血清syndecan-1、eNAMPT水平对重症肺炎并发脓毒症患者的诊断价值

doi:10.3969/j.issn.1673-8640.2025.09.005

摘要/Abstract

摘要：

目的探讨血清蛋白聚糖-1（syndecan-1）、细胞外烟酰胺磷酸核糖转移酶（eNAMPT）水平对重症肺炎（SP）患者并发脓毒症的诊断价值。方法选取2019年6月—2023年10月张家口市第一医院SP患者168例。根据入院后是否并发脓毒症将其分为并发脓毒症组（52例）和未并发脓毒症组（116例）。根据序贯器官衰竭评估（SOFA）评分，将并发脓毒症的SP患者分为脓毒症组（38例）和脓毒性休克组（14例）；根据预后情况，将其分为生存组（35例）和死亡组（17例）。采用酶联免疫吸附试验（ELISA）检测所有研究对象血清syndecan-1和eNAMPT水平。采用Pearson相关分析评估syndecan-1、eNAMPT水平与炎症指标的相关性。采用多因素Logistic回归分析评估SP并发脓毒症的影响因素。采用受试者工作特征（ROC）曲线分析评估血清syndecan-1、eNAMPT水平对SP并发脓毒症的诊断价值。结果并发脓毒症组血清C反应蛋白（CRP）、白细胞介素-6（IL-6）、心肌肌钙蛋白I（cTnI）、降钙素原（PCT）、白细胞（WBC）计数、syndecan-1、eNAMPT水平均显著高于未并发脓毒症组（P<0.001）。脓毒性休克组血清syndecan-1、eNAMPT水平均显著高于脓毒症组（P<0.001）。与生存组比较，死亡组血清syndecan-1、eNAMPT水平均显著升高（P<0.001）。血清syndecan-1、eNAMPT水平与CRP、IL-6、cTnI、PCT、WBC计数均呈显著正相关（P<0.001）。血清syndecan-1、eNAMPT、CRP、IL-6、cTnI、PCT、WBC计数均是SP并发脓毒症的危险因素（P<0.05）。血清syndecan-1和eNAMPT单项检测和联合检测诊断SP并发脓毒症的曲线下面积（AUC）分别为0.660、0.812、0.844。基于多因素Logistic回归分析结果建立的多指标联合诊断模型诊断SP并发脓毒症的AUC为0.981。结论 SP并发脓毒症患者血清syndecan-1、eNAMPT水平显著升高，且与病情和预后密切相关，与常规炎症指标联合检测可显著提高对SP并发脓毒症的诊断效能。

关键词: 蛋白聚糖-1, 细胞外烟酰胺磷酸核糖转移酶, 重症肺炎, 脓毒症

Abstract:

Objective To investigate the diagnostic roles of serum syndecan-1 and extracellular nicotinamide phosphoribosyltransferase（eNAMPT）levels in patients with severe pneumonia（SP）complicated with sepsis. Methods A total of 168 SP patients admitted to Zhangjiakou First Hospital from June 2019 to October 2023 were enrolled. They were classified into SP with sepsis group（52 cases）and SP without sepsis group（116 cases）based on whether they developed sepsis after admission. The SP with sepsis group was further classified into sepsis group（38 cases）and septic shock group（14 cases）according to the sequential organ failure assessment（SOFA）score. Additionally，they were classified into survival group（35 cases）and death group（17 cases）based on the prognosis. Serum syndecan-1 and eNAMPT levels were determined by enzyme-linked immunosorbent assay（ELISA）. Pearson correlation analysis was used to evaluate the correlation between syndecan-1，eNAMPT levels and inflammatory indicators. Multivariate Logistic regression analysis was used to assess the factors influencing sepsis in SP. Receiver operating characteristic（ROC）curve was used to analyze the diagnostic value of serum syndecan-1 and eNAMPT levels for sepsis in SP. Results The levels of serum C-reactive protein（CRP），interleukin-6（IL-6），cardiac troponin I（cTnI），procalcitonin（PCT），white blood cell（WBC）count，syndecan-1 and eNAMPT in SP with sepsis group were higher than those in SP without sepsis group（P<0.001）. The levels of serum syndecan-1 and eNAMPT in septic shock group were higher than those in sepsis group（P<0.001）. Compared with survival group，the levels of serum syndecan-1 and eNAMPT in death group were increased（P<0.001）. Serum syndecan-1 and eNAMPT levels were positively correlated with CRP，IL-6，cTnI，PCT and WBC count（P<0.001）. Serum syndecan-1，eNAMPT，CRP，IL-6，cTnI，PCT and WBC count were all risk factors for sepsis in SP（P<0.05）. The areas under curves（AUC）of serum syndecan-1，eNAMPT single and combined determinations for diagnosing sepsis in SP were 0.660，0.812 and 0.844，respectively. The AUC of the combined determination determination diapnosis medel for SP with sepsis based on multivariate Logistic regression analysis was 0.981. Conclusions The levels of serum syndecan-1 and eNAMPT in SP patients with sepsis are increased，which are related to the severity and prognosis. The combined determination with conventional inflammatory indicators has a better diagnostic efficiency for sepsis in SP.

