乌司他丁辅助治疗的脓毒症患者 HLE、mCD14 水平变化及早期检测 HLE、mCD14 水平对治疗反应性的评估价值.

OBJECTIVE: To probe into the changes of human leukocyte elastase ( HLE) and monocyte-surface lipopolysaccharide receptor (mCD14) levels in patients with sepsis receiving adjuvant treatment of ulinastatin, and the value of early detection of serum HLE and mCD14 levels in treatment responsiveness. METHODS: A total of 196 patients with sepsis admitted into this hospital from 2020 to 2022 were selected and given ulinastatin based on classical conventional therapeutic regimen, which were divided into good-response group (38 cases) and poor-response group (158 cases) according to different therapeutic effect. The serum HLE and mCD14 levels of two groups were detected before and after treatment. Clinical data were collected by the electronic medical record system, and both groups were matched 1 ∶ 1 according to the nearest matching method. Influencing factors of treatment responsiveness of ulinastatin in adjuvant treatment of sepsis were analyzed and the predictive model was established, the value of early detection of serum HLE and mCD14 levels in treatment responsiveness was analyzed by receiver operating characteristic (ROC) curve. RESULTS: The serum HLE level was lower and the mCD14 level was higher in both groups after treatment than those before treatment, with statistically significant differences (P<0. 05). The severity in the poor-response group after propensity score matching, procalcitonin (PCT), C-reactive protein (CRP) and HLE levels in the poor-response group before and after treatment were higher than those in the good-response group, while the mCD14 level in the poorresponse group before and after treatment was lower than that in the good-response group, with statistically significant differences (P<0. 05). The severity, PCT, CRP and HLE levels before treatment were the risk factors of treatment responsiveness of ulinastatin for the adjuvant treatment of sepsis patients, and the mCD14 level before treatment was a protective factor for the treatment responsiveness (P<0. 05); a joint prediction model was established, P = 1 / [1 + 1 / exp (0. 826 × severity + 0. 941 × PCT before treatment + 0. 694 × CRP before treatment + 1. 112 × HLE before treatment - 0. 963 × mCD14 before treatment - 3. 968)], with good calibration ability; the drug-time area under the curve ( AUC) for the prediction of treatment responsiveness by the HLE and mCD14 levels before treatment was respectively 0. 777 and 0. 779, while the AUC for the prediction of treatment responsiveness by the combined prediction model was 0. 947, which was higher than the AUC for HLE and mCD14 assessed individually, with statistically significant differences ( P < 0. 05 ). CONCLUSIONS: The application of ulinastatin in the adjuvant treatment of sepsis can decrease the serum HLE level and elevate mCD14 level, the decrease in blood HLE levels and the increase in mCD14 levels are closely related to treatment response, and the combined detection of these markers can further enhance their predictive value. [ABSTRACT FROM AUTHOR]