HCT-ALB在脓毒症相关性脑病早期诊断中的运用价值

李从信; 张大鹏; 沐领捷; 杨吉林; 董丽宏; 王怡洁

doi:10.12259/j.issn.2095-610X.S20220901

HCT-ALB在脓毒症相关性脑病早期诊断中的运用价值

doi: 10.12259/j.issn.2095-610X.S20220901

1.
昆明医科大学第一附属医院ICU，云南昆明　650032
2.
昆明美兆健康体检中心，云南昆明　650032

基金项目: 中华国际医学交流基金会心血管多学科整合思维研究基金资助项目（Z-2016-23-2001-42）；国家自然科学基金资助项目（81960109）；云南省科技厅—昆明医科大学应用基础研究联合专项基金资助项目（202001AY070001-205）

详细信息

作者简介:
李从信（1997～），男，云南玉溪人，在读硕士研究生，主要从事重症消化系统疾病及多器官功能保护临床工作

张大鹏与李从信对本文有同等贡献

通讯作者:
王怡洁，E-mail：81543505@qq.com

中图分类号: R446.1
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出版历程
- 收稿日期: 2022-07-26
- 网络出版日期: 2022-09-07
- 刊出日期: 2022-09-29

The Value of HCT-ALB in the Early Diagnosis of Sepsis-associated Encephalopathy

1.
Dept. of ICU，The 1st Affiliated Hospital of Kunming Medical University，Kunming Yunnan, 650032
2.
Kunming Meizhao Health Examination Center，Kunming Yunnan 650032，China

摘要

摘要: 目的寻找简便且可靠的临床定量指标对SAE进行早期诊断是防治SAE的关键。方法收集2020年4月至2022年4月入住ICU脓毒症患者72例，脓毒症脑病（SAE）组31例，无脓毒症脑病（Ne-SAE）组41例。记录患者APACHEⅡ、SOFA、一般资料和临床指标计算CLI、HCT-ALB。采集血浆用ELISA检测NT-proCNP、S100A 8、Tau 蛋白、C5a。结果 SAE组APACHEⅡ评分、SOFA评分较Ne-SAE组明显升高（P < 0.0001），血浆中NT-proCNP和S100A 8较Ne-SAE组明显升高（P < 0.05）。SAE组与Ne-SAE组患者CLI差异无统计学意义（P = 0.823），而2组间HCT-ALB有统计学意义（P = 0.035）。ROC曲线分析结果显示：CLI界值11.04，（AUC = 0.478，95%可信区间0.340～0.616，P = 0.746）敏感度46.34%，特异度80.65%，HCT-ALB界值14.85，（AUC = 0.627，95%可信区间0.491～0.762，P = 0.017）敏感度68.27%，特异度67.74%。结论 HCT-ALB对脓毒症患者发生SAE具有早期诊断价值。
- 脓毒症相关性脑病 /
- 毛细血管渗漏指数 /
- 红细胞压积与白蛋白差值 /
- 早期诊断
Abstract: Objective To find simple and reliable clinical quantitative indicators for the early diagnosis of SAE. Methods Seventy-two septic patients who were admitted to ICU from April 2020 to April 2022, including 31 with sepsis encephalopathy （SAE） and 41 without sepsis encephalopathy （Ne-SAE）, were collected. APACHE Ⅱ, SOFA and general data of Patients were recorded, and CLI, HCT-ALB were calculated based on the clinical assays. Plasma was collected using ELISA to detect NT-proCNP, S100A 8, Tau protein and C5a. Results APACHEⅡscore and SOFA score in SAE group were significantly higher compared with the patients in Ne-SAE group （P < 0.05）. Plasma NT-proCNP and S100A8 levels were significantly higher in the patients with SAE than that of the Ne-SAE group （P < 0.05）. There was no significant difference in CLI between SAE group and NE-SAE group. （P = 0.823）. But , the hct-alb was statistically significant between the two groups （P = 0.035）. The roc curve analysis showed: A cutoff value CLI of 11.04 （AUC = 0.478,95% CI 0.340-0.616, P = 0.746） had 46.34% sensitivity and 80.65% specificity in diagnosing SAE. A cutoff value HCT-ALB of 14.85 （AUC = 0.627,95% CI 0.491-0.762, P = 0.017） had 68.27% sensitivity and 67.74% specificity in diagnosing SAE. Conclusion The HCT-ALB level can be useful in the early diagnosis of SAE in patients with sepsis.
- Sepsis-associated encephalopathy /
- Capillary leakage index /
- The difference of hematocrit and plasma albumin （HCT-ALB） andearly diagnosis /

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Figure 1. A ROC curve graph about SAE diagnostic by CLI and HCT-ALB

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表 1 SAE组与Ne-SAE组患者一般资料比较（$\bar x \pm s $）

Table 1. The comparison of general data between SAE group and Ne-SAE group （$\bar x \pm s $）

一般资料	SAE组	Ne-SAE组	t/χ²	P
（男/女）n（%）	21/10 （67.7/32.3）	28/13（68.3/31.7）	0.002	0.580
年龄（岁）	58.29 ± 12.20	61.41 ± 11.18	−1.129	0.263
APACHEⅡ评分（分）	17.74 ± 2.00	14.78 ± 2.39	5.573	< 0.0001^***
SOFA评分（分）	7.42 ± 2.62	4.63 ± 2.03	5.083	< 0.0001^***
感染部位（n）			0.271	0.873
腹腔	18	26
下颌间隙	9	11
肺部	4	4
病原菌检出（n）			0.072	0.513
有	25	27
无	6	9
^P < 0.05，^P < 0.01，^**P < 0.001。

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表 2 SAE组与Ne-SAE组患者血浆NT-proCNP、S100A 8、C5a和Tau蛋白比较[（$\bar x \pm s $），pg/mL]

Table 2. The comparison of the levels of NT-proCNP, S100A 8, C5a, and Tau proteins between SAE group and Ne-SAE group [（$\bar x \pm s $），pg/mL]

指标	SAE组	Ne-SAE组	t	P
NT-proCNP	1.01 ± 0.19	0.76 ± 0.06	4.162	0.0005^***
S100A 8	1.06 ± 0.22	0.80 ± 0.23	2.760	0.012^*
Tau蛋白	1.03 ± 0.33	0.88 ± 0.25	1.162	0.259
C5a	0.20 ± 0.07	0.16 ± 0.04	1.494	0.151
^P < 0.05，^**P < 0.001。

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表 3 SAE组与Ne-SAE组患者CLI和HCT-ALB比较（$\bar x \pm s $）

Table 3. The comparison of the levels of CLI and HCT-ALB between SAE group and Ne-SAE group （$\bar x \pm s $）

指标	SAE组	Ne-SAE组	t	P
CLI	7.66 ± 3.94	7.02 ± 3.28	−0.224	0.823
HCT-ALB	17.45 ± 6.96	12.76 ± 4.72	2.155	0.035^*
^*P < 0.05。

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表 4 CLI和HCT-ALB对SAE诊断ROC分析结果

Table 4. The results of ROC analysis about SAE diagnostic by CLI and HCT-ALB

指标	界值	AUC	95%可信区间	敏感度（%）	特异度（%）
CLI	11.04	0.478	0.340～0.616	46.34	80.65
HCT-ALB	14.85	0.627	0.491～0.762	68.27	67.74

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