血浆MMP-9、HBP及IL-27联合检测在脓毒症早期诊断中的应用价值
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摘要
目的探讨血浆基质金属蛋白酶9(MMP-9)、肝素结合蛋白(HBP)及白细胞介素27(IL-27)联合检测对脓毒症早期诊断的应用价值。方法选取重庆巴南区人民医院重症监护病房收治的脓毒症患者(55例),按病情程度分为脓毒症组(24例)、严重脓毒症组(17例)及脓毒性休克组(14例),同时选取局部感染的非脓毒症患者21例为对照组。记录患者入院时血浆MMP-9、HBP、IL-27等相关检验指标及急性生理学与慢性健康状况评分系统Ⅱ(APACHE-Ⅱ)评分;利用Pearson相关分析血浆MMP-9、HBP、IL-27与降钙素原(PCT)、APACHE-Ⅱ评分的相关性;采用多因素logistic回归分析MMP-9、HBP、IL-27与脓毒症发生的相关性;采用受试者工作特征曲线(ROC曲线)分析MMP-9、HBP及IL-27联合检测对脓毒症早期诊断的应用价值。结果脓毒症患者血浆MMP-9、HBP及IL-27水平明显高于对照组,差异有统计学意义(P<0.05);MMP-9、HBP及IL-27水平与血清PCT(rMMP-9=0.534,rHBP=0.693,rIL-27=0.627,P<0.05)及APACHE-Ⅱ(rMMP-9=0.574,rHBP=0.723,rIL-27=0.669,P<0.05)评分呈正相关;多因素logistic回归分析显示,MMP-9、HBP、IL-27均为脓毒症发生的独立危险因素(P<0.05);ROC曲线分析结果显示MMP-9、HBP及IL-27诊断脓毒症的曲线下面积(AUC)分别为0.764(95%CI=0.755～0.916)、0.713(95%CI=0.627～0.795)及0.871(95%CI=0.762～0.936),MMP-9、HBP、IL-27三者联合检测的AUC为0.891(95%CI=0.822～0.943),三者联合检侧优于MMP-9、HBP及IL-27单一检测,差异有统计学意义(P<0.05)。结论血浆MMP-9、HBP及IL-27联合检测对早期诊断脓毒症有良好的应用价值。
Objective To investigate the value of combined detection of plasma matrix metalloproteinase 9(MMP-9),heparin binding protein(HBP)and interleukin 27(IL-27)in the early diagnosis of sepsis.Methods A total of 55 patients with sepsis in the ICU of People′s Hospital of Chongqing Banan District were selected and divided into sepsis group(24 cases),severe sepsis group(17 cases)and septic shock group(14 patients)according to the severity of illness.Meanwhile,21 patients with non-sepsis local infection were selected as the control group.Record the plasma levels of MMP-9,HBP,IL-27 relevant test data,acute physiology and chronic health status scoring system-Ⅱ(APACHE-Ⅱ)scores on admission.Pearson correlation test was used to analyze the correlation between plasma MMP-9,HBP and IL-27 levels with PCT and APACHE-Ⅱ.Multivariate logistic regression analysis was used to analyze the correlation between MMP-9,HBP,IL-27 and sepsis.The receiver operating characteristic curve(ROC)was used to analyze the combined detection of MMP-9,HBP,and IL-27 for the early diagnosis of sepsis.Results The plasma levels of MMP-9,HBP and IL-27 in patients with sepsis were significantly higher than those in the control group(P<0.05).The levels of MMP-9,HBP and IL-27 were positively correlated with serum PCT(rMMP-9=0.534,rHBP=0.693,rIL-27=0.627,P<0.05)and APACHE-Ⅱ(rMMP-9=0.574,rHBP=0.723,rIL-27=0.669,P<0.05).Multivariate logistic regression analysis showed that MMP-9,HBP and IL-27 were independent risk factors for sepsis(P<0.05).ROC curve analysis suggested that the area under the curve(AUC)of MMP-9,HBP,and IL-27 were 0.764(95%CI=0.755-0.916),0.713(95%CI=0.627-0.795)and 0.871(95%CI=0.762-0.936),combined detection of MMP-9,HBP and IL-27 had an AUC value of 0.891(95%CI=0.822-0.943),which were significantly higher than single detection of MMP-9,HBP and IL-27(P<0.05).Conclusion Combined detection of plasma MMP-9,HBP and IL-27 has a good application value for early diagnosis of sepsis.
