictive value for the prognosis of these patients.
张素婷;许银银
重庆医科大学附属永川医院检验科,重庆 402160重庆医科大学附属永川医院检验科,重庆 402160
医药卫生
血流感染革兰阴性菌内皮细胞特异性分子-1可溶性血栓调节蛋白可溶性E-选择素预后
Bloodstream infectionGram-negative bacteriaEndothelial cell-specific molecule 1Soluble throm-bomodulinSoluble E-selectinPrognosis
《陕西医学杂志》 2026 (5)
617-622,6
国家自然科学基金资助项目(82200218)
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