Key words: Syndecan-1, Extracellular nicotinamide phosphoribosyltransferase, Severe pneumonia, Sepsis

中图分类号:

R446.1

赵黎晓, 杨晓婷, 李丹, 张楠, 苏海燕, 王艳. 血清syndecan-1、eNAMPT水平对重症肺炎并发脓毒症患者的诊断价值[J]. 检验医学, 2025, 40(9): 856-861.

ZHAO Lixiao, YANG Xiaoting, LI Dan, ZHANG Nan, SU Haiyan, WANG Yan. Diagnostic roles of serum syndecan-1 and eNAMPT levels in patients with severe pneumonia complicated with sepsis[J]. Laboratory Medicine, 2025, 40(9): 856-861.

图/表 7

参考文献 25

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组别	例数	性别		年龄/岁	体重指数/（kg·m^-2）	吸烟史/[例（%）]	饮酒史/[例（%）]
组别	例数	男/[例（%）]	女/[例（%）]	年龄/岁	体重指数/（kg·m^-2）	吸烟史/[例（%）]	饮酒史/[例（%）]
并发脓毒症组	52	31（59.62）	21（40.38）	60.35±5.47	22.16±1.59	15（28.85）	9（17.31）
未并发脓毒症组	116	53（45.69）	63（54.31）	60.28±5.79	21.87±2.13	26（22.41）	24（20.69）
统计值		2.785		0.074	0.878	0.805	0.260
P值		0.095		0.941	0.381	0.370	0.610
组别	糖尿病史/[例（%）]		高血压史/[例（%）]		CRP/（mg·L^-1）	IL-6/（ng·L^-1）	cTnI/（ng·mL^-1）
并发脓毒症组	9（17.31）		6（11.54）		48.73±15.26	96.13±27.68	1.94±0.54
未并发脓毒症组	11（9.48）		6（5.17）		19.23±5.66	41.21±12.66	0.23±0.07
统计值	2.096		2.194		18.258	17.681	33.602
P值	0.148		0.139		<0.001	<0.001	<0.001
组别	PCT/（ng·mL^-1）		WBC计数/（×10⁹L^-1）		syndecan-1/（μg·L^-1）		eNAMPT/（ng·mL^-1）
并发脓毒症组	9.35±2.44		17.59±4.62		67.59±19.46		28.37±7.65
未并发脓毒症组	3.42±0.67		11.36±2.47		51.24±16.38		21.43±6.12
统计值	24.289		11.368		5.636		6.274
P值	<0.001		<0.001		<0.001		<0.001

组别	例数	性别		年龄/岁	体重指数/（kg·m^-2）	吸烟史/[例（%）]	饮酒史/[例（%）]
组别	例数	男/[例（%）]	女/[例（%）]	年龄/岁	体重指数/（kg·m^-2）	吸烟史/[例（%）]	饮酒史/[例（%）]
并发脓毒症组	52	31（59.62）	21（40.38）	60.35±5.47	22.16±1.59	15（28.85）	9（17.31）
未并发脓毒症组	116	53（45.69）	63（54.31）	60.28±5.79	21.87±2.13	26（22.41）	24（20.69）
统计值		2.785		0.074	0.878	0.805	0.260
P值		0.095		0.941	0.381	0.370	0.610
组别	糖尿病史/[例（%）]		高血压史/[例（%）]		CRP/（mg·L^-1）	IL-6/（ng·L^-1）	cTnI/（ng·mL^-1）
并发脓毒症组	9（17.31）		6（11.54）		48.73±15.26	96.13±27.68	1.94±0.54
未并发脓毒症组	11（9.48）		6（5.17）		19.23±5.66	41.21±12.66	0.23±0.07
统计值	2.096		2.194		18.258	17.681	33.602
P值	0.148		0.139		<0.001	<0.001	<0.001
组别	PCT/（ng·mL^-1）		WBC计数/（×10⁹L^-1）		syndecan-1/（μg·L^-1）		eNAMPT/（ng·mL^-1）
并发脓毒症组	9.35±2.44		17.59±4.62		67.59±19.46		28.37±7.65
未并发脓毒症组	3.42±0.67		11.36±2.47		51.24±16.38		21.43±6.12
统计值	24.289		11.368		5.636		6.274
P值	<0.001		<0.001		<0.001		<0.001

组别	例数	syndecan-1/（μg·L^-1）	eNAMPT/（ng·mL^-1）
脓毒症组	38	62.64±11.58	26.16±6.54
脓毒性休克组	14	81.03±15.84	34.38±7.15
t值		4.601	3.922
P值		<0.001	<0.001

组别	例数	syndecan-1/（μg·L^-1）	eNAMPT/（ng·mL^-1）
脓毒症组	38	62.64±11.58	26.16±6.54
脓毒性休克组	14	81.03±15.84	34.38±7.15
t值		4.601	3.922
P值		<0.001	<0.001

组别	例数	syndecan-1/ （μg·L^-1）	eNAMPT/（ng·mL^-1）
生存组	35	55.86±12.24	24.37±5.04
死亡组	17	91.74±25.37	36.61±7.64
t值		6.917	6.905
P值		<0.001	<0.001