Objective To investigate the value of combined detection of plasma matrix metalloproteinase 9(MMP-9),heparin binding protein(HBP)and interleukin 27(IL-27)in the early diagnosis of sepsis.Methods A total of 55 patients with sepsis in the ICU of People′s Hospital of Chongqing Banan District were selected and divided into sepsis group(24 cases),severe sepsis group(17 cases)and septic shock group(14 patients)according to the severity of illness.Meanwhile,21 patients with non-sepsis local infection were selected as the control group.Record the plasma levels of MMP-9,HBP,IL-27 relevant test data,acute physiology and chronic health status scoring system-Ⅱ(APACHE-Ⅱ)scores on admission.Pearson correlation test was used to analyze the correlation between plasma MMP-9,HBP and IL-27 levels with PCT and APACHE-Ⅱ.Multivariate logistic regression analysis was used to analyze the correlation between MMP-9,HBP,IL-27 and sepsis.The receiver operating characteristic curve(ROC)was used to analyze the combined detection of MMP-9,HBP,and IL-27 for the early diagnosis of sepsis.Results The plasma levels of MMP-9,HBP and IL-27 in patients with sepsis were significantly higher than those in the control group(P<0.05).The levels of MMP-9,HBP and IL-27 were positively correlated with serum PCT(rMMP-9=0.534,rHBP=0.693,rIL-27=0.627,P<0.05)and APACHE-Ⅱ(rMMP-9=0.574,rHBP=0.723,rIL-27=0.669,P<0.05).Multivariate logistic regression analysis showed that MMP-9,HBP and IL-27 were independent risk factors for sepsis(P<0.05).ROC curve analysis suggested that the area under the curve(AUC)of MMP-9,HBP,and IL-27 were 0.764(95%CI=0.755-0.916),0.713(95%CI=0.627-0.795)and 0.871(95%CI=0.762-0.936),combined detection of MMP-9,HBP and IL-27 had an AUC value of 0.891(95%CI=0.822-0.943),which were significantly higher than single detection of MMP-9,HBP and IL-27(P<0.05).Conclusion Combined detection of plasma MMP-9,HBP and IL-27 has a good application value for early diagnosis of sepsis.
引文
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[15]钱定良,闫绍荣,潘晓荷.肝素结合蛋白和降钙素原及C反应蛋白在脓毒症早期诊断中的价值比较[J].中华检验医学杂志,2017,40(6):451-455.
[16]JONES G W,HILL D G,CARDUS A,et al.IL-27:a double agent in the IL-6family[J].Clin Exp Immunol,2018,185(13):13116-13120.
[17]TROY A E,ZAPH C,DU Y,et al.IL-27regulates homeostasis of the intestinal CD4+effector T cell pool and limits intestinal inflammation in a murine model of colitis[J].J Immunol,2009,183(3):2037-2044.
[18]蔡业海.变应性鼻炎患者血清中IL-27、IL-17、IL-10的表达及意义[J].临床军医杂志,2015,43(9):960-965.
[19]HUBER M,STEINWALD V,GURALNIK A,et al.IL-27inhibits the development of regulatory T cells via STAT3[J].Int Immunol,2008,20(2):223-234.
[20]赵蓉,董士民.血清endocan和降钙素原对脓毒症早期诊断及预后评估的临床价值[J].中华危重病急救医学,2017,29(4):321-326.
