血清claudin-4水平在脓毒症患者中的变化及意义

发布时间：2018-07-09 18:13

  本文选题：claudin-4 + 降钙素原　； 参考：《宁夏医科大学》2016年硕士论文

【摘要】：目的探讨脓毒症患者血清中claudin-4水平的变化及其意义。资料与方法采用前瞻性研究方法,根据美国胸科医师协会/危重病医学会(ACCP/SCCM)对脓毒症定义的标准,选择对2015年6月至2015年12月收住宁夏医科大学总医院ICU的患者入科时分组,分为全身严重反应综合征组(SIRS,21例)、脓毒症组(24例)、严重脓毒症组(19例)、脓毒性休克组(20例)四组。选择同期22例健康体检者作为对照组。对所有研究对象入科24小时内进行急性生理学与慢性健康状况评分系统Ⅱ(APACHEⅡ)和SOFA评分,并留取静脉血采用酶联免疫吸附实试验(ELISA)检测血清中claudin-4水平,进行相关实验室检查。采用两组独立样本t检验,分析脓毒症患者中死亡组与存活组及MODS组与非MODS组患者血清claudin-4水平的差异;采用Speraman相关分析法分析claudin-4与APACHEⅡ和SOFA评分、PCT、Lac的相关性;采用受试者工作特征曲线(ROC)比较claudin-4、APACHEII评分、降钙素原、SOFA评分、乳酸对脓毒症的诊断价值。结果血清claudin-4水平在健康对照组低于试验组(P0.05),随着病情逐渐加重,claudin-4水平在SIRS组、脓毒症组、严重脓毒症组、脓毒性休克组逐渐升高,且组间比较差异均有统计学意义(p0.05)。两组独立样本t检验示:存活组与死亡组及MODS组与非MODS组中血清claudin-4水平均有显著性差异(均P0.01)。ROC曲线分析显示:claudin-4的ROC曲线下面积(AUC)为0.879(P0.01),截断值为67.6pg/ml,敏感度69.8%,特异度90.5%,阳性预测值95%,阴性预测值48.7%。Speraman相关分析结果显示:claudin-4与APACHEⅡ、SOFA评分及Lac水平均呈显著正相关(r1=0.57,r2=0.51,r3=0.54,均P0.01)。结论血清claudin-4水平可以评估脓毒症病情严重程度并可能作为脓毒症的早期诊断和预后的重要标志物。
[Abstract]:Objective to investigate the changes and significance of serum claudin-4 level in sepsis patients. Materials and methods according to the criteria for the definition of sepsis by the American Association of chest Physicians / Association of critically ill Medicine (ACCPP / SCCM), prospective study methods were used to select a group of patients admitted to ICU of Ningxia Medical University General Hospital from June 2015 to December 2015. The patients were divided into four groups: systemic severe response syndrome (SIRSN) group (n = 21), sepsis group (n = 24), severe sepsis group (n = 19) and septic shock group (n = 20). 22 healthy persons were selected as control group. Acute physiology and chronic health status scoring system 鈪，

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