摘要
目的:分析血清1-磷酸鞘氨醇受体3(S1P3)、载脂蛋白H(ApoH)水平与重症脓毒症患者预后的关系及其预测价值。方法:选取2021年1月—2024年1月重庆市沙坪坝区陈家桥医院收治的重症脓毒症患者113例,根据患者28 d内的预后结局分为病死组与存活组。比较2组基线资料及血清S1P3、ApoH水平。采用Cox回归模型检验血清S1P3、ApoH与重症脓毒症患者预后不良的关系。绘制受试者工作特征(ROC)曲线,以曲线下面积(AUC)评估血清S1P3、ApoH对重症脓毒症患者预后不良的预测价值;绘制决策曲线评估模型的临床净收益水平。采用双变量Pearson相关性检验血清S1P3、ApoH水平的相关性。结果:113例重症脓毒症患者28 d内病死55例(48.67%),纳入病死组;另58例(51.33%)存活,纳入存活组。病死组血清S1P3水平高于存活组,ApoH水平低于存活组(P<0.05)。经Cox回归模型检验显示:血清S1P3(HR=1.023,95%CI 1.007~1.040)、ApoH(HR=0.946,95%CI 0.929~0.962)是重症脓毒症患者预后不良的独立影响因素(P<0.05)。ROC曲线显示:血清S1P3、ApoH预测重症脓毒症患者预后不良的AUC为0.755、0.915,S1P3联合ApoH预测重症脓毒症患者预后不良的AUC为0.947(P<0.05)。决策曲线显示:在阈值0~0.96范围内,血清S1P3联合ApoH预测重症脓毒症患者预后的净收益率优于单独的净收益率。血清S1P3≥303.100 ng/mL、血清ApoH<191.750 ng/mL患者的病死率均明显低于血清S1P3≥303.100 ng/mL同时血清ApoH<191.750 ng/mL患者的病死率(P<0.05)。经双变量Pearson相关性检验显示:血清S1P3、ApoH水平呈负相关(r=-0.331,P<0.001)。结论:血清ApoH、S1P3水平与重症脓毒症患者预后密切相关,ApoH联合S1P3对重症脓毒症患者预后不良具有较好的预测价值,ApoH、S1P3或可作为预测脓毒症患者预后情况的生物学指标。
Objective:To analyze the relationship and predictive value between serum sphingosine l-phosphate 3(S1P3)and apolipoprotein H(ApoH)levels and the prognosis of patients with severe sepsis.Methods:113 patients with severc sepsis admitted to the hospital from January 2021 to January 2024 were selected as the research subjects.Immediately upon admission,serum SiP3 and ApoH levels were measured and baseline data were collected.Follow up was conducted,and the patients were divided into a mortality group and a survival group based on their survival outcomes within 28 days.The serum levels of SiP3,ApoH,and baseline data were compared between the two groups.Univariate and Cox regression models were used to test the impact of serum levels of S1P3,ApoH,and the prognosis of patients with severe sepsis,Receiver operating characteristic(ROC)curve was drawn at the same time,and the predictive value of serum SiP3 and ApoH for the prognosis of severe sepsis patients was evaluated by area under the curve(AUC).At the same time,the decision curve was drawn to evaluate the clinical net income level of the model,and the bivariate Pearson correlation test showed the correlation between serum S1P3 and ApoH levels.Results:Among 113 patients with severe sepsis,55 died within 28 days,with a mortality rate of 48.67%,and were included in the mortality group.Another 58 cases survived,accounting for 51.33%,and were included in the survival group.The serum S1P3 level in the mortality group was higher than that in the survival group,while the ApoH level was lower than that in the survival group,and the difference was statistically significant(P<0.05).There was no statistical significant difference between the other two groups of baseline data(P>0.05).According to the Cox regression model test,serum S1P3 and ApoH were influencing factors on the prognosis of sepsis patients(P<o.05).The ROC curve showed that serum S1P3 had moderate predictive value for the prognosis of severe sepsis patients,with an AUC of 0.755.ApoH and its combination had high predictive value for the prognosis of severe sepsis patients,and the combination had the highest predictive value,with AUC of 0.915 and 0.947,respectively(P<0.05).The decision curve showed that within the threshold range of O-0.96,the combined prediction of serum S1P3 and ApoH for the prognosis of severe sepsis patients had a better net return rate than the net return rate alone.The mortality rates of patients with serum SiP3>303.100 ng/mL or serum ApoH<191.750 ng/mL were significantly lower than those of patients with both serum S1P3≥303.100 ng/mL and serum ApoH<191.750 ng/mL(P<0.05).The bivariate Pearson correlation test showed a negative correlation between serum S1P3 and ApoH levels(P<0.05).Conclusion:The levels of serum ApoH and S1P3 were correlated with the prognosis of severe sepsis patients.The combination of ApoH and S1P3 had good predictive value for poor prognosis in severe sepsis patients.ApoH and S1P3 may serve as biological indicator in predicting the prognosis of severe sepsis patients.
作者
曾洪飞
蒋娜
吴可嘉
卢俊良
王茜
ZENG Hongfei;JIANG Na;WUKejia;LU Junliang;WANG Qian(Chongqing Medical and Pharmaceutical College,Chongqing,401331,China;Department of Critical Care Medicine,the Chenjiaqiao Hospital of Shapingba District of Chongqing City;Department of Human Organ Acquisition and Tissue Office,the First Affiliated Hospital of Army Medical University)
出处
《临床血液学杂志》
2025年第2期136-141,共6页
Journal of Clinical Hematology
基金
重庆医药高等专科学校科研计划项目(No:ygz2019114)。
