降钙素原对脓毒症患者病情及预后的临床价值  

The clinicalvalue of procalcitoninin the condition and prognosis of patients with sepsis

作　　者：赵倩[1] 谢月群 张涛[1] 赵光举[1] 洪广亮[1] 李萌芳[1] 吴斌[1] 支绍册[1] 邱俏檬[1] 卢中秋[1] 

机构地区：[1]温州医科大学附属第一医院急诊医学中心,浙江省温州325000

出　　处：《中华急诊医学杂志》2016年第7期937-943,共7页Chinese Journal of Emergency Medicine

基　　金：基金项目：浙江省医学创新学科建设计划（11-CX26）;浙江省中医药重点学科计划（2012-XK-A28）;浙江省“十二五”重点学科建设项目（2012-207）

摘　　要：目的 探讨降钙素原（procalcitonin，PCT）对脓毒症患者病情及预后的临床价值，及其与急性生理学与慢性健康状况Ⅱ评分（APACHEⅡ评分）的相关性。方法 回顾性分析2013年1月1日至2014年12月31日收住本院急诊科（包括普通病房及急诊重症监护室EICU）、感染科的109例脓毒症患者的临床资料（包括入院24 h内PCT值、白细胞计数WBC及中性粒细胞百分比Neut%、APACHEⅡ评分等）。据患者病情严重程度（脓毒血症组、严重脓毒症组和脓毒性休克组）、临床结局（存活组和死亡组）及多器官功能障碍综合征MODS（MODS组和非MODS组）不同进行分组，比较各组中各指标差异，分析PCT与APACHEⅡ评分两者之间的相关性，评价PCT、APACHEⅡ评分和APACHEⅡ评分＋PCT在评估患者预后及多器官功能障碍综合征中的价值，及分析PCT对脓毒症患者预后的独立效应及脓毒症患者预后的影响因素。结果 脓毒血症组中PCT值、APACHEⅡ评分均低于严重脓毒症组和脓毒性休克组，严重脓毒症组均低于脓毒性休克组，三组之间差异均有统计学意义（P〈0.05）。脓毒血症组中WBC明显低于脓毒性休克组（P〈0.05）。死亡组较存活组中的APACHEⅡ评分显著升高，差异有统计学意义（P〈0.01），而PCT值、WBC、Neut%在两组间则差异无统计学意义。非MODS组中APACHEⅡ评分、WBC、Neut%、PCT值均显著低于MODS组（均P〈0.05）。PCT与APACHEⅡ评分之间呈显著正相关关系（rs=0.403，P〈0.01）。通过绘制PCT、APACHEⅡ评分、APACHEⅡ评分＋PCT三者的受试者工作曲线（ROC）来评估脓毒症患者预后情况，得出三者的ROC曲线下面积（AUC）分别为0.617、0.899、0.917，而APACHEⅡ评分、APACHEⅡ评分＋PCT的预后评估价值均较PCT高（均P〈0.01），且PCT、APACHEⅡ评分的截断值（cut-off）、灵敏度、特异度分别为（3.40 ng/mL、88.24%、38.04%）和（20分、94.12%、8Objective To explore the clinical value of procalcitonin （PCT） in the disease severity and prognosis of patients with sepsis, and the relationship between PCT and acute physiology and chronic health evaluation Ⅱ score （ APACHE Ⅱ score）. Methods Clinical data （ including the value of PCT, thecount of the white blood cell WBC and the percent of neutrophils percentage Neut%, APACHE Ⅱ score, et al, within 24 hours after admission） of 109 sepsis patients admitted to the emergency department （ including the general ward and emergency intensive care unit EICU） and infections department of our hospital from January 1st 2013 to December 31st 2014 were retrospectively analyzed. The patients were divided into several groups according to the patients condition （the sepsis group, the severe sepsis group and the septic shock group ）, the clinical outcomes （the survival group and the dead group ）, and multiple organ dysfunction syndrome MODS （the MODS group and the non-MODS group）, comparing the differences of all markers in each group; to analyze the correlation between PCT and APACHE Ⅱ score ; to assess the value of PCT, APACHE Ⅱ score and APACHE Ⅱ score ＋ PCT for prognosis and multiple organ dysfunction syndrome of patients with sepsis; to have a understanding of the independent effect of PCT on the prognosis andthe factors of prognosis in patients with sepsis. Results The value of PCT, APACHE Ⅱ score in sepsis group was lower than the severe sepsis group and the septic shock group, also the severe sepsis was lower than the septic shock group, and each group was significantly different （P 〈 0. 05 ）. Compared with the septic shock group, the count of WBC of sepsis group was significantly lower （P 〈 0. 05 ）. Also the dead group compared with the survival group, the APACHE Ⅱ score was significantly increased （P 〈 0.01 ）, but the values of PCT, WBC, Neut% were not significantly different. The values of APACHE Ⅱ score, WBC, Neut%, PCT in the non-MDOS group were sig

关 键 词：脓毒症 降钙素原 急性生理学与慢性健康状况评分Ⅱ 病情严重程度 预后 

分 类 号：R459.7[医药卫生—急诊医学]