Value of cerebral hypoxic-ischemic injury markers in the early diagnosis of sepsis associated encephalopathy in burn patients with sepsis
-
摘要:
目的 探讨脑缺血缺氧性损伤标志物在烧伤脓毒症患者脓毒症相关性脑病（SAE）早期诊断中的价值。 方法 采用回顾性病例系列研究方法。2018年10月—2021年5月，郑州市第一人民医院收治41例符合入选标准的烧伤脓毒症患者，其中男23例、女18例，年龄18~65（35±3）岁。按住院期间是否发生SAE，将患者分为SAE组（21例）及非SAE组（20例）。比较2组患者性别、年龄、深Ⅱ度烧伤面积、Ⅲ度烧伤面积、急性生理学和慢性健康状况评价Ⅱ（APACHE Ⅱ）评分。统计2组患者脓毒症确诊后（以下简称确诊后）12、24、48 h的血清中枢神经特异蛋白S100β、神经元特异性烯醇化酶（NSE）水平，确诊后12、24、48、72、120、168 h血清白细胞介素6（IL-6）、IL-10、肿瘤坏死因子α（TNF-α）、Tau蛋白、促肾上腺皮质激素（ACTH）、皮质醇水平，确诊后1、3、7 d大脑中动脉平均血液流速（VmMCA）、搏动指数、脑血流指数（CBFi）。对数据行 χ 2检验、重复测量方差分析、独立样本 t检验及Bonferroni校正，行多因素logistic回归分析筛选预测SAE发生的自变量，绘制预测烧伤脓毒症患者发生SAE的受试者操作特征（ROC）曲线，计算曲线下面积（AUC）和最佳阈值及最佳阈值下的敏感度、特异度。 结果 2组患者性别、年龄、深Ⅱ度烧伤面积、Ⅲ度烧伤面积、APACHE Ⅱ评分均相近（ χ 2=0.02， t值分别为0.71、1.59、0.91、1.07， P>0.05）。确诊后12、24、48 h，SAE组患者血清S100β、NSE水平均明显高于非SAE组（ t值分别为37.74、77.84、44.16，22.51、38.76、29.31， P<0.01）。确诊后12、24、48、72、120、168 h，SAE组患者血清IL-10、Tau蛋白、ACTH水平均明显高于非SAE组（ t值分别为10.68、13.50、10.59、8.09、7.17、4.71，5.51、3.20、3.61、3.58、3.28、4.21，5.91、5.66、4.98、4.69、4.78、2.97， P<0.01）；确诊后12、24、48、72、120 h，SAE组患者血清IL-6、TNF-α水平均明显高于非SAE组（ t值分别为8.56、7.32、2.08、2.53、3.37，4.44、5.36、5.35、6.85、5.15， P<0.05或 P<0.01）；确诊后12、24、48 h，SAE组患者血清皮质醇水平均明显高于非SAE组（ t值分别为5.44、5.46、3.55， P<0.01）。确诊后1 d，SAE组患者VmMCA、CBFi均明显低于非SAE组（ t值分别为2.94、2.67， P<0.05）；确诊后1、3、7 d，SAE组患者搏动指数均明显高于非SAE组（ t值分别为2.56、3.20、3.12， P<0.05或 P<0.01）。确诊后12 h的血清IL-6、确诊后24 h的血清Tau蛋白、确诊后24 h的血清ACTH、确诊后24 h的血清皮质醇为烧伤脓毒症患者发生SAE的独立危险因素（比值比分别为2.42、1.38、4.29、4.19，95%置信区间分别为1.76~3.82、1.06~2.45、1.37~6.68、3.32~8.79， P<0.01）。对41例烧伤脓毒症患者，确诊后12 h的血清IL-6预测SAE发生的ROC的AUC=0.92（95%置信区间为0.84~1.00），最佳阈值为157 pg/mL，敏感度为81%，特异度为89%；确诊后24 h的血清Tau蛋白预测SAE发生的ROC的AUC=0.92（95%置信区间为0.82~1.00），最佳阈值为6.4 pg/mL，敏感度为97%，特异度为99%；确诊后24 h的血清ACTH预测SAE发生的ROC的AUC=0.96（95%置信区间为0.89~1.00），最佳阈值为14.7 pg/mL，敏感度为90%，特异度为94%；确诊后24 h的血清皮质醇预测SAE发生的ROC的AUC=0.93（95%置信区间为0.86~1.00），最佳阈值为89 nmol/L，敏感度为94%，特异度为97%。 结论 血清Tau蛋白和ACTH、皮质醇对烧伤脓毒症患者并发SAE具有较高临床诊断价值。 Abstract:Objective To explore the value of cerebral hypoxic-ischemic injury markers in the early diagnosis of sepsis associated encephalopathy (SAE) in burn patients with sepsis. Methods A retrospective case series study was conducted. From October 2018 to May 2021, 41 burn patients with sepsis who were admitted to Zhengzhou First People's Hospital met the inclusion criteria, including 23 males and 18 females, aged 18-65 (35±3) years. According to whether SAE occurred during hospitalization, the patients were divided into SAE group (21 cases) and non-SAE group (20 cases). The gender, age, deep partial-thickness burn area, full-thickness burn area, and acute physiology and chronic health evaluation Ⅱ (APACHE Ⅱ) scores of patients were compared between the two groups. The serum levels of central nervous system specific protein S100β and neuron specific enolase (NSE) at 12, 24, and 48 h after sepsis diagnosis (hereinafter referred to as after diagnosis), the serum levels of interleukin-6 (IL-6), IL-10, tumor necrosis factor α (TNF-α), Tau protein, adrenocorticotropic hormone (ACTH), and cortisol at 12, 24, 48, 72, 120, and 168 h after diagnosis, and the mean blood flow velocity of middle cerebral artery (VmMCA), pulsatility index, and cerebral blood flow index (CBFi) on 1, 3, and 7 d after diagnosis of patients in the two groups were counted. Data were statistically analyzed with chi-square test, analysis of variance for repeated measurement, independent sample t test, and Bonferroni correction. The independent variables to predict the occurrence of SAE was screened by multi-factor logistic regression analysis. The receiver operating characteristic (ROC) curve was drawn for predicting the occurrence of SAE in burn patients with sepsis, and the area under the curve (AUC), the best threshold, and the sensitivity and specificity under the best threshold were calculated. Results The gender, age, deep partial-thickness burn area, full-thickness burn area, and APACHE Ⅱ score of patients in the two groups were all similar ( χ 2=0.02, with t values of 0.71, 1.59, 0.91, and 1.07, respectively, P>0.05). At 12, 24, and 48 h after diagnosis, the serum levels of S100β and NSE of patients in SAE group were all significantly higher than those in non-SAE group (with t values of 37.74, 77.84, 44.16, 22.51, 38.76, and 29.31, respectively, P<0.01). At 12, 24, 48, 72, 120, and 168 h after diagnosis, the serum levels of IL-10, Tau protein, and ACTH of patients in SAE group were all significantly higher than those in non-SAE group (with t values of 10.68, 13.50, 10.59, 8.09, 7.17, 4.71, 5.51, 3.20, 3.61, 3.58, 3.28, 4.21, 5.91, 5.66, 4.98, 4.69, 4.78, and 2.97, respectively, P<0.01). At 12, 24, 48, 72, and 120 h after diagnosis, the serum levels of IL-6 and TNF-α of patients