血清降钙素原、C反应蛋白、乳酸、细胞因子及危重疾病评分对脓毒症预后分析  

Prognostic significance of serum procalcitonin,C-reactive protein, lactate,cytokines and clinical severity scores in patients with sepsis

作　　者：李真玉[1] 刘毅[1] 柴艳芬[2] 

机构地区：[1]天津医科大学第二医院急诊科,天津300211 [2]天津医科大学总医院急诊医疗中心,天津300052

出　　处：《临床荟萃》2011年第16期1381-1384,1387,共5页Clinical Focus

摘　　要：目的比较血清降钙素原(procalcitonin,PCT)、C反应蛋白(C-reactive protein,CRP)、乳酸(lactate,LAC)、白细胞介素6(interleukin-6,IL-6)、白细胞介素10(interleukin-10,IL-10)、急性生理学与慢性健康评分Ⅱ(acutephysiology and chronic health evaluationⅡ,APACHEⅡ)及序贯器官功能衰竭评分(sequentional organ failureassessment,SOFA评分)对脓毒症预后的预测价值。方法收集2008年12月至2010年8月天津医科大学总医院急诊医疗中心、天津医科大学第二医院ICU符合脓毒症诊断标准90例,根据28日生存与否分为生存组和死亡组。于入院第1日、3日测定血清PCT、CRP、LAC水平,并记录当日APACHEⅡ、SOFA评分。并于当日留取脓毒症患者血清,-20℃低温保存,集中测定IL-6、IL-10。结果死亡组的第1日、3日PCT水平高于生存组[11.89(18.35)μg/Lvs 2.25(9.25)μg/L,11.50(21.56)μg/L vs 0.65(1.15)μg/L,P<0.05],第1、3日死亡组IL-6、APACHEⅡ、SOFA评分高于生存组(P<0.05),死亡组第3日的LAC水平高于生存组[2.50(2.05)mmol/L vs 1.80(0.85)mmol/L,P<0.01];死亡组的器官衰竭数目高于生存组(P<0.01);生存组PCT、CRP、IL-6、LAC有下降趋势(P<0.01),IL-10无下降趋势(P>0.05),死亡组PCT水平无下降趋势(P>0.05),其余指标均有下降趋势(P<0.05);Logistic回归分析,第1日、3日的SOFA评分、第3日的LAC水平是28日病死率的独立危险因素;ROC曲线分析,第1日、3日的SOFA的曲线下面积最大。结论 SOFA评分是脓毒症28日病死率的独立危险因素,其诊断价值最高;PCT、LAC是判断脓毒症预后的良好生化指标,可以反映脓毒症严重程度,其预测价值高于CRP、IL-6、IL-10,在脓毒症不同的病程具有不同的预测价值,动态观察PCT、LAC变化可以提高脓毒症患者的死亡风险预测。Objective To investigate the prognostic significance of serum procalcitonin（PCT）,C-reactive protein（CRP）,lactate,cytokines and clinical severity scores in patients with sepsis.Methods 90 septic patients from Emergency Medical Center of Tianjin Medical University General Hospital and Emergency Department of the Second Hospital of Tianjin Medical University between December 2008 and August 2010 who met sepsis definition criteria,were divided into survival group and non-survival group according to 28 day mortality.The dynamic changes of serum PCT,CRP,LAC were monitored on the 1st,3rd day after admission.The serum samples were centrifugated and stored below 20 ℃,and IL-6,IL-10 measured in the end.Results The serum PCT,IL-6,APACHEⅡ,SOFA level and organ failure number of non-survival group on the 1st,3rd day were higher than those of survival group（P0.05）,the serum lactate level of non-survival group on the 3rd day was higher than that of survival group,2.50（2.05） μg/L vs 1.80（0.85） μg/L（P0.01）,and there was no difference in CRP,IL-10.There were decreasing trends for PCT,CRP,LAC,IL-6 in both groups（P0.01）,but there were no decreasing trends for IL-10 in survival group and PCT in non-survival group（P0.05）.Logistic analysis showed that SOFA and the 3rd serum lactate level were the independent predictors of 28 day mortality.ROC analysis showed the SOFA area under the ROC curve was bigger than others.Conclusion SOFA is the independent predictor of 28-day mortality with the best prognostic value.Serum PCT and lactate are better biomarkers in predicting the sepsis prognosis,and can reveal the severity,whose predictive values are superior to CRP,IL-6,IL-10.Monitoring the dynamic changes of serum PCT,lactate levels can improve the sepsis mortality risk prediction.

关 键 词：脓毒症 降钙素原 C反应蛋白质 乳酸 白细胞介素6 白细胞介素10 

分 类 号：R59[医药卫生—内科学]