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目的:观察感染性休克患者中趋化因子血清CXCL-12水平变化及评估患者预后的临床价值。方法:82例感染性休克患者分为无功能障碍组(无多器官功能障碍,n=58)和功能障碍组(有多器官功能障碍综合征,n=24),同期健康体检者50例作为对照组,采用酶联免疫吸附法(ELISA)检测感染性休克组入ICU时和对照组体检时的血清CXCL-12水平;感染性休克患者入ICU时进行APACHEⅡ评分,比较两组患者病死率,比较存活患者和死亡患者血清CXCL-12水平和APACHEⅡ评分;采用Spearman法分析患者血清CXCL-12水平与APACHEⅡ的相关性,采用多变量Logistic回归分析感染性休克死亡的危险因素,采用工作特征曲线(ROC)分析血清CXCL-12评估感染性休克患者预后的临床价值。结果:感染性休克无功能障碍组和功能障碍组患者血清CXCL-12水平均高于对照组(P<0.05),功能障碍组高于无功能障碍组(P<0.05),无功能障碍组患者APACHEⅡ评分和病死率均明显低于功能障碍组(P<0.05);感染性休克患者血清CXCL-12水平与APACHEⅡ评分呈明显正相关(r=0.751,P<0.01),存活患者的CXCL-12水平和APACHEⅡ评分明显低于死亡患者(P<0.01);多变量Logistic回归分析结果表明CXCL-12水平和APACHEⅡ评分是感染性休克预后差的独立危险因素(P<0.05),ROC曲线下面积为0.913(P<0.001,95%CI=0.880~0.963),敏感度为0.832,特异度为0.811,约登指数0.643。结论:血清CXCL-12水平与感染性休克患者的发病进程密切相关,可评估病情的严重程度及预后。
Objective: To observe the changes of chemokine serum CXCL-12 in patients with septic shock and evaluate the clinical value of the prognosis. Methods: Seventy-two septic shock patients were divided into four groups: non-dysfunction group (without multiple organ dysfunction, n = 58) and dysfunction group (multiple organ dysfunction syndrome, n = 24) In the control group, the level of serum CXCL-12 was measured by enzyme-linked immunosorbent assay (ELISA) when the septic shock was included in the ICU and in the control group. APACHEⅡscore was performed when the septic shock was admitted to the ICU. The mortality, The serum levels of CXCL-12 and APACHEⅡwere compared between survivors and death patients. Spearman's method was used to analyze the correlation between serum CXCL-12level and APACHEⅡ. Multivariate Logistic regression was used to analyze the risk factors of septic shock death. ROC) to analyze the clinical value of serum CXCL-12 in assessing the prognosis of patients with septic shock. Results: The levels of serum CXCL-12 in septic shock patients with dysfunction group and dysfunction group were higher than those in control group (P <0.05), those with dysfunction group were higher than those without dysfunction group (P <0.05), no dysfunction APACHEⅡscore and fatality rate were significantly lower than those in dysfunction group (P <0.05). Serum levels of CXCL-12 in septic shock were positively correlated with APACHEⅡscore (r = 0.751, P <0.01), and CXCL (P <0.01). Multivariate Logistic regression analysis showed that the CXCL-12 level and APACHEⅡ score were independent risk factors for the poor prognosis of septic shock (P <0.05). Under the ROC curve The area was 0.913 (P & lt; 0.001, 95% CI = 0.880-0.963) with a sensitivity of 0.832, a specificity of 0.811 and a Youden index of 0.643. Conclusion: The level of serum CXCL-12 is closely related to the pathogenesis of septic shock, and the severity and prognosis of the patients can be evaluated.