in SAE group were all significantly higher than those in non-SAE group (with t values of 8.56, 7.32, 2.08, 2.53, 3.37, 4.44, 5.36, 5.35, 6.85, and 5.15, respectively, P<0.05 or P<0.01). At 12, 24, and 48 h after diagnosis, the serum level of cortisol of patients in SAE group was significantly higher than that in non-SAE group (with t values of 5.44, 5.46, and 3.55, respectively, P<0.01). On 1 d after diagnosis, the VmMCA and CBFi of patients in SAE group were significantly lower than those in non-SAE group (with t values of 2.94 and 2.67, respectively, P<0.05). On 1, 3, and 7 d after diagnosis, the pulsatile index of patients in SAE group was significantly higher than that in non-SAE group (with t values of 2.56, 3.20, and 3.12, respectively, P<0.05 or P<0.01). Serum IL-6 at 12 h after diagnosis, serum Tau protein at 24 h after diagnosis, serum ACTH at 24 h after diagnosis, and serum cortisol at 24 h after diagnosis were the independent risk factors for SAE complicated in burn patients with sepsis (with odds ratios of 2.42, 1.38, 4.29, and 4.19, 95% confidence interval of 1.76-3.82, 1.06-2.45, 1.37-6.68, and 3.32-8.79, respectively, P<0.01). For 41 burn patients with sepsis, the AUC of ROC of serum IL-6 at 12 h after diagnosis for predicting SAE was 0.92 (95% confidence interval was 0.84-1.00), the best threshold was 157 pg/mL, the sensitivity was 81%, and the specificity was 89%. The AUC of ROC of serum Tau protein at 24 h after diagnosis for predicting SAE was 0.92 (95% confidence interval was 0.82-1.00), the best threshold was 6.4 pg/mL, the sensitivity was 97%, and the specificity was 99%. The AUC of ROC of serum ACTH at 24 h after diagnosis for predicting SAE was 0.96 (95% confidence interval was 0.89-1.00), the best threshold was 14.7 pg/mL, the sensitivity was 90%, and the specificity was 94%. The AUC of ROC of serum cortisol at 24 h after diagnosis for predicting SAE was 0.93 (95% confidence interval was 0.86-1.00), the best threshold was 89 nmol/L, the sensitivity was 94%, and the specificity was 97%. Conclusions Serum Tau protein, ACTH, and cortisol have high clinical diagnostic value for SAE complicated in burn patients with sepsis. -
Key words:
- Burns /
- Sepsis /
- Hypoxia-ischemia, brain /
- Brain diseases /
- Serum markers
-
参考文献
