探索血降钙素原和C反应蛋白对心搏骤停后综合征患者早期病情评估及预后的价值  

To explore condition evaluation and prediction value of blood procalcitonin and C-reactive protein in post-Cardiac arrest syndrome patients

作　　者：梁培培[1] 俞凤[1] 张泓[1] 

机构地区：[1]安徽医科大学第一附属医院急诊ICU,安徽合肥230022

出　　处：《安徽医药》2015年第2期284-287,共4页Anhui Medical and Pharmaceutical Journal

摘　　要：目的探索心搏骤停后综合征患者血降钙素原及C-反应蛋白对早期病情评估及预后的价值。方法收集2012年6月至2014年2月入住该院急诊重症监护室(EICU)成功心肺复苏自主循环恢复(存活≥24 h)并排除发病时未满18周岁、资料不完全、早期家属放弃抢救以及处于疾病终末期引起心搏骤停等病例,共113例。于患者入院0时及24时行血降钙素原(PCT)及C反应蛋白(CRP)检测。根据APACHEⅡ评分(入院0 h及24 h)将入选患者分为低、中、高危三组,根据患者出院存活预后情况分为存活组和死亡组,根据三种感染定义方法将入选患者分为感染组和非感染组。采用相关统计学方法分析血降钙素原和C-反应蛋白与APACHEⅡ评分相关性及与预后的关系,分析心搏骤停后综合征患者早期血降钙素原水平与感染相关性。结果 (1)血PCT24 h、PCT24 h-0 h及CRP24 h值均与APACHEⅡ评分显著正相关,相关系数分别为0.87、0.88、0.85,而CRP0 h与APACHEⅡ评分无相关性(r=0.25,P>0.05)。(2)血PCT0 h、PCT24 h及PCT24 h-0 h均是死亡预后的独立危险因素,三者ROC曲线下面积(AUC)分别为0.80、0.687、0.94,最佳预警戒值分别为8.35、20.06、15.84μg·L-1,对死亡预后的敏感度分别为88.80%、70.02%、89.10%,特异度分别为80.20%、72.00%、95.25%。(3)心搏骤停后综合征患者早期血PCT水平升高与感染无关。结论 (1)心搏骤停后综合征患者血降钙素原(PCT)在入院时即开始升高,而C反应蛋白(CRP)升高较晚,且两者水平与病情严重程度正相关,可用于早期病情评估。(2)患者入院时PCT0 h升高大于8.35μg·L-1提示不良预后,病程24 h内持续升高,且PCT24 h-0 h>15.84μg·L-1对死亡预后预测效能最高。可作为心搏骤停后综合征患者死亡预后的标志物。Objective to explore condition evaluation and prediction value of blood procalcitonin and C-reactive protein in Post-Cardi-ac arrest syndrome patients .Methods Review from June 2012 to February 2014 transferred into EICU ward,successful cardiopulmo-nary resuscitation （CPR） spontaneous circulation restoration≥24 hours.Excluded under 18 years of age at onset,the data is not com-plete,rescue abandoned after the onset of early cases and in families with end-stage disease caused by cardiac arrest.Finally selected 113 cases.Detect blood procalcitonin （ PCT） and C-reactive protein （ CRP） after patients admitted to hospital and 24 hours.According to the APACHEⅡscores （ admission 0 h and 24 h） ,divided into low,medium and high risk groups.According to patients＆#39;prognosis, divided into survival group and death group,Three definitions of infection were used to classified patients as infected group and non-in-fected group.Using related statistical methods to analyze the correlation of blood procalcitonin and C -reactive protein with the A-PACHE Ⅱscores and prognosis.analyzing the correlation of serum PCT levels in patients early post cardiac arrest syndrome with infec-tion.Result （1） The plasma levels of PCT24 h ,PCT24 h-0 h ,CRP24 h and APACHEII scores was significantly positive correlation, coeffi-cient respectively was 0.87,0.88,0.85,but CRP0 h have no correlation with APACHEⅡscores（r =0.25,P=0.54）.（2）PCT0 h, PCT24 hand PCT24 h-0 hwere independent prognostic factors of death,the areas under the ROC curve （AUC） were 0.80,0.687,0.94,the best warning plasma levels were 8.35,20.06,15.84μg· L-1 ,the prognosis of death sensitivity was 88.80%,70.02%,89.10%,spe-cificity was 80.20%,72.00%,95.25%.（3） Serum PCT levels in patients with early post cardiac arrest syndrome has nothing to do with infection.Conclusions （1）The blood procalcitonin （PCT）of Cardiac arrest syndrome patients began to increase at the time of admission,in contrast,C-reactive protein （ CRP） rises later

关 键 词：心搏骤停后综合征 血降钙素原 C反应蛋白 病情评估 预后 

分 类 号：R541.78[医药卫生—心血管疾病]