早期血浆DNA及其清除率预测心源性休克患者预后研究  

The prognostic value of early plasma DNA and its clearance rate among patients with cardiogenic shock

作　　者：张倩倩[1] 俞凤[1] 夏敦玲 张泓[1] Zhang Qianqian;Yu Feng;Xia Dunling;Zhang Hong(Department of Emergency Medicine,First Affliated Hospital of Anhui Medical University,Hefei 230022,China)

机构地区：[1]安徽医科大学第一附属医院急诊科,合肥230022

出　　处：《中华重症医学电子杂志》2018年第4期343-346,共4页Chinese Journal Of Critical Care & Intensive Care Medicine(Electronic Edition)

摘　　要：目的探讨心源性休克患者早期血浆DNA及其清除率对预后的预测。方法前瞻性观察研究2012年6至2015年8月安徽医科大学第一附属医院急诊重症监护病房(EICU)收治的心源性休克患者43例,抽取诊断心源性休克时(0 h)、24 h、48 h的血浆DNA水平。根据心源性休克患者28 d转归分为存活组(19例)与死亡组(24例),采用t检验比较2组患者血浆DNA及其清除率,通过受试者工作特征(ROC)曲线分析血浆DNA及其清除率预测心源性休克患者预后的阈值及其敏感度与特异度等诊断试验评价指标。结果 (1)死亡组0、48 h血浆DNA明显高于存活组,差异具有统计学意义[0 h:(2.05±3.10)×10~6 pg/ml vs(0.16±0.19)×10~6 pg/ml,P <0.05;48 h:(2.49±2.16)×10~6 pg/ml vs(0.07±0.09)×10~6 pg/ml,P <0.05]。同时,死亡组48 h血浆DNA清除率较存活组低,差异具有统计学意义[(-2.83±4.96)%vs(0.09±1.14)%,P <0.05]。(2)ROC曲线下面积显示:0、24、48 h血浆DNA阈值分别大于0.22×10~6、0.37×10~6、0.39×10~6 pg/ml时预测心源性休克患者死亡,敏感度高达91.7%,特异度高达100.0%。结论早期血浆DNA及其清除率可预测心源性休克患者预后。ObjectiveTo investigate the prognostic value of early plasma DNA and its clearance rate among patients with cardiogenic shock. MethodsA prospective study was performed in 43 patients with cardiogenic shock admitted to our EICU from June 2012 to August 2015. The plasma DNA levels were detected at 0 h, 24 h and 48 h after diagnosis of cardiogenic shock. According to the outcome of cardiogenic shock, the patients were divided into survival group （n=19） and death group （n=24）. T test was used to compare plasma DNA and clearance rate between these two groups. After correlation analysis between plasma DNA and clinical characteristics, receiver operator characteristic curve was performed to analyze sensitivity and specificity of plasma DNA. Results（1） The plasma DNA level in death group at 0 h, 48 h was significantly higher than that in survival group, with significantly statistical difference[0 h （2.05±3.10）×106 pg/ml vs （0.16±0.19）×106 pg/ml, P 〈 0.05; 48 h： （2.49±2.16）×106 pg/ml vs （0.07±0.09）×106 pg/ml, P 〈 0.05]. The plasma DNA clearance rate at 48 h in death group was lower than that in survival group [（-2.833±4.962）% vs （0.089±1.143）%, with significantly statistical difference （P 〈 0.05）. （2） A plasma DNA level of more than 0.22×106, 0.37×106, 0.39×106 pg/ml at 0 h, 24 h, 48 h could predict mortality in cariogenic shock patients with sensitivity of 91.7% and specificity of 100.0%. ConclusionPlasma DNA level and its clearance rate in early stage of cardiogenic shock can be used to predict the prognosis.

关 键 词：休克 心源性 血浆DNA 血浆DNA清除率 

分 类 号：R459.7[医药卫生—急诊医学]