血清LXA4联合MMP-9预测脓毒症患者发生多器官功能障碍综合征的临床研究

摘要 目的：探讨血清脂氧素A4（LXA4）联合基质金属蛋白酶-9（MMP-9）对脓毒症患者发生多器官功能障碍综合征（MODS）的预测价值。方法：选择2020年1月-2023年1月期间中国人民解放军空军军医大学第二附属医院接受治疗的140例脓毒症患者作为研究对象。根据患者入院28 d内是否发生MODS将其分为MODS组（n=41）和非MODS组（n=99）。检测并对比两组血清LXA4、MMP-9水平。采用单因素及多因素Logistic回归模型分析脓毒症患者发生MODS的影响因素。采用受试者工作特征（ROC）曲线分析血清LXA4、MMP-9对脓毒症患者发生MODS的预测价值。结果：本次纳入的140例脓毒症患者，入院28 d内共有41例发生MODS，发生率为29.29%（41/140）。MODS组血清LXA4水平低于非MODS组，MMP-9水平高于非MODS组（P<0.05）。单因素分析结果显示：脓毒症患者发生MODS与合并高血压、脓毒症病程、存在休克、年龄、合并糖尿病、存在细菌感染、APACHE II评分、疾病严重程度、SOFA评分、存在低血钙、PCT有关（P<0.05）。多因素Logistic回归分析结果显示：年龄偏大、MMP-9偏高、脓毒症病程偏长、LXA4偏低、APACHE II评分偏高、PCT偏高、SOFA评分偏高、存在休克、合并糖尿病、存在低血钙、合并高血压、疾病严重程度为危重、存在细菌感染均是脓毒症患者发生MODS的危险因素（P<0.05）。血清LXA4、MMP-9单独及联合检测预测脓毒症患者发生MODS的曲线下面积（AUC）分别为0.815、0.821和0.898，联合检测的效能优于单独检测。结论：脓毒症并发MODS患者血清LXA4下降，MMP-9升高，二者联合检测对脓毒症并发MODS中具有较好的预测价值。年龄、休克、脓毒症病程、低血钙、APACHE II评分、疾病严重程度、SOFA评分、细菌感染、合并糖尿病、PCT、LXA4、MMP-9、合并高血压均是脓毒症患者发生MODS的影响因素。

Clinical Study of Serum LXA4 Combined with MMP-9 in Predicting Multiple Organ Dysfunction Syndrome in Patients with Sepsis

ABSTRACT Objective: To investigate the predictive value of serum lipoxin A4 (LXA4) combined with matrix metalloproteinase-9 (MMP-9) on multiple organ dysfunction syndrome (MODS) in patients with sepsis. Methods: 140 patients with sepsis who were treated in The Second Affiliated Hospital of Air Force Medical University of PLA from January 2020 to January 2023 were selected as study subjects. The patients were divided into MODS group (n=41) and non MODS group (n=99) according to whether MODS occurred within 28 days after admission. The levels of serum LXA4 and MMP-9 were detected and compared between two groups. The influencing factors of MODS in patients with sepsis were analyzed by univariate and multivariate Logistic regression models. The predictive value of serum LXA4 and MMP-9 for MODS in patients with sepsis were analyzed by receiver operating characteristic (ROC) curve. Results: Among the 140 patients with sepsis included in this study, 41 patients developed MODS within 28 days of admission, with an incidence of 29.29% (41/140). The serum LXA4 level in MODS group was lower than that in non MODS group, and the serum MMP-9 level was higher than that in non MODS group(P<0.05). The results of univariate analysis showed that: MODS in patients with sepsis was related to complicated hypertension, sepsis course, shock, age, diabetes, bacterial infection, APACHE II score, disease severity, SOFA score, hypocalcemia, PCT(P<0.05). Multivariate Logistic regression analysis showed that, older, higher MMP-9, longer duration of sepsis, lower LXA4, higher APACHE II score, higher PCT, higher SOFA score, shock, diabetes, hypocalcemia, hypertension, critical disease, bacterial infection were risk factors for MODS in patients with sepsis (P<0.05). The area under the curve (AUC) of serum LXA4, MMP-9 alone and combined detection in predicting MODS in patients with sepsis was 0.815, 0.821 and 0.898 respectively, and the efficacy of combined detection was better than that of single detection. Conclusion: The serum LXA4 decrease and MMP-9 increase in MODS patients with sepsis, the combine detection of the two has a good predictive value for sepsis complicate with MODS. Age, shock, sepsis course, hypocalcemia, APACHE II score, disease severity, SOFA score, bacterial infection, diabetes, PCT, LXA4, MMP-9, hypertension are influencing factors of MODS in patients with sepsis.