[2]高戈,冯喆,常志刚,等.2012国际严重脓毒症及脓毒性休克诊疗指南[J].中华危重病急救医学,2013,25(8):501-505.
[3] BRIASSOULIS G,GALANI A.Prognostic markers of pediatric meningococcal sepsis[J].Expert Rev Anti Infect Ther,2014,12(9):1017-1020.
[4] ZHOU M,QIN S,CHU Y,et al.Immunolocalization of MMP-2and MMP-9in human rheumatoid synovium[J].Int J Clin Exp Pathol,2014,7(6):3048-3056.
[5]黄增相,何超,陶骅,等.严重脓毒症致ARDS患者血浆MMP-9和TFC的变化及乌司他丁干预效果的研究[J].临床急诊杂志,2015,16(8):614-617.
[6]易晓榕,桂晓美.肝素结合蛋白用于诊断脓毒症的研究[J].实验与检验医学,2017,35(5):654-657.
[7]李凡旺,鲍明征,徐刚,等.内毒素、降钙素原及白介素-2、在细菌性脓毒症患者诊断中的应用价值[J].疑难病杂志,2016,15(11):1155-1158.
[8] DELLINGER R P,LEVY M M,RHODES A,et al.Surviving sepsis campaign:international guidelines for management of severe sepsis and septic shock,2012[J].Intensive Care Med,2013,39(2):165-228.
[9] SINGER M,DEUTSCHMAN C S,SEYMOUR C W,et al.The third international consensus definitions for sepsis and septic shock(Sepsis-3)[J].JAMA,2016,315(8):801-810.
[10]LIU H,LIU Y,SUN J K,et al.Extravascular lung water monitoring of renal replacement therapy in lung water scavenging for septic acute kidney injury[J].Int J Clin Exp Med,2015,8(10):18907-18916.
[11]郝昱芳,耿立霞.脓毒症中介质的最新研究进展[J].中华危重病急救医学,2016,28(2):188-192.
[12]COLLAZOS J,ASENSI V,MARTIN G,et al.The effect of gender and genetic polymorphisms on matrix metalloprotease(MMP)and tissue inhibitor(TIMP)plasma levels in different infectious and non-infectious conditions[J].Clin Exp Immunol,2015,182(2):213-219.
[13]杨晓军,冯涛,丁欢.重症患者早期血清基质金属蛋白酶-9、可溶性P-选择素测定的临床意义[J].宁夏医学杂志,2011,33(10):914-916.
[14]MCNAMARA C,ZINKERNAGEL A S,MACHEBOEUF P,et al.Coiled-coil irregularities and instabilities in group A streptococcus M1are required for virulence[J].Science,2008,319(5868):1405-1408.
[15]钱定良,闫绍荣,潘晓荷.肝素结合蛋白和降钙素原及C反应蛋白在脓毒症早期诊断中的价值比较[J].中华检验医学杂志,2017,40(6):451-455.
[16]JONES G W,HILL D G,CARDUS A,et al.IL-27:a double agent in the IL-6family[J].Clin Exp Immunol,2018,185(13):13116-13120.
[17]TROY A E,ZAPH C,DU Y,et al.IL-27regulates homeostasis of the intestinal CD4+effector T cell pool and limits intestinal inflammation in a murine model of colitis[J].J Immunol,2009,183(3):2037-2044.
[18]蔡业海.变应性鼻炎患者血清中IL-27、IL-17、IL-10的表达及意义[J].临床军医杂志,2015,43(9):960-965.
[19]HUBER M,STEINWALD V,GURALNIK A,et al.IL-27inhibits the development of regulatory T cells via STAT3[J].Int Immunol,2008,20(2):223-234.
[20]赵蓉,董士民.血清endocan和降钙素原对脓毒症早期诊断及预后评估的临床价值[J].中华危重病急救医学,2017,29(4):321-326.