PCT、sTREM-1结合APACHE Ⅱ评分对脓毒症诊断和预后的价值  

PCT and sTREM-1 combined with APACHEⅡ score for assessing diagnosis of sepsis and prognostic value

作　　者：罗运山[1] 刘易林[1] 邓霞梅[2] 张健[3] 李莉[1] LUO Yunshan LIU Yilin DENG Xiamei ZHANG Jian LI Li(Intensive Care Unit, Yuebei People＇s Hospital, Shaoguan 512026, China)

机构地区：[1]广东省韶关市粤北人民医院重症医学科,512026 [2]广东省韶关市粤北人民医院产科,512026 [3]广东省韶关市粤北人民医院检验科,512026

出　　处：《实用医学杂志》2017年第4期586-590,共5页The Journal of Practical Medicine

基　　金：广东省韶关市科技局课题(编号:Y15033)

摘　　要：目的:探讨PCT、s TREM-1结合APACHEⅡ评分对脓毒症诊断和预后价值的评价。方法:采用前瞻性研究方法收集2015年1-10月相关患者临床资料,根据中国严重脓毒症/脓毒性休克治疗指南(2014)分为SIRS组、脓毒症组、严重脓毒症组、脓毒性休克组及对照组。结果:脓毒症总组及亚组CRP、s TREM-1水平均显著高于SIRS组、对照组,差异有统计学意义(P<0.05),但脓毒症各亚组间比较差异无统计学意义。在脓毒症总组及其各亚组中乳酸水平与对照组、SIRS组比较,差异有统计学意义,其中脓毒性休克组与其他各组间比较均有意义(P<0.05)。PCT在脓毒症总组及其亚组均较对照组、SIRS组显著升高,脓毒性休克组、严重脓毒症组较脓毒症组高,脓毒性休克组较严重脓毒症组明显升高(P<0.05)。APACHEⅡ评分在脓毒症总组及各亚组、SIRS组显著高于对照组,在脓毒性休克组与脓毒症组差异亦有统计学意义(P<0.05)。根据ROC曲线分析,PCT、s TREM-1及APACHEⅡ、CRP、乳酸的AUC分别为0.935、0.877、0.856及0.816。结论:在临床上可通过检测血清PCT和血浆s TREM-1结合APACHEⅡ评分来评价脓毒症的诊断和预后。Objective PCT and sTREM-1 combined with APACHE Ⅱ score for assessing diagnosis of sepsis and prognostic value. Methods The clinical data for related patients who had hospitalized between January and October 2015 were collected by prospective study methods. According to China guidelines for treatment of severe sepsis/septic shock （2014）. The patients were divided into SIRS group, sepsis group, severe sepsis group, septic shock group, and control group. Results Levels of CRP and sTREM- 1 were significantly higher in total sepsis group and subgroups than in SIRS group and control group, with a statistical difference （P 〈 0.05）; but there were no significant differences among he subgroups. Lactic acid level differed statistically between both total sepsis group and its subgroups and both control group and SIRS group, so did level of lactic acid between the other groups and septic shock group （P 〈 0.05）. PCT was significantly higher in total sepsis group and its subgroups than in the control group and SIRS group, so did it in septic shock and severe sepsis group than in sepsis group. PCT level was significantly higher in septic shock than in severe sepsis （P 〈 0.05）. APACHE Ⅱ scores were markedly in total sepsis group and its subgroups than in SIRS group and the control group; and it differed statistically between septic shock group and sepsis group （P 〈 0.05）. According to the ROC curve analysis, the area under the curve was 0.935, 0.877, 0.816, and 0.856 for PCT, sTREM- 1, APACHE Ⅱ, CRP, and lactic acid, respectively. Conclusions Detection of serum PCT and sTREM- 1 combined with APACHE Ⅱ score can be used to assess diagnosis of sepsis and prognostic value, which has more benefit to the diagnosis and treatment of sepsis.

关 键 词：脓毒症 可溶性髓样细胞触发性受体-1 降钙素原 诊断 预后 

分 类 号：R459.7[医药卫生—急诊医学]