脓毒症患者入ICU时血浆血小板活化因子水平与病情严重程度的相关性分析  

Correlation between plasma platelet activating factor level at admission to ICU and severity degree of patients with sepsis

作　　者：程鹏雁[1] 马渝[2] 陶杨[2] 刘海波[1] 申振亚 周发春[1] 

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]重庆市急救医疗中心ICU,重庆400014

出　　处：《重庆医科大学学报》2014年第7期1027-1031,共5页Journal of Chongqing Medical University

基　　金：重庆市卫生局资助项目(编号:2011-1-104)

摘　　要：目的:探讨脓毒症患者入ICU时血浆血小板活化因子(platelet activating factor,PAF)水平与患者病情严重程度及预后的关系。方法:将102例入选脓毒症患者分为脓毒症(n=30)、严重脓毒症(n=26)及脓毒性休克(n=46)3个亚组,按住院期间预后分为存活组及死亡组,以40例健康志愿者作为对照组。比较脓毒症患者入ICU时的血浆PAF水平、血清炎症标志物降钙素原(procalcitonin,PCT)浓度、急性生理和慢性健康评分(acute physiology and chronic health evaluationⅡ,APACHEⅡ)、简化急性生理评分Ⅱ(simplified acute physiology scoreⅡ,SAPSⅡ)以及序贯器官功能衰竭(sequential organ failure assessment,SOFA)评分,分析患者血浆PAF水平与血清PCT浓度、APACHEⅡ、SAPSⅡ及SOFA评分的相关性。结果:脓毒症组、严重脓毒症组及脓毒性休克组患者血浆PAF水平较对照组均明显增高(z=-5.424、-5.512、-7.662,P均=0.000),脓毒性休克组患者血浆PAF水平明显高于脓毒症及严重脓毒症组(z=-4.559、-3.910,P均=0.000),而后2组患者血浆PAF水平差异无统计学意义(z=-0.427,P=0.669);脓毒症患者血浆PAF水平与血清PCT浓度、SAPSⅡ及SOFA评分呈明显正相关(rs=0.376、0.326、0.483,P=0.000、0.001、0.000),但与APACHEⅡ评分相关性不明显(rs=0.143,P=0.152);死亡组患者血浆PAF水平较存活组明显增高(z=-3.152,P=0.002),受试者工作特征(receiver operating characteristics,ROC)曲线分析显示,PAF及APACHEⅡ评分可作为脓毒症患者住院期间死亡的预测指标(曲线下面积分别为0.708、0.787)。结论:脓毒症患者入ICU时的血浆PAF水平与患者病情严重程度基本呈正相关,并且与患者预后相关,可用于指导评估脓毒症患者的病情及预后。Objective ：To investigate the correlation of plasma platelet activating factor（PAF） level of patients with sepsis at admission to ICU with their illness severity and prognosis. Methods ：Totally 102 patients with sepsis were divided into three subgroups：sepsis group（n=30） ,severe sepsis group（n=26） and septic shock group（n=46）. All patients were divided into survival group and non-sur- vival group according to their prognosis during the hospital. Forty volunteers were selected as normal controls. The plasma PAF level, serum concentration of inflammatory biomarker procaleitonin （PCT）, acute physiology and chronic health evaluation Ⅱ （APACHE Ⅱ ）, simplified acute physiology score Ⅱ （SAPS Ⅱ ） and sequential organ failure assessment（SOFA） scores of patients at admission to ICU were compared. Correlation of plasma PAF level with serum concentration of PCT, scores of APACHE Ⅱ ,SAPS Ⅱ and SOFA were an- alyzed. Results ： Plasma PAF levels were significantly higher in sepsis group, severe sepsis group and septic shock group than in control group（z=-5.424,-5.512,-7.662, P=0.000）, and the PAF level was significantly higher in septic shock group than in sepsis and severe sepsis groups（z=-4.559,-3.910,P=0.000） while there was no statistically difference in PAF level between sepsis group and severe sepsis group （z=-0.427,P=0.669）. Plasma PAF level of patients with sepsis was positively correlated with the serum concentration of PCT,scores of SAPS 11 and SOFA（r,=0.376,0.326,0.483,P= 0.000,0.001,0.000）, while it was not correlated with APACHE I1 score（rs=0.143,P=0.152）. Plasma PAF level of patients in non-survival group was significantly higher than that in sur- vival group （z =-3.152, P=0.002）. Receiver operating character-istics（ROC） curve showed that both PAF and APACHE Ⅱ score could be used as predictors of mortality during the hospitalization （area under the curve=0.708,0.787）. Conclusion ：PAF level of patients with sepsis at admission to

关 键 词：脓毒症 血小板活化因子 危重病评分 预后 

分 类 号：R459.7[医药卫生—急诊医学]