血清和肽素联合动脉血乳酸评估危重症患者预后的价值  

The value of copeptin combined with arterial lactate for predicting the prognosis of emergency and critical patients

作　　者：文力[1] 安稳 张新超[1] Wen Li;An Wen;Zhang Xin-chao(Department of Emergency,Beijing Hospital,National Center of Gerontology,Beijing 100730,China)

机构地区：[1]国家老年医学中心北京医院急诊科,北京100730

出　　处：《中国急救医学》2019年第6期564-567,共4页Chinese Journal of Critical Care Medicine

摘　　要：目的探讨血清和肽素(copeptin)联合动脉血乳酸(lactate)对危重症患者预后评估的价值。方法选择北京医院急诊科2016年9月至2018年9月入住抢救室或急诊监护室的危重症患者128例为研究对象,收集来诊24 h内首次血清标本,测定和肽素和乳酸,随访30 d生存或死亡结果。应用单因素及二元Logistic回归模型分析影响危重症患者预后的危险因素,绘制ROC曲线评估和肽素和乳酸对危重症患者预后的评估价值。结果死亡组29例患者的和肽素(pg/mL)及乳酸(mmol/L)水平分别为22.55(12.77, 38.18)、3.24(1.35, 5.80),均明显高于生存组10.73(5.03,14.39)、1.52(1.01, 1.85),差异均有统计学意义(P<0.05)。和肽素和乳酸皆是危重症患者死亡的独立危险因素,二者的OR及95%CI分别为1.081(1.044,1.560)、2.597(1.119,4.323)。和肽素、乳酸单测与和肽素+乳酸联测对预后的评估价值以受试者工作特征曲线(ROC曲线)下面积(AUC)和95%CI表示,分别为0.836(0.747,0.925)、0.753(0.644,0.863)与0.904(0.825,0.982)。结论和肽素及乳酸可用于评估危重症患者的预后,二者联合检测对危重症患者近期死亡风险的预测能力更好。Objective To investigate the value of copept in combined with arterial lactate for predicting the prognosis of emergency and critical patients.Methods The 128 critically ill patients who came to the emergency department of Beijing Hospital from September 2016 to September 2018 were selected as the objects of the study.The serum samples were collected immediately as they came,and then the copeptin and arterial lactate were measured.Univariate Logistic regression model and multivariate Logistic regression model were used to analyze the risk factors affecting the prognosis of critically ill patients,and ROC curve was drawn to evaluate the predictive value of serum copeptin and lactate levels on the prognosis of emergency and critically ill patients.Results In the death group,copeptin and lactate levels were 22.55 (12.力,38.18) and 3.24 (1.35 ,5.80),respectively,which were significantly higher than those in the survival group [ 10.73 (5.03,14.39),1.52(1.01,1.85);P <0.05 ].The serum copeptin and arterial lactate were independent risk factors for death in emergency and critical patients,and their OR and CI were 1.081 (1.044,1.560) and 2.597 (1.119,4.323) respectively.The area (AUC) and 95% confidence interval (CI) under ROC curve of copeptin,lactate and copeptin + lactate were 0.836 (0.747,0.925),0.753 (0.644,0.863) and 0.904 (0.825 ,0.982),respectively.Conclusion Serum copeptin and arterial lactate levels can be used to evaluate the prognosis of emergency and critically ill patients,their ability to predict the risk of recent death in critically ill patients can be further improved when combined.

关 键 词：危重症 和肽素 乳酸 预后 联合 

分 类 号：R459.7[医药卫生—急诊医学]