动态监测血清降钙素原在评估ICU脓毒症患者预后与严重程度中的价值  

Dynamicly Monitoring Prognosis and Severity Value of Serum Procalcitonin in Patients with ICU Sepsis

作　　者：肖登峰[1] 

机构地区：[1]湖北职业技术学院附属惠济医院检验科,湖北省孝感市432000

出　　处：《中国全科医学》2017年第A01期8-11,共4页Chinese General Practice

摘　　要：目的对ICU脓毒症患者的血清降钙素原水平进行实时动态监测,探索动态监测血清降钙素原在评估ICU脓毒症患者预后与严重程度中的应用价值。方法选取2012年12月—2015年12月在本院ICU病房进行观察与治疗的100例脓毒症患者,分别为一般脓毒症组、严重脓毒症组、脓毒性休克组。对各组患者血清降钙素原水平进行为期1周的动态监测,通过急性生理学及慢性健康状况评分系统(APACHⅡ)评分判断3组患者入院当天症状严重程度,并统计30 d内患者的死亡率;结合ROC曲线评价血清降钙素原在评估脓毒症的预后与严重程度中的价值。结果患者痰细菌阳性培养率为42.0%。3组患者入院当天APACHⅡ评分比较,差异有统计学意义(P<0.05);两两比较显示,一般脓毒症组与其余两组差异有统计学意义(P<0.05),严重脓毒症组与脓毒性休克组差异无统计学意义(P>0.05)。3组患者30 d内死亡率比较,差异有统计学意义(P<0.05);两两比较差异均有统计学意义(P<0.05)。一般脓毒症组、严重脓毒症组、脓毒性休克组3组患者在入院第1、2、3、4天的血清降钙素原水平两两比较,差异有统计学意义,脓毒性休克组血清降钙素原水平高于其他两组(P<0.05);入院第5、6、7天差异无统计学意义(P>0.05)。入院第1天血清降钙素原水平对于脓毒症的诊断价值切点为6.68 ng/ml时,AUC为0.964,95%CI为(0.644,0.989),灵敏度为93.54%,特异度为73.96%。结论在评估脓毒症患者预后与严重程度的过程中,对ICU脓毒症患者血清降钙素原进行实时动态监测有较为明确的价值,可作为重要指标评价脓毒症患者预后与严重程度。Objective Dynamicly monitor the serum procalcitonin in patients with ICU sepsis in real time and explore dynamic monitoring in prognosis and severity value of serum procalcitonin in patients with ICU sepsis. Methods Grouped 100 cases of patients with ICU sepsis in our hospital from December 2012 to December 2015 into the sepsis group,severe sepsis group and septic shock group according to the severity of symptoms. Dynamicly monitored the serum procalcitonin level of patients in each group for a week. Judged the Severity of symptoms of patients in three groups at their admission day through APACHⅡscores and counted the death rate of patients within 30 days. Evaluated the diagnostic value of prognosis and severity of serum procalcitonin in patients with sepsis based on the ROC curve. Results The positive culture rate of sputum bacteria of all patients was 42. 0%. The death rate of patients in general sepsis group,severe sepsis group and septic shock group in 30 days were significant difference in pairwise comparison( P < 0. 05). The APACHⅡscores of patients in general sepsis group,severe sepsis group and septic shock group were significant difference between general sepsis group and the other two groups( P < 0. 05).There were significant difference in serum procalcitonin of patients in general sepsis group,severe sepsis group and septic shock group at the first day,the second day,the third day and the fourth day from their admission on. The concentration of serum procalcitonin in septic shock group was significant higher than that in the other two groups( P < 0. 05). The differences were statistical significance. There were no significant difference at the fifth day, the sixth day and the seventh day from their admission on( P > 0. 05). When the diagnostic value pointcut of the concentration of serum procalcitonin in the diagnosis of sepsis at the first day on their admission was 6. 68 ng/ml, then AUC: 0. 964, 95% CI( 0. 644, 0. 989), sensibility:93. 54%,specificity: 73. 96%. Conclusion At the process of progno

关 键 词：降钙素原 脓毒症 预后 

分 类 号：R631[医药卫生—外科学]