血清淀粉样蛋白A和白细胞介素-6对脓毒症诊断及病情严重程度评估的临床价值

牛凯旋; 吴淑璐; 刘成; 邓晰明

doi:10.16766/j.cnki.issn.1674-4152.002629

血清淀粉样蛋白A和白细胞介素-6对脓毒症诊断及病情严重程度评估的临床价值

doi: 10.16766/j.cnki.issn.1674-4152.002629

蚌埠医学院第一附属医院重症医学科, 安徽蚌埠 233004

基金项目:

安徽省临床重点专科建设项目 2019-54

安徽省高校自然科学研究重点项目 KJ2019A0351

详细信息

通讯作者:
邓晰明, E-mail: bbdxm@163.com

中图分类号: R631 R446
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出版历程
- 收稿日期: 2022-04-05
- 网络出版日期: 2022-11-29

Clinical value of serum amyloid A and interleukin-6 in the diagnosis and severity evaluation of sepsis

Department of Critical Care Medicine, the First Affiliated Hospital of Bengbu Medical College, Bengbu, Anhui 233004, China

摘要

摘要: 目的探究血清淀粉样蛋白A(SAA)、白细胞介素-6(IL-6)对脓毒症诊断及病情严重程度评估的意义。方法选取2020年10月1日—2021年5月31日蚌埠医学院第一附属医院重症医学科的患者80例，观察患者入科24 h内的SAA、IL-6、降钙素原(PCT)、C反应蛋白(CRP)、急性生理学和慢性健康状况评价Ⅱ(APACHEⅡ)评分及序贯性器官功能衰竭估计(SOFA)评分。根据脓毒症诊断标准将80例患者分为非脓毒症组(25例)和脓毒症组(55例)，通过ROC曲线评估SAA、IL-6对脓毒症的诊断效能，利用Spearman分析探究SAA、IL-6与APACHEⅡ评分、SOFA评分的相关性。根据脓毒性休克诊断标准将55例脓毒症患者分为普通脓毒症组(25例)和脓毒性休克组(30例)，评估SAA、IL-6对病情严重程度的判断价值。结果诊断脓毒症的ROC曲线示，IL-6的灵敏度和特异度(94.4%、63.4%)较高；联合应用时, SAA联合PCT的特异度(95.8%)最高；IL-6联合CRP的灵敏度(100.0%)最高。SAA、IL-6与APACHEⅡ评分、SOFA评分均呈正相关。评估病情程度的ROC结果示，SAA单独应用以及IL-6联合PCT的特异度(均为80.0%)最高，SAA联合PCT的灵敏度(96.0%)最高。结论 SAA、IL-6可作为评估脓毒症病情严重程度的有效标志物，IL-6也可以辅助脓毒症的早期诊断，两者与PCT、CRP联合应用后可提高临床价值。
- 脓毒症 /
- 脓毒性休克 /
- 血清淀粉样蛋白A /
- 白细胞介素-6 /
- 早期诊断 /
- 病情严重程度
Abstract: Objective To explore the significance of serum amyloid A (SAA) and interleukin-6 (IL-6) in the diagnosis and severity evaluation of sepsis. Methods A total of 80 patients in the Department of Critical Care Medicine of the First Affiliated Hospital of Bengbu Medical College from October 1, 2020 to May 31, 2021 were selected, and scores of SAA, IL-6, procalcitonin (PCT), C-reactive protein (CRP), APACHE Ⅱ and SOFA were collected within 24 hours from admission. According to the diagnostic criteria of sepsis, 25 cases were divided into the non-sepsis group and 55 cases were divided into the sepsis group. The diagnostic efficacy of SAA and IL-6 in sepsis was evaluated by ROC curve, while the correlation between SAA, IL-6 and APACHE Ⅱ score, SOFA score was explored by Spearman analysis. According to the diagnostic criteria of septic shock, patients with sepsis were divided into the common sepsis group (n=25) and the septic shock group (n=30), and the judgment value of SAA and IL-6 on the severity of the disease was evaluated. Results The ROC curve for the diagnosis of sepsis showed high sensitivity and specificity of IL-6 (94.4%, 63.4%). SAA combined with PCT had the highest specificity (95.8%). IL-6 combined with CRP had the highest sensitivity (100.0%). SAA and IL-6 were positively correlated with APACHE Ⅱ score and SOFA score. The ROC results to assess the severity of the disease showed that the specificity of SAA alone and IL-6 combined with PCT was the highest (both 80.0%), and the sensitivity of SAA combined with PCT was the highest (96.0%). Conclusion SAA and IL-6 can be used as effective markers to evaluate the severity of sepsis, and IL-6 can also assist in the early diagnosis of sepsis. The combination of SAA and IL-6 with PCT and CRP can improve the clinical value.
- Sepsis /
- Septic shock /
- Serum amyloid A /
- Interleukin 6 /
- Early diagnosis /
- Severity of illness

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图 1 SAA、IL-6等单一指标及多指标联合应用诊断脓毒症的ROC曲线

Figure 1. The ROC curve of single and multiple indexes such as SAA and IL-6 in the diagnosis of sepsis

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图 2 SAA、IL-6等单一指标及多指标联合应用评估脓毒症病情严重程度的ROC曲线

