中介素对老年脓毒症患者病情进展及预后的评估作用  

Evaluation function of intermedin on prognosis of elderly patients with sepsis

作　　者：张依[1] 朱凤雪[2] 杜维桓[1] 贺永梅[1] 郭丽[1] 严之红[1] 纪红[1] 

机构地区：[1]航天中心医院老年医学二科,北京100049 [2]北京大学人民医院重症医学科,100044

出　　处：《中华危重病急救医学》2017年第8期679-683,共5页Chinese Critical Care Medicine

基　　金：国家自然科学基金（81641089）

摘　　要：目的 探讨中介素（IMD）对老年脓毒症患者病情程度及预后的评估价值.方法 采用回顾性研究方法,选择2015年4月至2016年12月航天中心医院老年医学科重症加强治疗病房（ICU）收治的年龄≥65岁的脓毒症患者为研究对象（41例）,以同期年龄匹配的健康体检者作为健康对照组（30例）.收集患者入院24 h内血清C-反应蛋白（CRP）、降钙素原（PCT）、IMD水平,急性生理学与慢性健康状况评分系统Ⅱ（APACHEⅡ）评分及预后.根据APACHEⅡ评分将患者分为10-20分、21-30分、〉30分3组;根据住院期间预后将患者分成死亡组和生存组.分析各组间血清CRP、PCT和IMD水平的差异;Pearson法分析IMD与各感染指标的相关性;受试者工作特征曲线（ROC）评价CRP、PCT、IMD对老年脓毒症患者预后的预测价值.结果 与健康对照组比较,脓毒症组CRP、PCT、IMD水平均显著升高〔CRP（mg/L）：114.71±40.08比4.03±2.68,PCT（μg/L）：1.338±0.812比0.007±0.001,IMD（ng/L）：43.03±9.67比16.77±2.06,均P〈0.01〕.随APACHEⅡ评分的升高,PCT、IMD呈递增趋势,APACHEⅡ10-20分、21-30分、〉30分3组PCT（μg/L）分别为0.397±0.129、1.164±0.326、1.999±0.888（F=19.392,P=0.000）,IMD（ng/L）分别为29.12±5.60、40.48±4.40、52.75±4.73（F=33.310,P=0.000）,而APACHEⅡ评分各组间CRP差异无统计学意义（F=2.137,P=0.132）.老年脓毒症患者IMD与CRP、PCT均呈正相关（r1=0.351、P1=0.024,r2=0.617、P2=0.000）,与体温、白细胞计数（WBC）无相关性（r1=0.063、P1=0.697,r2=0.064、P2=0.692）.与生存组比较,死亡组PCT、IMD水平明显升高〔PCT（μg/L）：1.547±0.883比1.043±0.608,IMD（ng/L）：47.44±8.23比36.80±8.13,均P〈0.05〕,而CRP升高差异无统计学意义.ROC曲线分析显示,IMD评估老年脓毒症患者住院期间死亡的ROC曲线下面积〔AUC（95%可信区间,95%CI）〕大于PCT和CRP〔0.809（0.675-0.943）比0.680（0.511-0.849）、0.664（0.490-0.83Objective To investigate the predicting value of intermedin （IMD） for the prognosis of elderly sepsis patients.Methods A retrospective analysis was conducted. Forty-one patients with sepsis, aged ≥65 years, and admitted to geriatrics intensive care unit of Aerospace Center Hospital from April 2015 to December 2016 were enrolled. Thirty healthy patients were studied as control during the same time. The expression of C-reactive protein （CRP）, procalcitonin （PCT） and IMD were tested within 24 hours during hospitalization, and the acute physiology and chronic health evaluation Ⅱ（APACHE Ⅱ） score and prognosis was evaluated. According to APACHE Ⅱ score, patients were divided into 3 groups, 10-20 score, 21-30 score, and 〉 30 score group. And based on the prognosis, the patients were divided into death group and survival group. The differences of expression levels of CRP, PCT and IMD in each group were assessed. The relationship of IMD and infection index was analyzed by Pearson correlation. Receiver operating characteristic curve （ROC） was used to evaluate the prognostic value of CRP, PCT and IMD in patients with sepsis.Results Compared with the control group, the levels of CRP, PCT and IMD were significantly higher in the sepsis patients [CRP （mg/L）： 114.71±40.08 vs. 4.03±2.68, PCT （μg/L）： 1.338±0.812 vs. 0.007±0.001, IMD （ng/L）：43.03±9.67 vs. 16.77±2.06, allP 〈 0.01]. With the increase of APACHE Ⅱ score, the levels of PCT and IMD were gradually increased. In APACHE Ⅱ 10-20 score, 21-30 score, 〉 30 score groups, PCT （μg/L） were 0.397±0.129, 1.164±0.326, and 1.999±0.888, respectively （F = 19.392,P = 0.000）; IMD （ng/L） were 29.12±5.60, 40.48±4.40,52.75±4.73, respectively （F = 33.310,P = 0.000）. There was no significant difference in CRP among APACHE Ⅱ score groups （F = 2.137,P = 0.132）. The level of IMD was positively correlated with CRP and PCT （r1 = 0.351,P1 = 0.024;r2 = 0.617,P2 = 0.000）, and there was no correlation with t

关 键 词：中介素 降钙素原 C-反应蛋白 脓毒症 老年 

分 类 号：R459.7[医药卫生—急诊医学]