本文選題：claudin-4 + 降鈣素原�。� 參考：《寧夏醫(yī)科大學(xué)》2016年碩士論文

【摘要】：目的探討膿毒癥患者血清中claudin-4水平的變化及其意義。資料與方法采用前瞻性研究方法,根據(jù)美國胸科醫(yī)師協(xié)會(huì)/危重病醫(yī)學(xué)會(huì)(ACCP/SCCM)對膿毒癥定義的標(biāo)準(zhǔn),選擇對2015年6月至2015年12月收住寧夏醫(yī)科大學(xué)總醫(yī)院ICU的患者入科時(shí)分組,分為全身嚴(yán)重反應(yīng)綜合征組(SIRS,21例)、膿毒癥組(24例)、嚴(yán)重膿毒癥組(19例)、膿毒性休克組(20例)四組。選擇同期22例健康體檢者作為對照組。對所有研究對象入科24小時(shí)內(nèi)進(jìn)行急性生理學(xué)與慢性健康狀況評分系統(tǒng)Ⅱ(APACHEⅡ)和SOFA評分,并留取靜脈血采用酶聯(lián)免疫吸附實(shí)試驗(yàn)(ELISA)檢測血清中claudin-4水平,進(jìn)行相關(guān)實(shí)驗(yàn)室檢查。采用兩組獨(dú)立樣本t檢驗(yàn),分析膿毒癥患者中死亡組與存活組及MODS組與非MODS組患者血清claudin-4水平的差異;采用Speraman相關(guān)分析法分析claudin-4與APACHEⅡ和SOFA評分、PCT、Lac的相關(guān)性;采用受試者工作特征曲線(ROC)比較claudin-4、APACHEII評分、降鈣素原、SOFA評分、乳酸對膿毒癥的診斷價(jià)值。結(jié)果血清claudin-4水平在健康對照組低于試驗(yàn)組(P0.05),隨著病情逐漸加重,claudin-4水平在SIRS組、膿毒癥組、嚴(yán)重膿毒癥組、膿毒性休克組逐漸升高,且組間比較差異均有統(tǒng)計(jì)學(xué)意義(p0.05)。兩組獨(dú)立樣本t檢驗(yàn)示:存活組與死亡組及MODS組與非MODS組中血清claudin-4水平均有顯著性差異(均P0.01)。ROC曲線分析顯示:claudin-4的ROC曲線下面積(AUC)為0.879(P0.01),截?cái)嘀禐?7.6pg/ml,敏感度69.8%,特異度90.5%,陽性預(yù)測值95%,陰性預(yù)測值48.7%。Speraman相關(guān)分析結(jié)果顯示:claudin-4與APACHEⅡ、SOFA評分及Lac水平均呈顯著正相關(guān)(r1=0.57,r2=0.51,r3=0.54,均P0.01)。結(jié)論血清claudin-4水平可以評估膿毒癥病情嚴(yán)重程度并可能作為膿毒癥的早期診斷和預(yù)后的重要標(biāo)志物。
[Abstract]:Objective to investigate the changes and significance of serum claudin-4 level in sepsis patients. Materials and methods according to the criteria for the definition of sepsis by the American Association of chest Physicians / Association of critically ill Medicine (ACCPP / SCCM), prospective study methods were used to select a group of patients admitted to ICU of Ningxia Medical University General Hospital from June 2015 to December 2015. The patients were divided into four groups: systemic severe response syndrome (SIRSN) group (n = 21), sepsis group (n = 24), severe sepsis group (n = 19) and septic shock group (n = 20). 22 healthy persons were selected as control group. Acute physiology and chronic health status scoring system 鈪，

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