单纯脑外伤患者血清降钙素原的变化规律及其与预后的关系  

The dynamic change of procalcitonin and its relation to prognosis in simple brain trauma patients

作　　者：邓水香[1] 毛宜虎[2] 曹同瓦[1] 祝禾辰[1] 

机构地区：[1]复旦大学附属华山医院ICU, 上海200032 [2]复旦大学附属华山医院宝山分院 ICU, 上海200431

出　　处：《中国急救医学》2015年第10期903-907,共5页Chinese Journal of Critical Care Medicine

基　　金：上海市宝山区卫生局资助上海市医学重点专科建设项目

摘　　要：目的：探讨单纯脑外伤患者血清降钙素原（ PCT ）的变化规律及其与预后的关系。方法选取本院105例单纯脑外伤患者，于入住重症监护病房（ ICU）第1、2、3、5、7天检测血PCT、C－反应蛋白（ CRP）和白细胞计数（ WBC）。结果生存组89例，死亡组16例。死亡组入ICU第1、2、3、5、7天PCT水平明显高于生存组（ P＜0．01），入ICU第5、7天CRP水平明显高于生存组（ P＜0．05），入ICU第7天血WBC水平明显高于生存组（ P＜0．05）。入院期间血清PCT水平升高组患者死亡率与PCT下降组比较差异有统计学意义（χ2＝8．391，P＝0．004）；而入院期间 CRP、WBC升高组患者死亡率与CRP、WBC下降组比较差异均无统计学意义（分别为χ2＝0．787，P＝0.375；χ2＝0．111，P＝0．739）。患者PCT的动态变化与入院GCS评分、感染及预后存在相关性（r＝0．394，P＝0．001；r＝0．55，P＝0．000；r＝0．283，P＝0．003）。结论与CRP、WBC比较，PCT的动态变化与患者脑外伤的严重程度、感染及预后存在相关性，血清PCT水平的持续升高提示患者病情严重且预后不良，血清PCT可作为预测单纯脑外伤患者预后的指标之一。Objective To discuss the changes of serum procalcitonin （PCT） in the patients with simple brain trauma and its relationships with prognosis. Methods A total of 105 patients with simple brain trauma were evaluated in this prospective study. The serum levels of procaleitonin, C - reactive protein and white blood count were respectively measured 1, 2, 3, 5 and 7 days after the admission. Results The survival group contained 89 cases, and the nonsurvival group contained 16 cases. The PCT levels （ng/mL） of 1, 2, 3, 5, 7 days in nonsurvival group patients were significantly different （ P 〈 0.05 ） than that in survival group patients （ 1 d ： 1.36 ± 2.19 vs 0.31 ± 0.38 ; 2 d. 2.09 ±,2.81 vs 0.64 ±0.92; 3 d： 2.29 ±2.98 vs 0.61 ±0.96; 5 d： 5.17 ±14.74 vs 0.56 ±0.91; 7d：6.93 ±7.61 vs 0.41±0.54; P〈0. 01）. The CRPlevels of 5, 7 days in nonsurvival group patients were significantly different （P 〈 0. 05 ） than that in survival group patients （5 d： 113.10 ± 66.01 vs62.43±48.88,7 d： 109.76±73.33 vs62.20±54.17; P〈0.05）. The WBC levels of 7 day in nonsurvival group patients were significantly different （ P 〈 0.05 ） than that in survival group patients （7 d： 15.59 ±5.15 vs 11.38 ±4.68, P 〈0.05）. The mortality in PCT elevation group was significantly different （P〈0.05） than that in PCT decline group（χ2 = 8. 391, P =0. 004）; but the mortality in CRP, WBC elevation group was not significantly different （ P 〉 0. 05 ） than that in CRP, WBC decline group （ respectively with χ2 = 0. 787, P = 0. 375 and χ2 = 0. 1 11, P = 0. 739 ）. The dynamic change of procalcitonin was relation to GCS score, infection and prognosis in brain trauma patients （ the correlation coefficient respectively with r = 0. 394, P = 0. 001 ; r = 0. 55, P = 0. 000 ; r = 0. 283, P = 0. 003）. Conclusion Compared with CRP, WBC, the dynamic change of procalcitonin in brain trauma patients is related to severity of injury, infection and prognosis. Patients with continuous elev

关 键 词：降钙素原( PCT) C-反应蛋白( CRP) 单纯脑外伤 预后 

分 类 号：R51[医药卫生—内科学]