入院时血清嗜铬粒蛋白A浓度和ICU患者病情严重程度的相关性研究  

Correlation of serum level of chromogranin A at admission with severity in ICU patients

作　　者：谢明[1,2] 陈晓迎[1] 刘景仑[1] 古妮娜[1] 张丹[1] 任国胜[2] 

机构地区：[1]重庆医科大学附属第一医院重症医学科,重庆400016 [2]重庆医科大学附属第一医院内分泌乳腺外科,重庆400016

出　　处：《第三军医大学学报》2013年第2期157-160,共4页Journal of Third Military Medical University

基　　金：国家自然科学基金(81071531);重庆市自然科学基金(CSTC2009BB5066)~~

摘　　要：目的探讨重症患者入院时血清嗜铬粒蛋白A(Chromogranin A,CGA)浓度与危重病评分以及预后之间的关系。方法 105例连续收入ICU的患者被分为非全身炎症反应(systemic inflammatory response syndrome,SIRS)、SIRS和脓毒症组(包括脓毒症、严重脓毒症和脓毒性休克3个亚组),健康志愿者(n=18)为对照组。比较患者入院时血清CGA、降钙素原(procalcitonin,PCT)、急性生理与慢性健康评分(APACHEⅡ)和序贯器官衰竭(SOFA)评分。结果 SIRS组、脓毒症各亚组患者入院时血清CGA浓度比健康对照组和非SIRS组明显增高(P<0.05)。CGA浓度与PCT、WBC、血肌酐、APACHEⅡ和SOFA都成正相关(r=0.759、0.570、0.507、0.576、0.718,P<0.05)。ROC分析显示CGA、APACHEⅡ与PCT评分可作为28 d死亡的预测指标(曲线下面积分别为0.818、0.789和0.685)。以血清CGA浓度为139μg/L为截分值,Kaplan-Meier分析提示CGA增高患者死亡率明显高于对照组(P<0.01)。结论重症患者入院的血清CGA浓度和病情严重程度呈正相关,血清CGA浓度超过139μg/L的患者死亡率明显增高,CGA是预测ICU患者死亡风险的独立指标。Objective To investigate the correlation of the serum level of chromogranin A （CGA） in ICU patients at admission with their illness severity scores and prognosis. Methods One hundred and five consecutive patients admitted to intensive care unit in our department from March to May 2010 were recruited, and then divided into 3 groups, that is, non-systemic inflammatory response syndrome （non-SIRS） group, SIRS group and sepsis group （including sepsis, severe sepsis and septic shock subgroups）. Another 18 health volun- teers served as normal control. The serum levels of CGA and procalcitonin （PCT） at admission were measured. Acute physiology and chronic health evaluation Ⅱ （ APACHEⅡ ） was calculated as well as sequential organ failure assessment （SOFA）. Results Serum level of CGA was significantly higher in SIRS group and all the subgroups of sepsis than in the normal control and non-SIRS groups （ P 〈 0. 05 ）. The level of CGA was positively correlated with those of PCT, WBC and creatinine, and the score of APACHE 11 and SOFA （r = 0. 759, 0. 570, 0.507, 0. 576, 0.718,P 〈 0. 05）. Receiver operating characteristics （ROC） analysis indica- ted that CGA, APACHE Ⅱand PCT were indicators for 28-day mortality （Area under curve = 0. 818, 0. 789 and 0. 685）. Kaplan-Meier analysis showed that the mortality of higher CGA group （ with 139 μg/L as the cutoff） was significantly higher than the lower group（P 〈 0.01 ）. Conclusion Serum CGA level at admission is positively correlated with severity in critically ill patients. Those with the level higher than 139 μg/L have a significantly higher mortality than those with the lower level. CGA is an independent indictor to evaluate the risk of death for ICU patients.

关 键 词：嗜铬粒蛋白A 重症监护患者 危重病评分 预后 生物标志物 

分 类 号：R446.112[医药卫生—诊断学] R449[医药卫生—临床医学]