Objective To investigate the effect of serum soluble CD40 ligand (sCD40L) in the early diagnosis and severity in sepsis patients.Methods The present study is a prospective,observational and randomly control clinical trial.Fifty-four systemic inflammatory response syndrome (SIRS) patients who admitted to the intensive care unit (ICU) of Shaoxing People’s hospital from January 2011 to October 2012 were recruited.According to the diagnostic criteria made by ACCP and SCCM in 1991 all patients were divided into two groups:SIRS group (n =26) and Sepsis group (n =28).Based on whether sepsis patients had refractory hyotension,low histic irrigation and organ dysfunction,they were divided into septic shock group (n =12)and no-septic shock group (n =16).After patients were hospitalized,routine examinations and evaluated by APACHE Ⅱ and the Sepsis-related Organ Failure Assessment (SOFA) score system.Serum concentration of sCD40L and tissue factor (TF) were measured by enzyme linked immunoabsorbant assay (ELISA).Statistical analyses were conducted by SPSS 16.0.The cut-off value,sensitivity and specificity of sCD40L in sepsis diagnosis were calculated by receiver operating characteristic curve (ROC).Quantitative data were analyzed by F-test or Mann-Whitney U test.Enumeration data were compared by chi square test.Correlation of the parameters was analysed by Spearman test.Results Compared with sepsis group,the SIRS group exhibited lower levels of sCD40L and PCT.Serum levels of PLT in sepsis group is much less than SIRS group.Areas under the curve (AUC) of sCD40L in diagnosis of sepsis was 0.848(95％ CI:0.747-0.948).Based on a cut-off point of 2.75ng/ml,the sensitivity and specificity of sCD40L in early diagnosis of sepsis was 89.3％ and 82.1％.Furthermore,serum sCD40L concentration and SOFA scores were higher significantly in septic shock group in contrast to the no-septic shock group.A positive correlation was found between sCD40L and TF(correlation coefficient =0.57,P ＜0.01),while negative correlation between sCD40L and PCT(correlation coefficient =0.118,P ＜0.01).Conclusion Serum sCD40L may be an useful biomarker for diagnose sepsis.Additionally,high levels of sCD40L predicts occurrence of septic shock.%目的 探讨血清可溶性CD40配体(soluble CD40 ligand)对脓毒症患者早期诊断的价值及疾病程度的意义.方法 采用前瞻性、观察性、临床对照研究方法,以2011年1月～2012年10月绍兴市人民医院重症监护病房(ICU)收治的54例符合全身炎症反应综合征(systemic inflammatory response syndrome)的患者为研究对象,依据1991年美国胸科医师协会和危重症医学学会(ACCP/SCCM)诊断标准分为SIRS组(26例)和脓毒症组(28例),根据脓毒症患者是否存在顽固性低血压、低灌流或器官功能障碍分脓毒症休克组(12例),脓毒症组(16例).患者入院后行常规检查,记录各项生化指标数据,进行急性生理与慢性健康状况评分系统Ⅱ(APACHEⅡ)以及脓毒性相关器官功能衰竭评分系统(SOFA)评分.酶联免疫吸附法(ELISA)定量检测血清sCD40L浓度,组织因子(TF)抗原.应用SPSS 16.0统计分析软件进行数据处理,绘制受试者工作特征曲线(ROC),计量资料采用方差或Mann-Whitney U检验,计数资料比较采用x2检验,采用Spearman法进行参数相关性分析.结果 SIRS组血清sCD40L,PCT低于脓毒症组患者；脓毒症组PLT,较之SIRS组明显较少；血清sCD40L诊断脓毒症的曲线下面积为0.848,优于CRP和PCT,以2.75ng/ml为最佳截断值,敏感度为89.3％,特异性为82.1％；合并休克的脓毒症患者血清sCD40L,SOFA评分显著高于未发生休克患者；血清sCD40L水平与TF呈正相关,相关系数为0.57(P ＜0.01),与PLT呈负相关,相关系数为-0.118(P＜0.01).结论 血清sCD40L水平对脓毒症早期诊断有一定价值,高水平的sCD40L预示脓毒性休克的发生.
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