蛋白C预测外科ICU患者死亡风险的初步研究  

The preliminary study on mortality prediction for patients in surgical intensive care unit with protein C

作　　者：唐宁[1] 潘莹莹[1] 严灿[1] 张碧玉[1] 孙自镛[1] 

机构地区：[1]华中科技大学同济医学院附属同济医院检验科,武汉430030

出　　处：《中华检验医学杂志》2013年第4期339-342,共4页Chinese Journal of Laboratory Medicine

摘　　要：目的评价抗凝标志物蛋白C（PC）及其他凝血相关指标预测外科ICU患者死亡风险的能力。方法本研究为病例对照研究，纳入华中科技大学附属同济医院2011年8至12月252例外科ICU患者及30名健康对照者，检测其凝血、抗凝及炎症相关指标，包括活化部分凝血活酶时间、凝血酶原时间、纤维蛋白原含量、D一二聚体含量、纤溶酶原活性、PC活性、抗凝血酶活性、血栓调节蛋白含量、c反应蛋白含量。同时获取其急性生理学与慢性健康状况Ⅱ（APACHEⅡ）评分等相关临床信息。采用单因素方差分析、Kruskal—Wallis检验及曼．惠特尼u检验比较存活组、死亡组与健康对照组问上述各指标的差异；各指标预测能力评价采用ROC曲线下面积；评估ICU结局的独立危险因素采用单变量及多变量Logistic回归分析。结果入院28d后存活患者与死亡患者的Pc活性分别为（70．24±22．7）％和（48．64±29．8）％，差异有统计学意义（t=2．84，P〈0．01）；APACHEⅡ评分分别为（21．04±8．2）分和（29．5±10．9）分，差异有统计学意义（t=-2．51，P〈0．05）；凝血酶原时间分别为（t2．94±3．5）s和（18．84±10．2）s，差异有统计学意义（t=-2．13，P〈0．05）；PC活性与APACHElI评分联合预测外科ICU患者死亡风险准确性高于其他指标（曲线下面积=0．806）；在校正了一些凝血参数和患者临床特征的影响后，Pc活性〈47．5％[OR：6．40，95％可信区间（CI）：2．526～16．216，P〈0．001]与APACHEⅡ评分（OR=1．123，95％CI：1．012—1．250，P〈0．05）为外科ICU患者死亡的独立危险因素。结论PC活性降低预示外科ICU患者死亡风险增加，与APACHEⅡ评分联合应用可更准确地评估患者预后。（中华检：验医学杂岙，2013，36：339-342）Objective To determine whether anticoagulation markers can improve mortality prediction in patients of surgical intensive care unit （ICU）. Methods A case-control study was adopted, 252 patients from Tongji hospital＇s surgical ICU and 30 healthy control individuals were investigated. The protein C, antithrombin, thrombomodulin, and other coagulation/ inflammatory markers were detected. The Acute Physiology and Chronic Health Evaluation I] （ APACHE II ） score were obtained. Markers level comparison among survivors, non-survivors and controls were conducted with single factor variance analysis, Kruskal-Wallis test or Mann-Whitney U test. Results Between survivors and non-survivors after 28-day hospitalization, there were significant difference on protein C levels [ （70. 2 ± 22. 7 ）% vs （48.6 ± 29.8 ）% , t=2.84,P〈0.01], APACHE II scores[（21.0±8.2）vs （29.5±10.9）, t=-2.51,P〈0.05] and prothrombin times [ （ 12.9±3.5 ） s vs （ 18.8 ±10. 2） s, t = -2. 13, P 〈 0.05 ]. Combining protein C levels with APACHE lI score could obtain a higher mortality prediction efficiency in patients of surgical ICU than any single marker （ AUC = 0. 806） . That protein C concentration less than 47.5% [ OR = 6.40, 95% confidence interval（CI） 2. 526 - 16. 216, P 〈0. 001 ] and APACHE Ⅱ score （ OR = 1. 123, 95% CI 1. 012 - 1. 250, P 〈 0. 05 ） were the independent risk factors for surgical ICU death. Conclusion Decrease of protein C levels predict increase of mortality risk in patients of surgical ICU, combining protein C withAPACHE 11 score can improve the prognostic accuracy for patients of surgical ICU. （ Chin J Lab Med,2013, 36：339-342 ）

关 键 词：重症监护病房 蛋白质C 生物学标记 死亡 危险因素 急性病生理学和长期健康评价 

分 类 号：R193[医药卫生—卫生事业管理]