(37) [1] 杨梅, 钱素云. 脓毒症相关性脑病的生物学标志物研究进展[J].中华实用儿科临床杂志,2020,35(6):411-414. DOI: 10.3760/cma.j.cn101070-20200317-00428. [2] HelbingDL, BöhmL, WitteOW. Sepsis-associated encephalopathy[J]. CMAJ, 2018,190(36):E1083. DOI: 10.1503/cmaj.180454. [3] 冯颖, 谢波, 谈鹰, 等. 脓毒症相关性脑病的研究进展[J].内科急危重症杂志,2021,27(3):238-242. DOI: 10.11768/nkjwzzzz20210315. [4] AnnaneD, SharsharT. Cognitive decline after sepsis[J]. Lancet Respir Med, 2015, 3(1):61-69. DOI: 10.1016/S2213-2600(14)70246-2. [5] 冯颖, 谈鹰, 谢波, 等. TCD在脓毒症患者脑循环监测中的应用及对其转归的预测价值[J].中华急诊医学杂志,2020,29(8):1087-1092. DOI: 10.3760/cma.j.issn.1671-0282.2020.08.012. [6] SonnevilleR, de MontmollinE, PoujadeJ, et al. Potentially modifiable factors contributing to sepsis-associated encephalopathy[J]. Intensive Care Med, 2017,43(8):1075-1084. DOI: 10.1007/s00134-017-4807-z. [7] 辛璐, 张扬. 血清PCT、CRP、cTnⅠ及NT-proBNP水平与感染性休克患者病情危重程度的相关性研究[J].内科急危重症杂志,2020,26(3):207-211. DOI: 10.11768/nkjwzzzz20200308. [8] 中国医师协会烧伤医师分会《烧伤感染诊治指南》编辑委员会. 烧伤感染的诊断标准与治疗指南(2012版)[J].中华烧伤杂志,2012,28(6):401-403. DOI: 10.3760/cma.j.issn.1009-2587.2012.06.001. [9] 刘辉, 童亚林, 姚咏明. 新的挑战——中枢神经系统在脓毒症发病中重要作用再认识[J]. 中华急诊医学杂志, 2020, 29(2):141-144. DOI: 10.3760/cma.j.issn.1671-0282.2020.02.001. [10] SwannK, BergerJ, SpragueSM, et al. Peripheral thermal injury causes blood-brain barrier dysfunction and matrix metalloproteinase (MMP) expression in rat[J]. Brain Res, 2007,1129(1):26-33. DOI: 10.1016/j.brainres.2006.10.061. [11] 罗高兴. 烧伤后脏器并发症的发生与防治[J].中华烧伤杂志,2019,35(8):565-567. DOI: 10.3760/cma.j.issn.1009-2587.2019.08.002. [12] GreenhalghDG. Sepsis in the burn patient: a different problem than sepsis in the general population[J/OL]. Burns Trauma, 2017,5:23[2021-10-06]. https://pubmed.ncbi.nlm.nih.gov/28795054/.DOI: 10.1186/s41038-017-0089-5. [13] 郐国虎, 蒋伟. 血清标记物检测在创伤性颅脑损伤辅助诊断及严重程度评估中的应用研究进展[J].山东医药,2020,60(21):100-102. DOI: 10.3969/j.issn.1002-266X.2020.21.027. [14] MolnárL, FülesdiB, NémethN, et al. Sepsis-associated encephalopathy: a review of literature[J]. Neurol India, 2018,66(2):352-361. DOI: 10.4103/0028-3886.227299. [15] VachharajaniV, CunninghamC, YozaB, et al. Adiponectin-deficiency exaggerates sepsis-induced micro- vascular dysfunction in the mouse brain[J]. Obesity (Silver Spring), 2012,20(3):498-504. DOI: 10.1038/oby.2011.316. [16] 兰雪, 崔艳芳, 陈国萍, 等. 血清生物标志物在缺血缺氧性脑病新生儿中的研究进展[J].