降钙素原联合血乳酸水平预测脓毒症休克患者预后  

Utility of serum procalcitonin combined with arterial lactate in predicting the outcome of patients with septic shock

作　　者：尹燕燕 董秉生 姜利[2] YIN Yanyan;DONG Bingsheng;JIANG Li(Urinary and Metabolic Center,Beijing Rehabilitation Hospital affiliated to Capital Medical University,Beijing 100144,China)

机构地区：[1]首都医科大学附属北京康复医院泌尿与代谢中心,北京100144 [2]首都医科大学附属复兴医院重症医学科

出　　处：《中国感染与化疗杂志》2019年第6期600-604,共5页Chinese Journal of Infection and Chemotherapy

基　　金：十二五国家科技支撑计划课题（2012BAI11B05）

摘　　要：目的探讨血清降钙素原(PCT)和乳酸(LAC)水平与脓毒症休克患者28d预后的关系。方法分析2016年1月-2018年2月入住首都医科大学附属复兴医院ICU,诊断为脓毒症休克且存活时间超过48h的患者,进行急性生理和慢性健康评分(APACHEⅡ评分),记录患者一般资料(姓名、性别、年龄),主要诊断,动脉血LAC、血清PCT水平,入ICU24、48h监测动脉血LAC水平和血清PCT水平,并计算24、48h LAC及PCT变化率,将入ICU 28d作为观察终点,分为生存组和死亡组,比较两组上述指标的差异,24、48h的LAC变化率(LAC0-24h和LAC0-48h);以24、48h的PCT变化率(PCT0-24h、PCT0-48h)作为自变量,生存、死亡分别作为因变量,作logistic回归分析,分析患者预后的影响因素;绘制受试者工作特征(ROC)曲线,观察LAC0-24h、LAC0-48h、PCT0-24h、PCT0-48h对脓毒症休克患者预后的预测价值。结果 28d观察终点生存组53例,死亡组52例。两组间性别、年龄、主要感染部位、APACHEⅡ评分无显著差异,LAC0-24h、LAC0-48h、PCT0-24h、PCT0-48h两组间比较差异有统计学意义。logistic回归分析,LAC0-48h、PCT0-48h引入回归方程,LAC0-48h的回归系数3.966,Wald值为12.709,P<0.001;PCT0-48h的回归系数3.197,Wald值为11.651,P=0.001。单独使用LAC0-48h或PCT0-48h以及联合LAC0-48h和PCT0-48h预测脓毒症休克的死亡风险,并绘制出ROC曲线,结果显示LAC0-48h和PCT0-48h联用对脓毒症休克死亡的预测价值最大,曲线下面积0.961,灵敏度为90.4%,特异度为91.6%,P<0.001。结论影响ICU脓毒症患者预后的因素较多,联合LAC0-48h和PCT0-48h监测是预测ICU脓毒症患者死亡较为简单有效的指标。Objective To explore the relationship between percent change of serum procalcitonin and arterial lactate and the 28-day outcome of patients with septic shock. Methods From January 2016 to February 2018, patients with septic shock who were admitted to the ICU of Fuxing Hospital affiliated to Capital Medical University and survived for at least 48 hours were included. Study endpoint was patient outcome 28 days after admission. The patients survived the 28-day period(cured, under treatment, discharged or transferred to other ward) were assigned to survivor group. The patients who died in the 28-day period were assigned to the dead group. Clinical details were collected from all patients, including acute physiology and chronic health evaluation(APACHE Ⅱ) score in the first 24 hours in ICU, primary diagnosis, arterial lactic acid(LAC0h) and calcitonin level(PCT0h) before treatment. After 24-and 48-hour treatment, lactate and procalcitonin levels(LAC24 h, LAC48 h, PCT24 h, PCT48 h) were retested. The percent change of LAC and PCT were calculated at 24 h and in 48 h: LAC0-24h, LAC0-48h, PCT0-24h, and PCT0-48h. The two groups of patients were compared in terms of relevant parameters, including APACHE Ⅱ score, LAC0-24h, LAC0-48h, PCT0-24h, and PCT0-48h. Logistic regression was used to analyze the effect of LAC0-24h, LAC0-48h, PCT0-24h, and PCT0-48h on patient outcome. ROC curve was plotted to observe the prognostic value of the percent change of serum PCT and arterial lactate at 24 and 48 hours(LAC0-24h, LAC0-48h, PCT0-24h, PCT0-48h) in patients with septic shock. Results The eligible patients were divided into survivor group(53 cases) or death group(52 cases) based on the survival status 28 days after admission to ICU. The patients in the two groups did not show significant difference in sex, age, primary site of infection, and APACHE Ⅱ score. LAC0-24h, LAC0-48h, PCT0-24h, and PCT0-48h were significantly different between the two groups. LAC0-24h, LAC0-48h, PCT0-24h, and PCT0-48h were taken as independent variables

关 键 词：脓毒症休克 乳酸变化率 降钙素原变化率 预后 

分 类 号：R631[医药卫生—外科学] R446.11[医药卫生—临床医学]