动态监测外周血降钙素原水平对脓毒性休克患者预后的预测价值  

The predictor value of peripheral blood procalcitonin levels in the evaluation of prognosis of patients with septic shock

作　　者：陈炜[1] 李丽娟[1] 古旭云[1] 王锁柱[1] 赵磊[1] 

机构地区：[1]首都医科大学附属北京世纪坛医院重症医学科,100038

出　　处：《中国危重病急救医学》2012年第8期470-473,共4页Chinese Critical Care Medicine

基　　金：北京市教委科技发展计划项目（D200710025027）

摘　　要：目的探讨脓毒性休克患者外周血降钙素原（PCT）水平动态变化对其预后的预测价值。方法采用前瞻性研究方法，选择2011年5月至2012年1月入住本院重症监护病房（ICU）的84例脓毒性休克患者，在入院1、3、5、7d抽取其外周血检测PCT水平，并记录当日急性生理学与慢性健康状况评分系统Ⅱ（APACHEⅡ）评分、序贯器官衰竭评分（SOFA）。根据28d生存情况分为存活组和死亡组，比较两组PCT水平及APACHEⅡ评分、SOFA评分，并分析各指标之间的相关性。结果①死亡组（38例）入院1d和3d外周血PCT水平（μg／L）与存活组（46例）患者无明显差异，但5d和7dPCT水平较存活组明显升高（5d：8．79±2．38比2．38±0．88，7d：12．57±3．29比0．71±0．22，均P〈0．05），且PCT下降程度明显小于存活组（1．91±1．21比10．27±4．49，P〈0．05）。入院5d和7dPCT水平与APACHEⅡ评分、SOFA评分呈显著正相关（5d：RAPA/CHE）Ⅱ=0．395，RFOFA=0．396；7d：RAPN/CFDⅡ：0．675，RSOFA=0．648，均P〈0．01）。②受试者工作特征曲线（ROC曲线）显示，7dPCT水平对28d病死率有一定的预测价值，其曲线下面积（AUC）最大，为0．886；以PCT0．965μg／L为临界点，敏感性和特异性较高；但多因素分析显示PCT水平与28d病死率无关。③入院7dPCT水平〈1．0μg，L者的中位生存期（d）明显长于PCT水平〉1．0μg/L者（28．0比14．1，P〈0．05）。结论在脓毒性休克患者，动态监测外周血PCT水平的变化趋势有助于对脓毒性休克的预后和严重程度进行判断，但不是预测28d生存情况的独立预后指标。Objective To investigate the predictor value of peripheral blood procalcitonin （PCT） levels in the evaluation of prognosis of patients with septic shock. Methods A prospective study was conducted. Eighty-four patients with septic shock in intensive care unit （ICU） of Beijing Shijitan Hospital Affiliated to Capital Medical University were enrolled from May, 2011 to January, 2012. Serum PCT levels were monitored, and the acute physiology and chronic health evaluation II （APACHE II ） score, sequential organ failure assessment （SOFA） score were recorded at the 1st, 3rd, 5th, and 7th day after admission. According to the 28-day outcome after admission to ICU, the patients with septic shock were divided into the survivor group and non-survivor group, dynamic changes in serum PCT levels were compared between two groups and correlation analysis was carried out on serum PCT levels and the APACHE II score, SOFA score. Results ① There was no significant difference in serum PCT levels （μg/L） at the 1st and 3rd day between survivor group （n=38） and non-survivor group （n=46）, but the serum PCT levels at the 5th and 7th day in non-survivor group were significantly higher than that in survivor group （5 days： 8.79 ± 2.38 vs. 2.38 ± 0.88, 7 days： 12.57 ±3.29 vs. 0.71 ± 0.22, both P〈0.05）, and the drop of PCT concentrations were significant compared with survivor group （1.91 ± 1.21 vs. 10.27 ± 4.49, P〈0.05）. At the same time, positive statistical correlation was found between serum PCT levels and APACHE II score, SOFA score （5 days： RAPACHEII =0.395, RSOFA=0.396; 7 days： RAPACHEII =0.675, RSOFA=0.648, all P〈0.01）. ② Receiver operator characteristic curve （ROC curve） of serum PCT levels on the 7th day could significantly predict the 28-day mortality, maximal area under the curve （AUC） of PCT was 0.886. When PCT was 0.965 μg/L, the sensitivity and specificity were appropriate. By multivariate factors logistic regression, serum PCT concentrations were not signif

关 键 词：脓毒性休克 降钙素原 预后 

分 类 号：R459.7[医药卫生—急诊医学]