肝素结合蛋白联合SOFA评分对脓毒性休克的预测价值  

Predictive value of heparin-binding protein combined with sequential organ failure assessment score in patients with septic shock

作　　者：杨亚南 邵换璋 史源 董鑫 王旭 秦秉玉 Yang Yanan;Shao Huanzhang;Shi Yuan;Dong Xin;Wang Xu;Qin Bingyu(Department of Critical Care Medicine, People's Hospital of Zhengzhou University, Henan Provincial People's Hospital, Zhengzhou 450003, Henan, China)

机构地区：[1]郑州大学人民医院,河南省人民医院急危重症医学部,河南郑州450003

出　　处：《中华危重病急救医学》2019年第3期336-340,共5页Chinese Critical Care Medicine

基　　金：河南省科技攻关计划项目(142102310403).

摘　　要：目的探讨肝素结合蛋白(HBP)联合序贯器官衰竭评分(SOFA)对脓毒性休克患者的预测价值。方法选择2016年12月至2017年5月河南省人民医院重症医学科(ICU)收治的78例脓毒症患者;以同期30例健康体检者作为对照。记录患者性别、年龄、ICU住院时间,入院24 h内血培养结果、白细胞计数(WBC)、C-反应蛋白(CRP)、降钙素原(PCT)、血乳酸(Lac)、HBP、SOFA和急性生理学与慢性健康状况评分Ⅱ(APACHEⅡ)以及器官衰竭、血管活性药物应用情况。比较各组上述指标的差异,并绘制受试者工作特征曲线(ROC),评价HBP、SOFA及二者联合对脓毒性休克的预测价值。结果所有研究对象均纳入最终分析,其中脓毒症64例,脓毒性休克14例。与脓毒症组比较,脓毒性休克组患者血培养阳性率、器官衰竭发生率和血管活性药物应用率均较高〔57.1%(8/14)比7.8%(5/64),100.0%(14/14)比65.6%(42/64),100.0%(14/14)比18.8%(12/64),均P<0.01〕,SOFA、APACHEⅡ评分也较高〔SOFA(分):8.93±4.16比5.89±2.68,APACHEⅡ(分):22.29±4.89比15.28±5.14,均P<0.01〕,但两组患者性别、年龄、ICU住院时间比较差异均无统计学意义。与健康对照组相比,脓毒症组和脓毒性休克组患者HBP、PCT、CRP、Lac水平均明显升高;脓毒性休克组HBP较脓毒症组升高更为显著(μg/L:120.33±43.49比68.95±54.15,P<0.05),但脓毒性休克组与脓毒症组PCT、CRP、Lac比较差异均无统计学意义〔PCT(μg/L):1.42(0.47,46.00)比0.71(0.19,4.50),CRP(mg/L):102.90±78.12比102.07±72.15,Lac(mmol/L):1.81(1.14,3.65)比1.59(1.17,2.24),均P>0.05〕。ROC曲线分析结果显示,SOFA评分预测脓毒性休克的ROC曲线下面积(AUC)为0.715〔95%可信区间(95%CI)=0.540~0.890,P=0.012〕,其最佳临界值为7.5分时,敏感度为64.3%,特异度为76.6%;HBP的AUC为0.814(95%CI=0.714~0.913,P<0.001),最佳临界值为89.43 μg/L时,敏感度为78.6%,特异度为76.6%;当二者联合诊断时,AUC为0.829(95%CI=0.724~0.935,P<0.001),敏感度Objective To explore the predictive value of heparin-binding protein (HBP) combined with sequential organ failure assessment (SOFA) score in patients with septic shock. Methods Seventy-eight patients with sepsis admitted to intensive care unit (ICU) of Henan Provincial People's Hospital from December 2016 to May 2017 were enrolled. Thirty healthy persons were enrolled as controls. The patient's gender, age, length of ICU stay, and blood culture results, white blood cell count (WBC), C-reactive protein (CRP), procalcitonin (PCT), blood lactate (Lac), HBP, SOFA score, acute physiology and chronic health evaluationⅡ(APACHEⅡ) score, organ failure and vasoactive agents usage within 24 hours of admission were recorded. The differences in the above indicators between the groups were compared, and the receiver operating characteristic (ROC) curve was drawn to evaluate the predictive value of HBP, SOFA score and their combination in patients with septic shock. Results All patients were enrolled in the final analysis, including 64 with sepsis and 14 with septic shock. Compared with the sepsis group, the proportion of patients with septic shock who were positive for blood culture, organ failure, and vasoactive agents was higher [57.1%(8/14) vs. 7.8%(5/64), 100.0%(14/14) vs. 65.6%(42/64), 100.0%(14/14) vs. 18.8%(12/64), all P < 0.01], SOFA and APACHEⅡ scores were also higher (SOFA: 8.93±4.16 vs. 5.89±2.68, APACHEⅡ: 22.29±4.89 vs. 15.28±5.14, both P < 0.01);however, there was no significant difference in gender, age or length of ICU stay between the two groups. Compared with the healthy control group, HBP, PCT, CRP and Lac levels were significantly increased in the sepsis group and the septic shock group. HBP in the septic shock group was significantly higher than that in the sepsis group (μg/L: 120.33±43.49 vs. 68.95±54.15, P < 0.05), but there was no significant difference in PCT, CRP or Lac between septic shock group and sepsis group [PCT (μg/L): 1.42 (0.47, 46.00) vs. 0.71 (0.19, 4.50), CRP (mg/L): 102.90�

关 键 词：肝素结合蛋白 序贯器官衰竭评分 脓毒症 脓毒性休克 

分 类 号：R459.7[医药卫生—急诊医学]