中国医院用药评价与分析2024，Vol.24Issue(6) ：705-708,713.DOI:10.14009/j.issn.1672-2124.2024.06.015

乌司他丁辅助治疗的脓毒症患者HLE、mCD14水平变化及早期检测HLE、mCD14水平对治疗反应性的评估价值

Changes of HLE and mCD14 Levels in Patients with Sepsis Receiving Adjuvant Treatment of Ulinastatin and Value of Early Detection of HLE and mCD14 Levels in Treatment Responsiveness

曾聪慧 师艳艳 谢志军 高亚敏 于丹丹
中国医院用药评价与分析2024，Vol.24Issue(6) ：705-708,713.DOI:10.14009/j.issn.1672-2124.2024.06.015
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  • NSTL
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乌司他丁辅助治疗的脓毒症患者HLE、mCD14水平变化及早期检测HLE、mCD14水平对治疗反应性的评估价值

Changes of HLE and mCD14 Levels in Patients with Sepsis Receiving Adjuvant Treatment of Ulinastatin and Value of Early Detection of HLE and mCD14 Levels in Treatment Responsiveness

曾聪慧 1师艳艳 1谢志军 1高亚敏 1于丹丹1
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作者信息

  • 1. 喀什地区第一人民医院药学部,新疆 喀什 844000
  • 折叠

摘要

目的:探讨乌司他丁辅助治疗脓毒症时,患者血人白细胞弹性蛋白酶(HLE)、单核细胞表面脂多糖受体(mCD14)水平变化,以及早期检测血HLE、mCD14 水平对治疗反应性的评估价值.方法:选取 2020-2022 年该院脓毒症患者 196 例,均在经典常规治疗方案基础上加用乌司他丁治疗,根据治疗效果分为反应良好组(38 例)、反应差组(158 例).治疗前后检测两组患者血HLE、mCD14 水平.通过电子病历系统收集患者资料,根据最邻近匹配法对两组进行1∶1匹配.分析乌司他丁辅助治疗脓毒症患者的治疗反应性影响因素并建立预测模型,通过受试者工作特征曲线(ROC曲线)分析早期检测血HLE、mCD14 水平对治疗反应性的评估价值.结果:两组患者治疗后的血HLE水平低于治疗前,mCD14 水平高于治疗前,差异均有统计学意义(P<0.05).反应差组患者倾向性评分匹配后的严重程度和治疗前后降钙素原(PCT)水平、C反应蛋白(CRP)水平、HLE水平高于反应良好组,治疗前后mCD14 水平低于反应良好组,差异均有统计学意义(P<0.05).对于乌司他丁辅助治疗脓毒症患者,严重程度和治疗前PCT、CRP、HLE水平是治疗反应性的危险因素,治疗前mCD14 水平是治疗反应性的保护因素(P<0.05);建立联合预测模型,P=1/[1+1/exp(0.826×严重程度+0.941×治疗前PCT水平+0.694×治疗前CRP 水平+1.112×治疗前HLE水平-0.963×治疗前mCD14 水平-3.968)],有较好的校准能力;治疗前HLE、mCD14 水平预测治疗反应性的药时曲线下面积(AUC)分别为 0.777、0.779,而联合预测模型预测治疗反应性的AUC为 0.947,高于HLE、mCD14 单独评估的AUC,差异有统计学意义(P<0.05).结论:采用乌司他丁辅助治疗脓毒症,患者血HLE水平降低,mCD14 水平升高;血HLE水平降低、mCD14 水平升高与治疗反应性密切相关,联合检测可进一步提升预测价值.

Abstract

OBJECTIVE:To probe into the changes of human leukocyte elastase(HLE)and monocyte-surface lipopolysaccharide receptor(mCD14)levels in patients with sepsis receiving adjuvant treatment of ulinastatin,and the value of early detection of serum HLE and mCD14 levels in treatment responsiveness.METHODS:A total of 196 patients with sepsis admitted into this hospital from 2020 to 2022 were selected and given ulinastatin based on classical conventional therapeutic regimen,which were divided into good-response group(38 cases)and poor-response group(158 cases)according to different therapeutic effect.The serum HLE and mCD14 levels of two groups were detected before and after treatment.Clinical data were collected by the electronic medical record system,and both groups were matched 1∶1 according to the nearest matching method.Influencing factors of treatment responsiveness of ulinastatin in adjuvant treatment of sepsis were analyzed and the predictive model was established,the value of early detection of serum HLE and mCD14 levels in treatment responsiveness was analyzed by receiver operating characteristic(ROC)curve.RESULTS:The serum HLE level was lower and the mCD14 level was higher in both groups after treatment than those before treatment,with statistically significant differences(P<0.05).The severity in the poor-response group after propensity score matching,procalcitonin(PCT),C-reactive protein(CRP)and HLE levels in the poor-response group before and after treatment were higher than those in the good-response group,while the mCD14 level in the poor-response group before and after treatment was lower than that in the good-response group,with statistically significant differences(P<0.05).The severity,PCT,CRP and HLE levels before treatment were the risk factors of treatment responsiveness of ulinastatin for the adjuvant treatment of sepsis patients,and the mCD14 level before treatment was a protective factor for the treatment responsiveness(P<0.05);a joint prediction model was established,P=1/[1+1/exp(0.826×severity+0.941×PCT before treatment+0.694×CRP before treatment+1.112×HLE before treatment-0.963×mCD14 before treatment-3.968)],with good calibration ability;the drug-time area under the curve(AUC)for the prediction of treatment responsiveness by the HLE and mCD14 levels before treatment was respectively 0.777 and 0.779,while the AUC for the prediction of treatment responsiveness by the combined prediction model was 0.947,which was higher than the AUC for HLE and mCD14 assessed individually,with statistically significant differences(P<0.05).CONCLUSIONS:The application of ulinastatin in the adjuvant treatment of sepsis can decrease the serum HLE level and elevate mCD14 level,the decrease in blood HLE levels and the increase in mCD14 levels are closely related to treatment response,and the combined detection of these markers can further enhance their predictive value.

关键词

脓毒症/乌司他丁/人白细胞弹性蛋白酶/单核细胞表面脂多糖受体

Key words

Sepsis/Ulinastatin/Human leucocyte elastase/Monocyte-surface lipopolysaccharide receptor

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基金项目

新疆维吾尔自治区药学会科研基金资助项目(YXH202213)

出版年

2024
中国医院用药评价与分析
中国医药生物技术协会，中国药房杂志社

中国医院用药评价与分析

CSTPCD
影响因子：1.142
ISSN：1672-2124
参考文献量8
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