降钙素原清除率联合序贯器官衰竭评分差值对儿童脓毒性休克预后评估的应用价值  

Prognostic value of procalcitonin clearance rate and sequential organ failure assessment score in septicshock children

作　　者：黄娇甜[1] 卢秀兰[1] 张新萍[1] 肖政辉[1] 陈梦施[1] 

机构地区：[1]湖南省儿童医院,长沙410007

出　　处：《中国小儿急救医学》2017年第11期831-836,共6页Chinese Pediatric Emergency Medicine

基　　金：国家十二五科技支撑计划（2012BA104802）

摘　　要：目的监测脓毒性休克患儿血清降钙素原（PCT）、降钙素原清除率（PCT—C）及序贯器官衰竭评分（SOFA）差值（ASOFA）的动态变化，探讨PCT—C及ASOFA在脓毒性休克患儿病情评估及预后判断中的价值。方法采用单中心观察性研究方法，选择2013年7月至2015年12月收住湖南省儿童医院重症监护二病房确诊为脓毒性休克的患儿274例，根据28d预后分为存活组（178例）和死亡组（96例）。确诊24h内监测PCT并对患儿进行SOFA评分，分别监测两组患儿确诊脓毒性休克时及确诊后2d、3d、5d、7d、9d血清PCT水平及SOFA评分，计算PCT—C及ASOFA。采用受试者工作特征曲线（ROC）分析上述指标在脓毒性休克患儿病情评估及预后判断中的价值。结果存活组与死亡组比较，确诊时及确诊后2d、3dPCT水平差异均无统计学意义（P〉0．05），存活组2d、3d、5d、7d、9dPCT—C明显高于死亡组。2d、3d、5d、7d、9dPCT—C水平与当ElASOFA评分均呈显著正相关。9dPCT—C、9dASOFA及确诊24h内SOFA评分预测28d死亡的ROC曲线下面积分别为0．800（95％C10．69—0．91，P=0．000）、0．980（95％C10．78—0．95，P〈0．000）与0．779（95％C10．66～0．89，P〈0．001）。9dPCT—C预测28d死亡的最佳截断值为38．98％，敏感度为78．90％，特异度为66．80％；9dASOFA预测28d死亡的最佳截断值为-0．5分，敏感度为89．10％，特异度为91．50％。结论脓毒性休克患儿持续高水平的PCT与感染控制不佳及病情恶化相关，能及时反映患儿的病情变化，持续动态观察PCT并进行PCT．C分析较仅关注PCT更有价值。PCT-C及ASOFA评分可以作为脓毒症患儿病情发展趋势判断和疾病风险评估的指标，较低的PCT—C及ASOFA对严重的感染相关并发症具有较好的警示作用并与低存活率相关。Objective To assess the disease severity and prognosis value by observing the kinetic change of serum procalcitonin（ PCT）, PCT clearance rate （PCT-C） and Asequential organ failure assessment （ASOFA） score in the patients with septic shock. Methods A single-center observational study was conduc- ted. A total of 274 patients with septic shock admitted into intensive care unit of Hunan Province Children＇s Hospital from July 2013 to December 2015 were enrolled. The patients were divided into survival group（ n -- 178） and nonsurvival group（n --96） according to the therapeutic outcome on day 28. The PCT and SOFA scores were estimated within 24 hours when septic shock was diagnosed. PCT-C and ASOFA were examined on day 2, day 3, day 5, day 7, day 9 after the septic shock was diagnosed. The diagnostic and predictive per- formance of PCT, PCT-C and ASOFA score were assessed by the receiver operating characteristic curve （ROC）. Results There were no statistical differences on serum concentrations of PCT at 24 hour,48 hour, 72 hour between two groups. But PCT-C in survival group on day 2, day 3, day 5, day 7, day 9 were signifi- cant higher than those of nonsurvival group. The area under the ROC curve were 0. 800 （95 % CI O. 69 -0. 91, P = 0. 000） for PCT-C on day 9,0.980 （ 95 % CI O. 78 %0. 95, P 〈 0. 000 ） for ASOFA on day 9 and 0. 779 （95% CI O. 66 - 0. 89, P 〈 0. 001 ） for SOFA score when septic shock was diagnosed. A ROC analysis identified a PCT-C on day 9 more than 38.98% （sensitivity： 78.90%, specificity： 66. 80% ） as the most accurate cut-off in predicting death. A ROC analysis identified ASOFA score on day 9 less than - 0. 5 （ sensi- tivity：89. 10%, specificity：91.50% ） as the most accurate cut-off in predicting death. Conclusion Theincreased levels of PCT in patients with septic shock were associated with the poor control of infection and may indicate the deterioration of septic shock, it also can reflect the activity of infection in time. Keeping observin

关 键 词：降钙素原 降钙素原清除率 脓毒性休克 序贯器官衰竭评分 

分 类 号：R720.597[医药卫生—急诊医学]