标记免疫分析与临床,2021,28(2):353-357. DOI: 10.11748/bjmy.issn.1006-1703.2021.02.039. [17] KambeT, MotoiY, InoueR, et al. Differential regional distribution of phosphorylated tau and synapse loss in the nucleus accumbens in tauopathy model mice[J]. Neurobiol Dis, 2011,42(3):404-414. DOI: 10.1016/j.nbd.2011.02.002. [18] StukasS, HigginsV, FrndovaH, et al. Characterisation of serum total tau following paediatric traumatic brain injury: a case-control study[J]. Lancet Child Adolesc Health, 2019,3(8):558-567. DOI: 10.1016/S2352-4642(19)30194-4. [19] WangJW, LiJ, HanL, et al. Serum τ protein as a potential biomarker in the assessment of traumatic brain injury[J]. Exp Ther Med, 2016,11(3):1147-1151. DOI: 10.3892/etm.2016.3017. [20] ZhaoT, XiaY, WangDW, et al. Association between elevated serum tau protein level and sepsis-associated encephalopathy in patients with severe sepsis[J]. Can J Infect Dis Med Microbiol, 2019,2019:1876174. DOI: 10.1155/2019/1876174. [21] 高玉春, 曹玲, 薛勇. 缺氧缺血性脑病早产儿血清Tau蛋白与病情严重程度和预后的关系[J].中国急救复苏与灾害医学杂志,2020,15(2):164-167. DOI: 10.3969/j.issn.1673-6966.2020.02.011. [22] OlssonB, LautnerR, AndreassonU, et al. CSF and blood biomarkers for the diagnosis of Alzheimer's disease: a systematic review and meta-analysis[J]. Lancet Neurol, 2016,15(7):673-684.DOI: 10.1016/S1474-4422(16)00070-3. [23] HagagAA, El FrargyMS, YonisRL, et al. Diagnostic value of assessment of serum cortisol, hepcidin and thyroid hormones levels in neonates with late-onset sepsis[J]. Infect Disord Drug Targets, 2021,21(2):248-256. DOI: 10.2174/1871526520666200327185244. [24] 姚咏明, 盛志勇. 重视对脓毒症本质的探讨[J].中华急诊医学杂志,2005, 14(3):185-186. DOI: 10.3760/j.issn:1671-0282.2005.03.002. [25] 林建华. ACTH、COR在评估颅脑损伤患者病情与预后的临床意义[J].中华全科医学,2013,11(7):1115-1116. [26] 徐鹏, 张国斌, 刘睽, 等. 颅脑创伤后的血清皮质醇变化及对机体的影响[J].国际神经病学神经外科学杂志,2008,35(5):420-423. DOI: 10.16636/j.cnki.jinn.2008.05.006. [27] SörboA, EivingI, TheodorssonE, et al. Pre-traumatic conditions can influence cortisol levels before and after a brain injury[J]. Acta Neurol Scand, 2020,141(4):342-350. DOI: 10.1111/ane.13212. [28] 柳建生, 屠传建, 章月江, 等. 亚低温治疗重型颅脑损伤的有效性在血皮质醇、促肾上腺皮质激素的反映[J].浙江创伤外科,2009,14(6):559-560. DOI: 10.3969/j.issn.1009-7147.2009.06.007. [29] 李志涛, 闫华, 刘暌, 等. 脑损伤后神经内分泌改变研究进展[J].国际神经病学神经外科学杂志,2008,35(3):217-220. DOI: 10.16636/j.cnki.jinn.2008.03.025. [30] 姚咏明, 黄立锋. 烧伤后脓毒性脑病发生机制与诊治对策[J/CD]. 中华损伤与修复杂志:电子版, 2011, 6(2):167-173. DOI: 10.3877/cma.j.issn.1673-9450.2011.02.002. [31] FlierlMA, StahelPF, ToubanBM, et al. Bench-to-bedside review: burn-induced cerebral inflammation--a neglected entity?