临床误诊误治

目的 探讨脓毒症合并结核感染T细胞斑点试验（T-SPOT）阳性患者预后的影响因素及预测模型构建。方法 选取2021年6月至2024年6月治疗的脓毒症合并结核感染T-SPOT阳性患者共93例为研究对象，按照随访结果分为预后良好组（n=56）以及预后不良组（n=37）。比较两组C反应蛋白（CRP）、肝素结合蛋白（HBP）水平以及急性生理与慢性健康状况Ⅱ（APACHEⅡ）评分和序贯器官衰竭评估（SOFA）评分的差异。采用Pearson相关分析各变量之间的相关性，患者预后的影响因素通过多因素logistic回归分析，其具体预测价值则通过受试者工作特征（ROC）曲线分析。结果 在CRP、HBP水平以及APACHEⅡ、SOFA评分方面，相较于预后良好组，预后不良组更高（P<0.05）。预后不良组中HBP、CRP与APACHEⅡ和SOFA评分呈正相关（P<0.01）。高CRP、高HBP、高APACHEⅡ评分和高SOFA评分均是脓毒症合并结核感染T-SPOT阳性患者发生不良预后的危险因素（P<0.05,P<0.01）。HBP、CRP、APACHEⅡ和SOFA评分联合对脓毒症合并结核感染T-SPOT阳性患者预后的预测效能最高，曲线下面积为0.914。结论 高HBP、高CRP、高APACHEⅡ评分和高SOFA评分是脓毒症合并结核感染T-SPOT阳性患者预后的预测不良独立危险因素，4个指标分别能作为预测患者预后不良的生物标志物，且联合的预测效能更高。

Objective To explore prognostic factors and construct a prognostic model for sepsis patients with tuberculosis coinfection and positive T-SPOT results. Methods A total of 93 patients with sepsis complicated with tuberculosis infection and positive T-SPOT results, treated between June 2021 and June 2024, were enrolled as the research subjects. The patients were divided into the good prognosis group(n=56) and the poor prognosis group(n=37) based on follow-up outcomes. The differences in C-reactive protein(CRP) levels, heparin-binding protein(HBP) levels, Acute Physiology, Age and Chronic Health Evaluation Ⅱ(APACHEⅡ) scores, and Sequential Organ Failure Assessment(SOFA) scores were compared between the two groups. The correlations among the variables were determined with Pearson correlation analysis, and the prognostic factors of patients were analyzed through multivariate Logistic regression. The specific prognostic value of these influencing factors was analyzed using the receiver operating characteristic(ROC) curve. Results Compared with the good prognosis group, the poor prognosis group exhibited higher levels of CRP and HBP, as well as higher APACHEⅡ and SOFA scores(P<0.05). HBP and CRP were positively correlated with APACHEⅡ score and SOFA score in the poor prognosis group(P<0.01). Elevated CRP, elevated HBP, high APACHEⅡ scores, and high SOFA scores were all risk factors for poor prognosis in sepsis patients with tuberculosis infection who tested positive by T-SPOT test(P<0.05, P<0.01). The combination of HBP, CRP, APACHEⅡ, and SOFA scores demonstrated the highest predictive efficacy for the prognosis of patients with sepsis complicated by TB infection who tested positive for T-SPOT, with an area under the curve of 0.914. Conclusion Elevated HBP, elevated CRP, high APACHEⅡ score, and high SOFA score are independent risk factors for poor prognosis in sepsis patients with tuberculosis infection and positive T-SPOT results. Each of these four indicators can serve as a biomarker for predicting poor prognosis, and moreover, their combination has higher predictive efficacy.