摘要
目的探讨血清葡萄糖调节蛋白78(GRP78)、抗增殖蛋白1(PHB1)与急诊脓毒症患者预后不良的相关性。方法回顾性选取淄博一四八医院2021年1月至2024年1月收治的99例脓毒症患者为研究对象,入院后均检测血清GRP78、PHB1水平,统计患者入院28 d内生存情况。另取同期至淄博一四八医院健康体检的99例无感染人群为对照组。比较脓毒症患者与对照组患者血清GRP78、PHB1水平;比较不同预后脓毒症患者基线资料及血清学指标;通过相关性分析、Logistic回归分析及受试者工作特征(ROC)曲线探讨血清GRP78、PHB1与急诊脓毒症患者预后不良的关系。结果脓毒症患者血清GRP78、PHB1水平较对照组高[(125.08±27.92)μg/L比(97.73±15.62)μg/L、(186.65±26.85)ng/L比(147.89±24.63)ng/L],差异有统计学意义(P<0.05)。99例脓毒症患者中,入院28 d内死亡25例(25.25%),将死亡患者纳入预后不良组,其余74例(74.75%)患者纳入预后良好组。预后不良组年龄较预后良好组大[(66.52±4.72)岁比(62.24±3.67)岁],糖尿病占比较预后良好组高[72.00%(18/25)比25.68%(19/74)],感染性休克占比较预后良好组高[60.00%(15/25)比16.22%(12/74)],血清GRP78、PHB1水平较预后良好组高[(149.50±31.53)μg/L比(116.82±21.13)μg/L、(209.91±19.06)ng/L比(178.79±24.51)ng/L],差异有统计学意义(P<0.05)。经相关性分析提示,年龄、糖尿病、疾病严重程度、血清GRP78、PHB1与急诊脓毒症患者预后不良发生有关(相关性系数为0.428、0.416、0.427、0.511、0.506,P<0.05)。经Logistic回归分析显示,血清GRP78、PHB1、年龄、糖尿病、严重程度可影响急诊脓毒症患者预后不良发生(P<0.05)。绘制ROC曲线,结果提示,血清GRP78、PHB1联合预测急诊脓毒症患者预后不良的曲线下面积为0.889(95%CI 0.823~0.955),灵敏度为96.00%,特异度为66.20%,高于任一单项指标。结论急诊脓毒症患者预后不良发生与血清GRP78、PHB1表达升高相关,临床可通过患者入院时检测的血清GRP78、PHB1水平提前评估脓毒症患者不良预后发生风险。
Objective To explore the correlation between serum glucose regulated protein 78(GRP78)and prohibitin11(PHB1)with poor prognosis in emergency sepsis patients.Methods A prospective study was conducted to select 99 patients with sepsis admitted to the emergency department of the Zibo 148 Hospital from January 2021 to January 2024 as the study subjects.After admission,serum GRP78 and PHB1 levels were tested,and the survival status of patients within 28 d of admission was statistically analyzed.In addition,99 non-infected people who came to the Zibo 148 Hospital for physical examination during the same period were taken as the control group.The serum levels of GRP78 and PHB1 between patients with sepsis and the control group were compared.Baseline data and serological indicators of sepsis patients with different prognoses were compared.Correlation analysis,Logistic regression analysis and receiver operating characteristic curve(ROC)were used to explore the relationship between serum GRP78,PHB1 and poor prognosis in patients with emergency sepsis.Results The serum levels of GRP78 and PHB1 in sepsis patients were higher than those in the control group:(125.08±27.92)μg/L vs.(97.73±15.62)μg/L,(186.65±26.85)ng/L vs.(147.89±24.63)ng/L,there was statistical difference(P<0.05).Among the 99 patients with sepsis,25 patients(25.25%)died within 28 d of admission.The deceased patients were included in the poor prognosis group,while the remaining 74 patients(74.75%)were included in the good prognosis group.The age of the poor prognosis group was older than that of the good prognosis group:(66.52±4.72)years vs.(62.24±3.67)years,the proportion of diabetes in the good prognosis group was higher:72.00%(18/25)vs.25.68%(19/74),the infectious shock group was higher than that of the good prognosis group:60.00%(15/25)vs.16.22%(12/74),and the serum GRP78 and PHB1 levels were higher than those in the good prognosis group:(149.50±31.53)μg/L vs.(116.82±21.13)μg/L,(209.91±19.06)ng/L vs.(178.79±24.51)ng/L,there were statistical differences(P<0.05).The correlation analysis showed that age,diabetes,disease severity,serum GRP78,PHB1 were associated with poor prognosis of emergency sepsis patients(correlation coefficient was 0.428,0.416,0.427,0.511,0.506,P<0.05).Logistic regression analysis showed that serum GRP78,PHB1,age,diabetes and severity could affect the poor prognosis of emergency sepsis patients(P<0.05).ROC curve was drawn,and the results indicated that the area under the curve value of serum GRP78 and PHB1 combined to predict poor prognosis in patients with emergency sepsis was 0.889(95%CI 0.823-0.955),the sensitivity was 96.00%,and the specificity was 66.20%,which was higher than any single index.Conclusions The occurrence of poor prognosis in patients with emergency sepsis is related to the increased expression of serum GRP78 and PHB1.Clinically,the risk of poor prognosis in patients with sepsis can be evaluated in advance by the levels of serum GRP78 and PHB1 detected at admission.
作者
吕攀峰
杨森
马红梅
Lyu Panfeng;Yang Sen;Ma Hongmei(Department of Emergency,Zibo 148 Hospital,Zibo 255300,China)
出处
《中国医师进修杂志》
2025年第6期528-534,共7页
Chinese Journal of Postgraduates of Medicine