[J]. Crit Care, 2009,13(3):215. DOI: 10.1186/cc7794. [32] PatelTH, SpragueS, LaiQ, et al. Blood brain barrier (BBB) dysfunction associated with increased expression of tissue and urokinase plasminogen activators following peripheral thermal injury[J]. Neurosci Lett, 2008,444(3):222-226. DOI: 10.1016/j.neulet.2008.08.020. [33] 万田田, 姬文卿, 郭树彬. 脓毒症相关性脑病的发病机制和干预措施研究进展[J].中华急诊医学杂志,2021,30(7):902-907. DOI: 10.3760/cma.j.issn.1671-0282.2021.07.026. [34] RehmanSU, AliT, AlamSI, et al. Ferulic acid rescues LPS-induced neurotoxicity via modulation of the TLR4 receptor in the mouse hippocampus[J]. Mol Neurobiol, 2019,56(4):2774-2790. DOI: 10.1007/s12035-018-1280-9. [35] 姚咏明, 张卉, 童亚林. 深化对烧伤脓毒症诊断体系与治疗策略的认识[J].中华烧伤杂志,2021,37(5):404-409. DOI: 10.3760/cma.j.cn501120-20200703-00337. [36] PileriD, Accardo PalomboA, D'AmelioL,et al. Concentrations of cytokines IL-6 and IL-10 in plasma of burn patients: their relationship to sepsis and outcome[J]. Ann Burns Fire Disasters, 2008,21(4):182-185. [37] KraftR, HerndonDN, FinnertyCC, et al. Predictive value of IL-8 for sepsis and severe infections after burn injury: a clinical study[J]. Shock, 2015,43(3):222-227. DOI: 10.1097/SHK.0000000000000294. -
表1 2组烧伤脓毒症患者一般情况比较
组别 例数 性别（例） 年龄 （岁， 深Ⅱ度烧伤面积（%TBSA， Ⅲ度烧伤面积 （%TBSA， 急性生理学和慢性健康状况评价Ⅱ评分（分， 男 女 非SAE组 20 21 12 8 38±4 45±7 29±3 22±3 SAE组 13 8 37±5 48±5 28±4 23±3 统计量值 χ 2=0.02 t=0.71 t=1.59 t=0.91 t=1.07 P值 0.901 0.485 0.124 0.369 0.293 注：SAE为脓毒症相关性脑病，TBSA为体表总面积 
下载: 导出CSV
表2 2组烧伤脓毒症患者血清S100β和NSE水平在脓毒症确诊后各时间点的比较（μg/L，
组别与指标 例数 12 h 24 h 48 h SAE组 21 S100β 2.38±0.21 3.52±0.16 2.45±0.18 NSE 18.4±2.2 26.3±1.8 21.8±2.0 非SAE组 20 S100β 0.35±0.12 0.42±0.08 0.38±0.11 NSE 6.3±1.1 8.4±1.0 6.8±1.1 t 1值 37.74 77.84 44.16 P 1值 <0.001 <0.001 <0.001 t 2值 22.51 38.76 29.31 P 2值 <0.001 <0.001 <0.001 注：NSE为神经元特异性烯醇化酶，SAE为脓毒症相关性脑病；S100β、NSE处理因素主效应， F值分别为18.36、7.12， P值均<0.001；时间因素主效应， F值分别为7.11、4.38， P值均<0.001；两者交互作用， F值分别为2.34、0.78， P值均<0.001； t 1值、 P 1值， t 2值、 P 2值分别为组间S100β、NSE于脓毒症确诊后各时间点比较所得
下载: 导出CSV
表3 2组烧伤脓毒症患者SAE血清标志物在脓毒症确诊后各时间点的比较（
