标题：血清 sST2、CTRP1与脓毒症患者病情的关系及预后影响因素分析

      作者：陈建玲 1，惠永林 2，谈晓侠 3    西安医学院第二附属医院急诊科 1、重症医学科 2、门诊部 3，陕西 西安 710038

      卷次： 2020年31卷19期

      【摘要】 目的 研究血清可溶性人基质裂解素2 (sST2)、补体C1q肿瘤坏死因子相关蛋白1 (CTRP1)与脓毒症患者病情的关系及预后影响因素。方法 将2016年10月至2019年10月西安医学院第二附属医院收治的100例脓毒症患者纳入研究，将其按照是否休克分为休克组62例与非休克组38例。另选取同期于我院体检的40例健康志愿者作为对照组。比较三组受检者的血清 sST2、CTRP1水平，分析血清 sST2、CTRP1水平与脓毒症严重程度的关系。根据所有患者住院30 d内的存活状态将其分为存活组70例和死亡组30例，比较两组患者的基线资料和各项血清指标。采用多因素Logistic回归分析法分析脓毒症患者住院30 d内死亡的影响因素。结果 休克组、非休克组和对照组受检者的血清 sST2水平[(694.82±124.59) pg/mL vs (510.27±102.83) pg/mL vs (76.22±2.39) pg/mL]、CTRP1水平[(21.33±5.28) ng/mL vs (16.79±4.14) ng/mL vs (3.55±1.05) ng/mL]比较，休克组明显高于非休克组和对照组，非休克组又明显高于对照组，差异均有统计学意义(P<0.05)；Spearman相关性分析结果显示，血清 sST2、CTRP1水平与脓毒症严重程度均呈正相关(r=0.628、0.647，P<0.05)；死亡组患者的年龄、APACHEⅡ评分、血清肌酐、尿素氮、CRP、sST2、CTRP1水平明显高于存活组，差异均有统计学意义(P<0.05)；多因素Logistic回归分析结果显示，年龄较大、APACHEⅡ评分较高，血清尿素氮、CRP、sST2及CTRP1水平较高均是脓毒症患者住院30 d内死亡的独立危险因素(P<0.05)。结论 血清 sST2、CTRP1水平升高预示着脓毒症患者病情加剧，患者预后影响因素包括年龄、APACHEⅡ评分、尿素氮、CRP、sST2及CTRP1等，均值得临床重点关注。
      【关键词】 脓毒症；预后；影响因素；补体C1q肿瘤坏死因子相关蛋白1；可溶性人基质裂解素2
      【中图分类号】 R631 【文献标识码】 A 【文章编号】 1003—6350（2020）19—2473—04

Relationship between serum sST2 and CTRP1 and the condition of sepsis patients and the prognostic factors.CHEN Jian-ling 1, HUI Yong-lin 2, TAN Xiao-xia 3.
Department of Emergency 1, Department of Critical Medicine 2,Outpatient Department 3, the Second Affiliated Hospital of Xi'an Medical College, Xi'an 710038, Shaanxi, CHINA
【Abstract】 Objective To study the relationship between serum soluble human matrix lysin 2 (sST2), comple-ment C1q tumor necrosis factor-associated protein 1 (CTRP1) and the condition of sepsis patients and prognostic factors.Methods A total of 100 patients with sepsis admitted to the Second Affiliated Hospital of Xi 'an Medical Universityfrom October 2016 to October 2019 were included and divided into a shock group (62 patients) and a non-shock group(38 patients) according to their shock status. In addition, 40 healthy volunteers who underwent physical examination inthe hospital during the same period were selected as the control group. The serum levels of sST2 and CTRP1 of the threegroups were compared, and the relationship between serum sST2 and CTRP1 and the severity of sepsis was analyzed.All patients were divided into a survival group (70 patients) and a death group (30 patients) according to their survivalstatus within 30 days of hospitalization. Baseline data and serum indicators were compared between the two groups. Mul-tivariate Logistic regression analysis was used to analyze the influencing factors of death in patients with sepsis within30 days of hospitalization. Results The serum sST2 and CTRP1 levels in the shock group were (694.82±124.59) pg/mLand (21.33±5.28) ng/mL, significantly higher than (510.27±102.83) pg/mL and (16.79±4.14) ng/mL in non-shock groupand (76.22±2.39) pg/mL and (3.55±1.05) ng/mL in the control group (P<0.05); the levels in non-shock group were alsosignificantly higher than those in the control group (P<0.05). Spearman correlation analysis showed that serum sST2 andCTRP1 were positively correlated with the severity of sepsis (r=0.628, 0.647, P<0.05). The age, APACHE Ⅱ score, se-rum creatinine, urea nitrogen, C-reactive protein (CRP), sST2, CTRP1 level were significantly higher in the death groupthan the survival group (P<0.05). Multivariable Logistic regression analysis showed that older age, higher APACHE Ⅱscore, higher serum urea nitrogen, elevated CRP, sST2, and CTRP1 levels were the independent risk factors of deathwithin 30 d after admission (P<0.05). Conclusion Elevated sST2, CTRP1 levels indicate the aggravation of sepsis. Theprognostic factors include age, Apache Ⅱ score, urea nitrogen, CRP, sST2 and CTRP1, which are worthy of clinical at-tention.
      【Key words】 Sepsis; Prognosis; Influencing factors; C1q complement tumor necrosis factor-associated protein 1(CTRP1); Soluble human matrix lycrin 2 (sST2)