2025 年第 2 期 第 20 卷

血清多配体蛋白聚糖1和肽基精氨酸脱氨基酶2水平与感染性休克患者病情及预后的关系研究

The relationship between serum syndecan-1 and peptidyl arginine deiminase2 levels and the condition and prognosis of patients with septic shock

作者：唐源1张晴晴2李岩1杨健1罗彬1王博青1

英文作者：Tang Yuan1 Zhang Qingqing2 Li Yan1 Yang Jian1 Luo Bin1 Wang Boqing1

单位：1新疆医科大学第五附属医院重症医学科，乌鲁木齐830000；2新疆维吾尔自治区巴音郭楞蒙古自治州人民医院妇科，巴音郭楞831000

英文单位：1Department of Intensive Care Unit the Fifth Affiliated Hospital of Xinjiang Medical University Urumqi 830000 China; 2Department of Gynecology Bayingolin Mongolian Autonomous Prefecture People′s Hospital Bayingolin 831000 China

关键词：感染性休克；多配体蛋白聚糖1；肽基精氨酸脱氨基酶2；病情；预后

英文关键词：Septicshock;Syndecan-1;Peptidylargininedeiminase2;Condition;Prognosis

• 摘要：

• 目的 探讨血清多配体蛋白聚糖1（SDC-1）、肽基精氨酸脱氨基酶2（PAD2）水平与感染性休克（SS）患者病情及预后的关系。方法 选取2021年1月至2024年1月新疆医科大学第五附属医院重症监护病房收治的SS患者124例（SS组）和同期53名体检健康者（对照组），SS患者根据急性生理学与慢性健康状况评分系统Ⅱ（APACHEⅡ）评分分为轻度SS组（33例）、中度SS组（42例）、重度SS组（49例），根据28 d预后分为死亡组和存活组。采用酶联免疫吸附试验法检测血清SDC-1、PAD2水平；Spearman相关系数分析SS患者血清SDC-1、PAD2水平与APACHEⅡ评分的相关性；以SS患者预后为因变量，多因素非条件Logistic回归方法确定其影响因素，绘制受试者工作特征曲线评价血清SDC-1、PAD2水平对SS患者死亡的预测价值。结果 SS组血清SDC-1、PAD2水平均高于对照组［（17.2±3.4）μg/L比（9.5±2.1）μg/L、（43±6）μg/L比（29±5） μg/L］，差异均有统计学意义（均P＜0.001）。重度SS组血清SDC-1、PAD2水平高于中度SS组、轻度SS组，且中度SS组均高于轻度SS组（均P＜0.001）。SS患者血清SDC-1、PAD2水平与APACHEⅡ评分呈正相关（rs＝0.840、0.846，均P＜0.001）。124例SS患者28 d死亡51例（死亡组），存活73例（存活组）。Logistic回归分析结果显示，机械通气时间≥3 d、APACHEⅡ评分增加、SDC-1升高、PAD2升高为SS患者死亡的独立危险因素，氧合指数增加为独立保护因素（均P＜0.05）。血清SDC-1、PAD2水平联合预测SS患者死亡的曲线下面积为0.869，大于血清SDC-1、PAD2水平单独预测的0.779、0.784（均P＜0.05）。结论 血清SDC-1、PAD2水平升高与SS患者病情加重和预后不良有关，血清SDC-1、PAD2水平联合预测SS患者死亡的价值较高。

• Objective To investigate the relationship between serum syndecan-1 (SDC-1)and peptidyl arginine deiminase2(PAD2) levels and the condition and prognosis of patients with septic shock(SS). Methods A total of 124 SS patients (SS group) admitted to the Department of Intensive Care Unit, the Fifth Affiliated Hospital of Xinjiang Medical University from January 2021 to January 2024 and 53 healthy subjects (control group) in the same period were selected. SS patients were divided into mild SS group (33 cases), moderate SS group (42 cases) and severe SS group (49 cases) according to the acute physiology and chronic health evaluation Ⅱ(APACHEⅡ) score. According to the 28 d prognosis, they were divided into death group and survival group. The levels of serum SDC-1 and PAD2 were detected by enzyme-linked immunosorbent assay. Spearman correlation coefficient was used to analyze the correlation between serum SDC-1, PAD2 levels and APACHEⅡ score in SS patients.With the prognosis of SS as the dependent variable, multivariate unconditional Logistic regression was used to determine the influencing factors. Receiver operating characteristic curve was drawn to evaluate the predictive value of serum SDC-1 and PAD2 levels on the death of SS patients. Results The levels of SDC-1 and PAD2 in SS group were higher than those in control group［（17.2±3.4）μg/L vs （9.5±2.1）μg/L，（43±6）μg/L比（29±5）μg/L］(both P＜0.001). The serum levels of SDC-1 and PAD2 in severe SS group were higher than those in moderate and mild SS groups, and those in moderate SS group were higher than those in mild SS group(all P＜0.001). The serum levels of SDC-1 and PAD2 in SS patients were positively correlated with APACHEⅡ score(rs＝0.840, 0.846, both P＜0.001). Among 124 SS patients, 51 patients died (death group) and 73 patients survived (survival group) at 28 days. Logistic regression analysis showed that duration of mechanical ventilation ≥3 days, increased APACHEⅡ score, increased SDC-1 and PAD2 were independent risk factors for death in SS patients, and increased oxygenation index was an independent protective factor(all P<0.05). The area under the ROC curve of the combination of serum SDC-1 and PAD2 in predicting the death of SS patients was 0.869, which was larger than 0.779 and 0.784 of serum SDC-1 and PAD2 alone(both P<0.05). Conclusion The increased levels of serum SDC-1 and PAD2 are related to the aggravation and poor prognosis of SS patients. The combination of serum SDC-1 and PAD2 levels has a higher value in predicting the death of SS patients.