组别与指标 例数 12 h 24 h 48 h 72 h 120 h 168 h SAE组 21 IL-6（pg/mL） 237±16 208±19 160±14 135±17 121±20 98±17 IL-10（pg/mL） 30.3±1.8 28.8±1.1 24.4±1.3 19.1±1.1 17.0±1.5 8.1±1.6 TNF-α（pg/mL） 17.1±1.6 15.8±1.5 13.3±1.4 10.8±1.3 8.7±1.0 6.5±1.1 Tau蛋白（pg/mL） 7.0±0.8 11.1±1.1 8.6±1.1 7.1±0.9 6.2±1.1 4.4±1.0 ACTH（pg/mL） 60.8±32.6 78.3±30.2 49.1±28.5 34.8±18.7 25.0±11.2 12.6±4.9 皮质醇（nmol/L） 895±178 1 225±132 602±180 456±84 391±80 329±70 非SAE组 20 IL-6（pg/mL） 191±18 167±16 150±18 122±17 100±20 88±19 IL-10（pg/mL） 25.2±1.2 24.1±1.1 20.4±1.1 16.3±1.1 14.0±1.2 6.1±1.0 TNF-α（pg/mL） 15.1±1.1 13.4±1.2 10.8±1.6 8.5±0.8 7.1±1.0 6.0±0.9 Tau蛋白（pg/mL） 5.4±1.0 9.0±1.1 7.4±1.0 6.1±0.9 5.1±1.0 3.2±0.9 ACTH（pg/mL） 16.3±4.2 18.1±1.3 16.8±5.8 14.8±3.9 12.4±3.4 8.6±3.6 皮质醇（nmol/L） 381±91 431±78 365±102 343±97 302±60 278±49 t 1值 8.56 7.32 2.08 2.53 3.37 1.79 P 1值 <0.001 <0.001 0.045 <0.001 <0.001 0.480 t 2值 10.68 13.50 10.59 8.09 7.17 4.71 P 2值 <0.001 <0.001 <0.001 <0.001 <0.001 <0.001 t 3值 4.44 5.36 5.35 6.85 5.15 1.85 P 3值 <0.001 <0.001 <0.001 <0.001 <0.001 0.216 t 4值 5.51 3.20 3.61 3.58 3.28 4.21 P 4值 <0.001 <0.001 <0.001 <0.001 <0.001 <0.001 t 5值 5.91 5.66 4.98 4.69 4.78 2.97 P 5值 <0.001 <0.001 <0.001 <0.001 <0.001 <0.001 t 6值 5.44 5.46 3.55 2.19 2.10 2.69 P 6值 <0.001 <0.001 <0.001 0.242 0.252 0.066 注：SAE为脓毒症相关性脑病，IL为白细胞介素，TNF-α为肿瘤坏死因子α，ACTH为促肾上腺皮质激素；IL-6、IL-10、TNF-α、Tau蛋白、ACTH、皮质醇处理因素主效应， F值分别为9.42、1.23、20.10、2.43、6.82、1.12， P值均<0.001；时间因素主效应， F值分别为13.41、3.91、23.43、1.92、11.32、2.91， P值均<0.001；两者交互作用， F值分别为0.79、12.12、15.60、0.48、4.91、0.31， P值均<0.001； t 1值、 P 1值， t 2值、 P 2值， t 3值、 P 3值， t 4值、 P 4值， t 5值、 P 5值， t 6值、 P 6值分别为组间IL-6、IL-10、TNF-α、Tau蛋白、ACTH、皮质醇于脓毒症确诊后各时间点比较所得
下载: 导出CSV
表4 2组烧伤脓毒症患者脑血流参数在脓毒症确诊后各时间点的比较（
组别与指标 例数 1 d 3 d 7 d SAE组 21 VmMCA（cm/s） 36±21 42±20 46±21 搏动指数 1.7±0.5 1.5±0.3 1.4±0.3 CBFi 405±105 441±98 460±96 非SAE组 20 VmMCA（cm/s） 54±18 56±20 59±19 搏动指数 1.3±0.5 1.2±0.3 1.0±0.5 CBFi 490±102 513±99 524±104 t 1值 2.94 2.24 2.08 P 1值 0.015 0.093 0.135 t 2值 2.56 3.20 3.12 P 2值 0.042 0.009 0.009 t 3值 2.67 2.34 2.05 P 3值 0.036 0.075 0.141 注：SAE为脓毒症相关性脑病，VmMCA为大脑中动脉平均血液流速，CBFi为脑血流指数；VmMCA、搏动指数、CBFi处理因素主效应， F值分别为2.49、11.45、4.72， P值均<0.001；时间因素主效应， F值分别为4.61、13.51、5.17， P值均<0.001；两者交互作用， F值分别为1.12、7.89、3.78， P值分别为<0.001、0.183、<0.001； t 1值、 P 1值， t 2值、 P 2值， t 3值、 P 3值分别为组间VmMCA、搏动指数、CBFi于脓毒症确诊后各时间点比较所得
下载: 导出CSV
表5 41例烧伤脓毒症患者发生脓毒症相关性脑病的多因素logistic回归模型的分析结果
因素 回归系数 标准误 比值比 95%置信区间 P值 确诊后12 h的血清IL-6（pg/mL） 0.45 0.08 2.42 1.76~3.82 <0.001 确诊后24 h的血清Tau蛋白（pg/mL） 0.62 0.09 1.38 1.06~2.45 0.002 确诊后24 h的血清ACTH（pg/mL） 0.45 0.34 4.29 1.37~6.68 0.007 确诊后24 h的血清皮质醇（nmol/L） 0.65 0.26 4.19 3.32~8.79 <0.001 注：确诊后为脓毒症确诊后；IL-6为白细胞介素6，ACTH为促肾上腺皮质激素
下载: 导出CSV
-
图(1) / 表(5)
计量
- 文章访问数: 326
- HTML全文浏览量: 69
- PDF下载量: 45
- 被引次数: 0
