摘要
目的探讨血浆焦孔素D C-末端片段(GSDMD-CT)作为新的血浆标志物在脓毒症早期诊断中的价值。方法收集2021年7月至2024年11月唐山市工人医院住院的患者样本245例,根据脓毒症、全身炎症反应综合征的诊断标准将患者分为脓毒症组(Sepsis组)、全身炎症反应综合征组(SIRS组),收集同期健康体检者样本作为健康对照组(HC组)。Sepsis组根据病原学感染类型进一步分为革兰阳性细菌亚组(Gram-positive组)、革兰阴性细菌亚组(Gram-negative组)、真菌亚组(Fungal组)。所有研究对象均进行GSDMD-CT、C-反应蛋白(CRP)、降钙素原(PCT)水平检测。利用非参数检验比较不同组间各指标的差异,通过绘制受试者工作特征(ROC)曲线,评价血浆GSDMD-CT对脓毒症的早期诊断价值,采用Spearman相关性分析患者血浆GSDMD-CT与CRP、PCT表达水平的相关性。结果血浆GSDMD-CT水平Sepsis组23.02(16.71,33.01)pg/mL、SIRS组16.52(11.26,22.22)pg/mL显著高于HC组7.02(4.42,11.43)pg/mL(U=-10.175、-7.890,P<0.001),Sepsis组GSDMD-CT水平高于SIRS组,差异有统计学意义(U=-2.941,P<0.05)。Gram-positive组、Gram-negative组、Fungal组血浆GSDMD-CT水平分别为23.01(17.16,27.51)pg/mL、23.41(16.78,35.50)pg/mL、16.29(14.53,56.27)pg/mL,3个亚组与HC组相比GSDMD-CT水平升高(P<0.05),而3个亚组之间GSDMD-CT水平差异无统计学意义(P>0.05)。血浆GSDMD-CT诊断脓毒症曲线下面积(AUC)为0.881(95%CI:0.833~0.929),约登指数(YI)0.695,敏感度(sensitivity)、特异度(specificity)分别为85.0%、84.5%。采用Spearman相关性分析GSDMD-CT与CRP、PCT表达水平的相关性,发现GSDMD-CT与CRP的表达呈弱相关(r=0.32,P<0.001),与PCT的表达呈正相关(r=0.65,P<0.001)。结论血浆GSDMD-CT在脓毒症中具有一定的诊断价值,其有可能成为脓毒症早期诊断的一个新的生物标志物。
Objective To assess the effectiveness of the Gasdermin D C-terminal fragment(GSDMD-CT)as a novel plasma biomarker for the clinical diagnosis of sepsis.Methods Between July 2021 and November 2024,245 patients from Tangshan Gongren Hospital were enrolled in this study.In accordance with the diagnostic criteria for sepsis and the systemic inflammatory response syndrome(SIRS),patient samples were classified into the sepsis group and the SIRS group.Meanwhile,healthy individuals were selected as the healthy control(HC)group.Sepsis patients were further categorized into the Gram-positive bacterial group,the Gram-negative bacterial group,and the fungal group based on the type of pathogen infection.The levels of GSDMD-CT,C-reactive protein(CRP),and procalcitonin(PCT)were measured in all subjects.Nonparametric tests were employed to compare the differences in various indices among different groups.The diagnostic value of GSDMD-CT in sepsis was evalu⁃ated by constructing the receiver operating characteristic(ROC)curve.Spearman's correlation analysis was used to examine the relationships among GSDMD-CT,CRP,and PCT.Results The plasma GSDMD-CT levels in the sepsis group 23.02(16.71,33.01)pg/mL and in the SIRS group 16.52(11.26,22.22)pg/mL were significantly higher than those in the healthy control group 7.02(4.42,11.43)pg/mL(U=-10.175,-7.890,P<0.001).Moreover,the plasma GSDMD-CT levels in the sepsis group were significantly higher than those in the SIRS group(U=-2.941,P<0.05).In the Gram-positive bacterial group,the Gram-negative bacterial group,and the fungal group,the GSDMD-CT levels were 23.01(17.16,27.51)pg/mL,23.41(16.78,35.50)pg/mL,and 16.29(14.53,56.27)pg/mL,respectively.When compared with the healthy control group,the GSDMD-CT levels in these three groups were all significantly higher(P<0.05).However,there were no significant differences in GSDMD-CT levels among these three groups(P>0.05).The area under the curve(AUC)of plasma GSDMD-CT for diagnosing sepsis was 0.881(95%confidence interval:0.833~0.929),with a Youden index(YI)of 0.695,a sensitivity of 85.0%,and a specificity of 84.5%.Spearman correlation analysis indicated a weak correlation between GSDMD-CT and C-reactive protein(CRP)(r=0.32,P<0.001)and a positive correlation between GSDMD-CT and procalci⁃tonin(PCT)(r=0.65,P<0.001).Conclusion GSDMD-CT exhibits significant clinical value in the diagnosis of sepsis and holds great potential as a biomarker in the diagnostic process of sepsis.
作者
吕月贤
毕秀
刘颖
崔淑静
赵立新
高歌
王建霞
李娟
李军
LYU Yuexian;BI Xiu;LIU Ying;CUI Shujing;ZHAO Lixin;GAO Ge;WANG Jianxia;LI Juan;LI Jun(Department of Clinical Laboratory,Tangshan Gongren Hospital,Tangshan 064300,Hebei,China;不详)
出处
《实用医学杂志》
北大核心
2025年第12期1899-1906,共8页
The Journal of Practical Medicine
基金
河北省重点研发计划项目(编号:22377727D)
河北省自然科学基金项目(编号:H2022105001)。
