半胱氨酸蛋白酶抑制剂C在脓毒症的阳性率及预后意义  

The positive detection rate of cystatin C in patients with sepsis and its prognostic significance

作　　者：王军宇[1] 李春盛[1] 

机构地区：[1]首都医科大学附属北京朝阳医院急诊科,北京100020

出　　处：《中华急诊医学杂志》2012年第8期858-862,共5页Chinese Journal of Emergency Medicine

摘　　要：目的探讨急诊抢救室脓毒症（sepsis）、全身炎症反应总综合征（systemic inflammatory response syndrome，SIRS）与非SIRS患者半胱氨酸蛋白酶抑制剂C（cystainC，Cys-C）阳性检出率的差异；Cys-C与APACHE（acute physiology and chronic health evaluation）Ⅱ评分的相关性及对于死亡预后的意义。方法选取2008年10月到2009年10月在北京朝阳医院急诊抢救室救治的患者250例，排除存活不足24h者。将所有入选病例分为3组：非SIRS组（n=74）、SIRS组（n=121）及脓毒症组（n：55），检测3组病例的Cys-C水平并评估APACHEⅡ评分，计算Cys—C〉830-s／ml的检出率并进行比较。统计3组病例的28d病死率，研究Cys—C、APACHEⅡ评分对于3组病例28d病死率的预测价值。结果Cys—C的阳性检出率在脓毒症组与非SIRS组之间差异有统计学意义（41．38％VS．13．57％，P=0．007），SIRS组与非SIRS组之间比较，差异具有统计学意义（32．79％VS．13．57％，P=0．005），但在脓毒症组与SIRS组之间差异无统计学意义（41．38％VS．32．79％，P=0．346）。脓毒症组、SIRS组患者28d病死率与非SIRS组比较，差异具有统计学意义（41．6％VS．17．2％，P〈0．01；36．91％vs．17．2％，P〈0．05）。脓毒症组患者Cys—C与APACHEⅡ评分有良好正相关（P〈0．0001）。Cys—C与APACHEII评分是脓毒症组28d死亡的独立预测因素。结论SIRS患者和脓毒症患者Cys-C阳性率较非SIRS患者明显升高，并且脓毒症患者Cys-C是预后不良的指标。Objective The difference of Cys-C （serum cysteine proteinase inhibitor C） among sepsis group, systemic inflammatory response syndrome （SIRS） group, and non -SIRS group were explored in this study. The significance of mortality and the relationship between Cys-C and acute physiology and chronic health evaluation （APACHE） lI score were under discussed. Methods After excluding the individual whose survival less than 24 hours, two hundred and fifty patients sought medical care in the emergency department of Beijing Chaoyang Hospital of the Capital Medical University were selected as samples from October 2008 to October 2009. They were classified into three groups ： SIRS group （ n = 121 ）, non-SIRS group （ n = 74） and sepsis group （ n = 55）. The serum Cys-C level and APACHE II score were determined for each patient. The positive detection rate of Cys-C （ 〉 830 ng/ml） was calculated and then a 28-day mortality was recorded according to this study result. The positive detection rate and 28-day mortality were also compared with chi-square test. The prognostic values of Cys-C, APACHE II score for the 28-day mortality were evaluated by logistic regression analysis. Results There was significant change observed between sepsis group and non-SIRS group （41.38% vs. 13.57% , P =0. 007 ） for the positive detection rate of Cys-C, as well as that between SIRS group and non-SIRS group （ 32. 79% vs. 13.57%, P =- 0. 005）. However, a contrary result was obtained when compared sepsis group with SIRS group （41.38% vs. 32.79% , P =0. 346） ）. Significant difference was noticed in the 2$-day mortality of the patients from sepsis group and SIRS group in comparison to those of non-SIRS group （41.6% vs. 17. 2%, P 〈0. 01; 36. 9t% vs. 17.2%, P 〈 0. 05）. Cys-C level in patient with sepsis indicated a positive correlation to APACHE Ⅱ score （P 〈 0. 0001 ）. Conclusions The positive rate of Cys-C in SIRS group and septic group were significantly higher than that of non-SIRS patients, and

关 键 词：半胱氨酸蛋白酶抑制剂C APACHE II评分 全身炎症反应综合征 脓毒症 病 死率 

分 类 号：R459.7[医药卫生—急诊医学]