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投稿时间：2024-12-17 网络发布日期：2025-11-26
投稿时间：2024-12-17 网络发布日期：2025-11-26
中文摘要: 目的 探讨血清骨形态发生蛋白9（BMP9）及外周血单核细胞人类白细胞抗原-DR（mHLA-DR）表达率与脓毒症预后的相关性及预测预后的价值。方法 回顾性选取2020年2月至 2024年2月南京医科大学第四附属医院 ICU 收治的脓毒症患者 102 例，按照 90 d 内是否全因死亡将脓毒症患者分为死亡组（n=28）、存活组（n=74）。比较两组入院第1天及治疗第7天的血清BMP9水平、mHLA-DR表达率，应用多因素logistic回归分析影响患者90 d内死的风险因素，受试者工作特征（ROC）曲线分析各风险因素预测患者90 d内死亡的价值。结果 死亡组入院第1天、治疗第7天血清BMP9水平及治疗第7天mHLA-DR表达率均显著低于存活组（P<0.05）。入院第1天、治疗第7天血清BMP9水平低及治疗第7天mHLA-DR表达率低是90 d死亡的独立危险因素（P<0.05）。入院第1天、治疗第7天血清BMP9预测脓毒症90 d死亡的最佳截断值分别为98 pg/mL、85 pg/mL，曲线下面积（AUC）分别为0.791（95%CI：0.666~0.886）、0.830（95%CI：0.710~0.915）；治疗第7天 mHLA-DR 表达率预测的最佳截断值为 80.50%，AUC 为 0.898（95% CI：0.792~0.962）。联合预测的 AUC 最高（AUC=0.942，95% CI：0.848~0.986）。结论 脓毒症患者入院第1天、治疗第7天血清BMP9水平低及治疗第7天mHLA-DR表达率低是90 d死亡的独立危险因素，可以作为改善脓毒症患者预后的中期干预靶标，二者联合预测有较好的临床应用价值。
中文关键词: 脓毒症 血清骨形态发生蛋白9 血清单核细胞人类白细胞抗原⁃DR 预后
Abstract:Objective To investigate the associations of serum level of bone morphogenetic protein 9（BMP9）and monocyte human leukocyte antigen-DR（mHLA-DR）expression rate in peripheral blood with the prognosis of sepsis，and to evaluate their predictive value for patient outcomes. Methods A total of 102 patients with sepsis admitted to the Department of Intensive Care Unit，Fourth Affiliated Hospital of Nanjing Medical University between February 2020 and February 2024 were enrolled as the study subjects. Based on all-cause mortality within 90 days，they were divided into a death group（n=28）and a survival group（n=74）. Serum BMP9 levels and mHLA-DR expression rates on admission（day1）and the 7th day of treatment were compared between the two groups. Multivariate logistic regression analysis was used to identify risk factors associated with death within 90 days，and receiver operating characteristic（ROC）curves were employed to evaluate the predictive performance of these factors. Results Serum BMP9 levels on admission（day 1）and the 7th day of treatment and the mHLA-DR expression rate on the 7th day of treatment were significantly lower in the death group compared to the survival group（P<0.05）. Low serum BMP9 levels upon admission（day 1）and the 7th day of treatment, as well as low mHLA-DR expression rate on the 7th day of treatment emerged as independent risk factors for 90-day mortality（P<0.05）. The optimal cutoff values of serum BMP9 for predicting 90-day mortality in sepsis were 98 pg/mL on admission（day 1）and 85 pg/mL on the 7th day of treatment，with areas under the curve（AUC）of 0.791（95%CI：0.666-0.886）and 0.830（95%CI：0.710-0.915），respectively；the optimal cutoff value of mHLA-DR expression rate on the 7th day of treatment was 80.50%，with an AUC of 0.898（95%CI：0.792-0.962）. The joint prediction model achieved the highest AUC（AUC=0.942，95%CI：0.848-0.986）. Conclusion Low serum BMP9 concentration on admission（day 1）and the 7th day of treatment, as well as low mHLA-DR expression rate on the 7th day of treatment are independent risk factors for 90-day mortality in sepsis patients. These markers may be served as mid-term intervention targets to improve sepsis outcomes，and their combination demonstrates good clinical utility for prognostic prediction.
keywords: Sepsis Serum bone morphogenetic protein 9 Serum mononuclear cell human leukocyte antigen ⁃ DR Prognosis
文章编号： 中图分类号：R631 文献标志码：A
基金项目:南京医科大学第四附属医院院级课题（23YJRC06）
附件
引用文本：
王硕,杨文学,王巍,等.骨形态发生蛋白9及单核细胞人类白细胞抗原⁃DR在预测脓毒症患者预后中的价值[J].中国临床研究,2025,38(11):1665-1669.
王硕,杨文学,王巍,等.骨形态发生蛋白9及单核细胞人类白细胞抗原⁃DR在预测脓毒症患者预后中的价值[J].中国临床研究,2025,38(11):1665-1669.