suPAR及PCT对脓毒症患者病情严重程度及预后的评判价值  

Soluble urokinase plasminogen activator receptor and procalcitonin for assessment of disease severity and prognosis in sepsis

作　　者：李志华[1] 刘宣[1] 葛勤敏[1] 王海嵘[1] 潘曙明[1] 

机构地区：[1]上海交通大学附属新华医院急诊科,上海200009

出　　处：《中华急诊医学杂志》2015年第6期629-633,共5页Chinese Journal of Emergency Medicine

基　　金：上海市科委项目资助（13DZ19411003）;上海市卫计委项目资助（2013SY038）;国家临床重点专科建设项目资助

摘　　要：目的探讨血浆可溶性尿激酶型纤溶酶原激活物受体（suPAR）及降钙素原（PCT）对脓毒症患者病情严重程度及预后的评判价值。方法采用前瞻性研究方法，将上海交通大学附属新华医院收治的77例脓毒症患者按照病情严重程度分为脓毒症组、严重脓毒症组和脓毒性休克组，测定患者入院后24h内PCT、suPAR水平，并进行APACHE Ⅱ评分及SOFA评分，比较suPAR、PCT和APACHE Ⅱ、SOFA评分的差异。后再根据28d的结局比较suPAR、PCT和APACHE Ⅱ、SOFA评分的差异。结果脓毒症组患者血浆suPAR为（7．9±6．5）ng／mL，低于严重脓毒症组[（8．4±4．5）ng／mL]和脓毒性休克组[（13．9±8．0）ng／mL]，但脓毒症组和严重脓毒症组之间的差异没有统计学意义，而严重脓毒症组低于脓毒性休克组，差异具有统计学意义。脓毒症组患者血浆PCT为（6．3±3．5）ng／mL，低于严重脓毒症组[（23．7±3．9）ng／mL]和脓毒性休克组[（25．7±4．3）ng／mL]，差异具有统计学意义，但是严重脓毒症组和脓毒性休克组之间的差异无统计学意义。死亡组患者血浆suPAR水平及APACHE Ⅱ、SOFA评分高于生存组，差异具有统计学意义，而PCT水平在生存组和死亡组之间的差异没有统计学意义。根据受试者工作特征曲线（ROC曲线）分析，PCT的ROC曲线下面积（AUC）为0．61（P〉0．05），suPAR的AUC为0．803（P〈0．05），APACHE Ⅱ评分的AUC为0．832（P〈0．05），SOFA评分的AUC为0．767（P〈0．05）。其截断值suPAR为9．905ng／mL。结论监测脓毒症患者入院当天血浆suPAR及APACHE Ⅱ评分有助于早期对脓毒症患者进行预后评估和病情严重程度的判断。Objective To evaluate the value of plasma soluble urokinase plasminogen activator receptor （suPAR） and serum pmcalcitonin （PCT） to investigate their assessment of disease severity and prognosis in patients with sepsis. Methods The levels of plasma suPAR and serum PCT were monitored in 77 patients with sepsis. The acute physiology and chronic health evaluation Ⅱ （ APACHE Ⅱ ） and sequential organ failure assessment （SOFA） score were recorded. According to the disease severity and their prognosis, the value of plasma suPAR, serum PCT, APACHE II and SOFA score on predict the disease severity and prognosis of septic patients were compared. Results The levels of plasma suPAR in septic patients [ （7.9±6. 5） ng/mL] were lower than severe sepsis patients [ （8.4 ±4. 5） ng/mL] and septic shock patients [ （13.9 ± 8.0） ng/mL], allP 〈0. 05. The levels of serum PCT in septic patients （6. 3±3.5） ng/mLwere lower than severe sepsis patients [ （23.7 ± 3.9 ） ng/mL ] and septic shock patients [ （25.7±4. 3） ng/mL] , allP 〈0. 05. But there was no significant difference in the levels of serum PCT between the severe sepsis group and the septic shock group. Receiver operator characteristic curve （ROC） of the level of plasma suPAR could distinguish survivors from non-survivors in septic patients, maximal area under curve （AUC） of plasma suPAR was 0. 803. The best cut-off value of plasma suPAR to distinguish survivors from non-survivors was 9.905 ng/mL. And the AUC of serum PCT was 0. 61 （ P 〉 0. 05 ） ; the AUCofAPACHE Ⅱ score was 0.832 （P〈0.05）; the AUC of SOFA score was 0.767 （P〈0.05）. Conclusion Monitoring of the levels of plasma suPAR and the APACHE Ⅱ score can help to assess the severity and the prognosis of sepsis in the early stage.

关 键 词：脓毒症 SUPAR 降钙素原 严重程度 预后 

分 类 号：R459.7[医药卫生—急诊医学]