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中华危重病急救医学 2018 年 10 月第 30 卷第 10 期 Chin Crit Care Med,October 2018,Vol.30,No.10
·论著·
血浆游离 DNA 对脓毒症预后的预测价值
黄天宝 杨志燕 陈少剑 陈金图
362000 福建泉州
,
福建医科大学附属泉州第一医院急诊中心
通讯作者
:
黄天宝
,
Email
:
hhttbbcn@163.com
DOI:10.3760/cma.j.issn.2095-4352.2018.10.003
【
摘要
】
目的 探讨血浆游离 DNA(cf
-
DNA)对脓毒症患者预后的预测价值。方法 选择 2015 年 6 月至
2017 年 6 月福建医科大学附属泉州第一医院急诊中心收治的 105 例脓毒症患者为研究对象,并根据病情程度
分为脓毒症组(50 例)和严重脓毒症组(55 例);同时选择本院体检中心 50 例健康体检者作为健康对照组。比
较 3 组间 cf
-
DNA、降钙素原(PCT)、急性生理学与慢性健康状况评分Ⅱ(APACHE Ⅱ)的差异 ;采用 Bivariate
法分析 cf
-
DNA 与 PCT、APACHE Ⅱ的相关性。采用 Logistic 回归分析脓毒症的独立预测因素 ;绘制受试者工
作特征曲线(ROC),评估 cf
-
DNA、PCT、APACHE Ⅱ单独或联合对脓毒症预后的预测能力。结果 脓毒症组和
严重脓毒症组 PCT、APACHE Ⅱ及 cf
-
DNA 均明显高于健康对照组〔PCT(μg/L):5.80(3.28,8.85)、17.53(8.40,
29.61)比 0.02(0.01,0.03),APACHE Ⅱ(分):13.04±3.03、23.29±8.02 比 2.10±1.05,cf
-
DNA(μg/L):1 438.0
(1 154.0,1 576.0)、2 595.0(2 162.0,5 198.0)比 17.0(13.0,20.5),均 P<0.05〕,且严重脓毒症组各指标较脓毒症
组进一步升高(均 P<0.05)。相关性分析显示,cf
-
DNA 与 PCT 〔r=0.675,95% 可信区间(95%CI)=0.575~0.766,
P<0.001〕、APACHE Ⅱ(r=0.911,95%CI=0.874~0.939,P<0.001)均呈显著正相关。ROC 曲线分析显示,
PCT、APACHE Ⅱ、cf
-
DNA、PCT+APACHE Ⅱ、cf
-
DNA+PCT、cf
-
DNA+APACHE Ⅱ、cf
-
DNA+PCT+APACHE Ⅱ
预测脓毒症患者预后的 ROC 曲线下面积(AUC)分别为 0.898、0.905、0.961、0.941、0.974、0.976、0.982。脓毒症
预后的预测能力显示,PCT、APACHE Ⅱ、cf
-
DNA 单独预测时,cf
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DNA 的 AUC 最大(0.961),敏感度为 100%,特
异度为 81.43%;cf
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DNA 与 PCT 或 APACHE Ⅱ联合预测可进一步增加 AUC,且 cf
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DNA+PCT+APACHE Ⅱ三者
联合预测的 AUC 达最大(0.982),敏感度为 94.29%,特异度为 98.57%。结论 cf
-
DNA、PCT、APACHE Ⅱ对脓
毒症患者的预后均具有一定的预测价值,单独预测时 cf
-
DNA 的价值最高,但 cf
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DNA、PCT、APACHE Ⅱ三者联
合的预测能力最佳。
【
关键词
】
脓毒症; 血浆游离 DNA ; 急性生理学与慢性健康状况评分Ⅱ; 降钙素原; 预后
基金项目 :福建省泉州市科技计划项目(Z[2015]0079)
Predictive value of plasma cell
-
free DNA for prognosis of sepsis Huang Tianbao, Yang Zhiyan, Chen Shaojian,
Chen Jintu
Department of Emergency, the First Hospital of Quanzhou Affiliated to Fujian Medical University, Quanzhou 362000,
Fujian, China
Corresponding author: Huang Tianbao, Email: hhttbbcn@163.com
【
Abstract
】
Objective
To explore the predictive value of plasma cell
-
free DNA (cf
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DNA) for prognosis in
patients with sepsis. Methods 105 patients with sepsis admitted to department of emergency of the First Hospital of
Quanzhou Affiliated to Fujian Medical University from June 2015 to June 2017 were enrolled. Patients were divided into
sepsis group (n = 50) and severe sepsis group (n = 55). At the same time, 50 cases of physical examination center in our
hospital were randomly selected as the healthy control group. The differences of cf
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DNA, procalcitonin (PCT) and acute
physiology and chronic health evaluation Ⅱ (APACHE Ⅱ ) score among the three groups were compared. The correlation
between cf
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DNA and PCT or APACHE Ⅱ were analyzed by Bivarite method. Logistic regression was used to analyze the
independent predictors of sepsis. The receiver operating characteristic curve (ROC) was made to evaluate cf
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DNA, PCT,
APACHEⅡ alone or combined ability to predict the prognosis of sepsis. Results The PCT, APACHE Ⅱ and cf
-
DNA
in the sepsis group and severe sepsis group were significantly higher than those in the healthy control group [PCT (μg/L):
5.80 (3.28, 8.85), 17.53 (8.40, 29.61) vs. 0.02 (0.01, 0.03); APACHE Ⅱ : 13.04±3.03, 23.29±8.02 vs. 2.10±1.05;
cf
-
DNA (μg/L): 1 438.0 (1 154.0, 1 576.0), 2 595.0 (2 162.0, 5 198.0) vs. 17.0 (13.0, 20.5); all P ﹤ 0.05], and the
indicators in the severe sepsis group were further higher than the sepsis group (all P < 0.05). Correlation analysis showed
that cf
-
DNA was significantly positive correlated with PCT [r = 0.675, 95% confidence interval (95%CI) = 0.575-
0.766, P < 0.001] and APACHE Ⅱ (r = 0.911, 95%CI = 0.874-0.939, P < 0.001). ROC curve analysis showed that the
areas under ROC curve (AUC) of PCT, APACHE Ⅱ, cf
-
DNA, PCT+APACHE Ⅱ, cf
-
DNA+PCT, cf
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DNA+APACHE Ⅱ,
cf
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DNA+PCT+APACHE Ⅱ to predict the prognosis of sepsis patients were 0.898, 0.905, 0.961, 0.941, 0.974, 0.976
and 0.982, respectively. It was shown that when predicted alone with PCT, APACHE Ⅱ and cf
-
DNA, the AUC of cf
-
DNA
was the largest (0.961), the sensitivity was 100%, and the specificity was 81.43%; the combined prediction of cf
-
DNA
with PCT or APACHE Ⅱ could further increase AUC, and the combined prediction of cf
-
DNA, PCT and APACHE Ⅱ
had the highest AUC (0.982), the sensitivity was 94.29%, the specificity was 98.57%. Conclusions cf
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DNA, PCT