Figure 2. ROC curve of SAA, IL-6 and other single indexes and multiple indexes combined to evaluate the severity of sepsis

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表 1 非脓毒症组与脓毒症组患者各项指标比较

Table 1. Comparison of various indexes between the non-sepsis group and the sepsis group

组别	例数	SAA[M(P₂₅, P₇₅)，mL/L]	IL-6[M(P₂₅, P₇₅)，pg/mL]	CRP[M(P₂₅, P₇₅)，mg/L]	PCT[M(P₂₅, P₇₅)，mg/mL]	SOFA评分[M(P₂₅, P₇₅)，分]	APACHE Ⅱ评分(x±s，分)
非脓毒症组	25	100.70(68.89, 200.00)	56.78(43.69, 100.60)	77.50(38.16, 113.40)	0.45(0.31, 1.67)	0	16.48±4.88
脓毒症组	55	200.00(119.80, 200.00)	67.75(34.67, 110.40)	205.40(84.67, 220.60)	9.54(2.32, 20.70)	10.00(4.00, 18.00)	21.47±6.10
统计量		-3.353^a	-4.392^a	-4.550^a	-5.928^a	-8.614^a	4.285^b
P值		＜0.001	＜0.001	＜0.001	＜0.001	＜0.001	＜0.001
注：^a为Z值，^b为t值。

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表 2 SAA、IL-6等单一指标及多指标联合应用诊断脓毒症的能力

Table 2. The ability of SAA, IL-6 and other single indexes and multiple indexes combined in the diagnosis of sepsis

项目	AUC	截断值	灵敏度(%)	特异度(%)	约登指数	95% CI
SAA(mL/L)	0.687	187.350	75.0	63.4	0.384	0.581~0.794
IL-6(pg/mL)	0.761	108.200	94.4	63.4	0.578	0.672~0.849
CRP(mg/L)	0.770	184.210	97.2	56.3	0.536	0.683~0.857
PCT(mg/mL)	0.852	2.175	86.1	80.3	0.664	0.776~0.928
SAA+IL-6	0.779		94.4	69.0	0.635	0.692~0.865
SAA+CRP	0.769		91.7	59.2	0.508	0.681~0.856
IL-6+CRP	0.790		100.0	66.2	0.662	0.706~0.874
PCT+SAA	0.886		66.7	95.8	0.624	0.820~0.952
PCT+IL-6	0.851		91.7	76.1	0.677	0.775~0.927

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表 3 SAA、IL-6与APACHEⅡ评分、SOFA评分的相关性分析

Table 3. Correlation analysis of SAA, IL-6 with APACHEⅡ score and SOFA score

项目	APACHEⅡ评分		SOFA评分
项目	r值	P值	r值	P值
SAA	0.276	0.041	0.342	0.011
IL-6	0.538	＜0.001	0.471	＜0.001

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表 4 普通脓毒症组与脓毒性休克组患者各项指标的比较

Table 4. Comparison of various indexes between general sepsis group and septic shock group

组别	例数	SAA[M(P₂₅, P₇₅)，mL/L]	IL-6[M(P₂₅, P₇₅)，pg/mL]	CRP[M(P₂₅, P₇₅)，mg/L]	PCT[M(P₂₅, P₇₅)，mg/mL]	SOFA评分[M(P₂₅, P₇₅)，分]	APACHEⅡ评分(x±s，分)
普通脓毒症组	25	174.80(81.81, 200.00)	76.00(28.16, 122.15)	110.40(65.93, 214.82)	2.78(0.43, 8.50)	4.00(3.00, 6.50)	17.44±4.92
脓毒性休克组	30	200.00(196.98, 200.00)	275.80(127.40, 457.95)	212.20(131.45, 270.24)	13.11(8.61, 37.56)	16.00(12.00, 20.00)	24.83±4.86
统计值		-2.630^a	-4.177^a	-3.034^a	-4.488^a	-5.584^a	5.585^b
P值		0.009	＜0.001	0.004	＜0.001	＜0.001	＜0.001
注：^a为Z值，^b为t值。

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表 5 SAA、IL-6等单一指标及多指标联合应用评估脓毒症病情严重程度的能力

Table 5. The ability of SAA, IL-6 and other single and multiple indicators combined to evaluate the severity of sepsis

项目	AUC	截断值	灵敏度(%)	特异度(%)	约登指数	95% CI
SAA(mL/L)	0.681	183.150	56.0	80.0	0.360	0.536~0.827
IL-6(pg/mL)	0.829	129.480	80.0	76.7	0.567	0.720~0.938
PCT(mg/mL)	0.854	10.890	92.0	70.0	0.620	0.755~0.953
CRP(mg/L)	0.705	194.825	68.0	70.0	0.380	0.568~0.842
SAA+IL-6	0.864		88.0	76.7	0.647	0.765~0.963
SAA+PCT	0.867		96.0	66.7	0.627	0.768~0.965
IL-6+PCT	0.895		92.0	80.0	0.720	0.807~0.982
SAA+CRP	0.759		84.0	63.3	0.473	0.631~0.886
IL-6+CRP	0.836		80.0	76.7	0.567	0.731~0.941

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