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| PTX-3对肾综合征出血热患者疾病严重程度及预后的预测价值研究 |
| Predictive value of PTX-3 on disease severity and prognosis in patients with hemorrhagic fever with renal syndrome |
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| DOI：10.3969/j.issn.1007-8134.2020.03.005 |
| 中文关键词: 肾综合征出血热 正五聚素-3 早期预警 预后 |
| 英文关键词: hemorrhagic fever with renal syndrome pentraxin-3 early prediction and warning prognosis |
| 基金项目:“十三五”国家科技重大专项（2017ZX10204401）；陕西省自然科学基金一般面上项目（2018JM7103）；唐都医院科技创新发展基金面上项目（2016JCYJ001） |
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| 中文摘要: |
| 目的 分析肾综合征出血热（hemorrhagic fever with renal syndrome, HFRS）患者血浆正五聚素-3（pentraxin-3, PTX-3）的水平变化，探讨其对HFRS病情严重程度及预后的预测价值。方法 随机纳入105例2012年10月—2014年12月空军军医大学第二附属医院传染科收治的HFRS患者，依据HFRS临床分型标准，将纳入患者分为轻型、中型、重型和危重型4组。采集患者急性期静脉血标本96份，恢复期65份，同时采集27名健康志愿者静脉血标本作为对照，分离血浆，应用ELISA法检测PTX-3水平。分析PTX-3水平在不同分型患者急性期及恢复期的表达变化，以及与对照组的差异，评估其在重症HFRS早期预警中的价值；分析急性期PTX-3与常规实验室指标及预后的相关性，采用ROC曲线评估急性期PTX-3水平对HFRS患者预后（死亡）的预测价值。结果 105例患者中，轻型17例、中型27例、重型26例、危重型35例。各型患者及对照组之间性别、年龄比较，差异均无统计学意义（P均＞0.05）。各型患者急性期血浆PTX-3水平均显著高于同型恢复期和对照组（P均＜0.05），危重型患者急性期PTX-3水平显著高于其他分型（P均＜0.05）。患者急性期PTX-3水平与WBC、AST、APTT呈正相关，与PLT、ALB、血浆纤维蛋白原水平呈负相关（|rs|＞0.500，P＜0.05）。ROC曲线分析急性期PTX-3水平对HFRS患者预后（死亡）的预测价值，AUC为0.753（95%CI：0.593～0.914，P=0.003）。结论 PTX-3可作为重症HFRS的早期预警指标，其有助于评估HFRS疾病严重程度及预测患者预后。 |
| 英文摘要: |
| Objective To analyze the changes of plasma pentraxin-3 (PTX-3) in patients with hemorrhagic fever with renal syndrome (HFRS) prospectively and evaluate its predictive value on HFRS disease severity and prognosis. Methods One hundred and five patients with HFRS who were treated at Department of Infectious Diseases in the Second Affiliated Hospital of Air Force Medical University from October 2012 to December 2014 were randomly enrolled in this study. The enrolled patients were divided into a mild-type group, a moderate-type group, a severe-type group and a critical-type group according to the criteria for HFRS clinical typing. Ninety-six venous blood samples at acute stage and 65 venous blood samples at convalescent stage were collected from patients, while venous blood samples of 27 healthy volunteers were taken as controls. The plasma was separated and the plasma levels of PTX-3 were detected using enzyme linked immunosorbent assay (ELISA). The value of PTX-3 in early prediction and warning of severe HFRS was evaluated by analyzing the concentrations of PTX-3 at the acute and convalescent stages in different types of patients, as well as comparing with control group. The correlation of PTX-3 at acute stage with conventional laboratory parameters and prognosis was analyzed. The predictive value of PTX-3 level at acute stage on the prognosis (death) of HFRS patients was evaluated by using ROC curve. Results Among the enrolled 105 patients, there were 17 mild cases, 27 moderate cases, 26 severe cases and 35 critical cases. There was no significant difference in the gender and age among all types of patients and control group (P＞0.05). In all types of patients, the plasma levels of PTX-3 at the acute stage were significantly higher than those of healthy control group and at the convalescent stage of same type (P＜0.05). The levels of PTX-3 at acute stage significantly increased in the critical patients as compared with patients of other types (P＜0.05). At the acute stage, PTX-3 was positively correlated with WBC, AST and APTT, and negatively correlated with PLT, ALB and fibrinogen (|rs|＞0.500, P＜0.05). ROC curve analysis was performed to explore the predictive value of PTX-3 at acute stage on the prognosis (death) of HFRS patients, with the AUC of 0.753 (95%CI: 0.593～0.914, P=0.003). Conclusions PTX-3 can be used as an indicator of early prediction and warning of severe HFRS. It is beneficial to evaluate the disease severity and predict the prognosis of patients with HFRS. |
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