血清胆碱酯酶对感染性休克预后的预测价值  

Value of serum cholinesterase in the prognosis of septic shock

作　　者：赵瑞巧 张晓娟[1] 王海旭[1] 张瑞芳[1] 段晓光[1] 刘韶华[1] 韩冰[1] 丁显飞 王栋[1] 孙同文[1] Zhao Ruiqiao;Zhang Xiaojuan;Wang Haixu;Zhang Ruifang;Duan Xiaoguang;Liu Shaohua;Han Bing;Ding Xianfei;Wang Dong;Sun Tongwen(Department of General ICU,the First Affiliated Hospital of Zhengzhou University,Zhengzhou 450052,Henan,China)

机构地区：[1]郑州大学第一附属医院综合ICU,450052

出　　处：《中华危重病急救医学》2020年第1期44-49,共6页Chinese Critical Care Medicine

基　　金：河南省高层次人才中原领军人才项目(194200510017);河南省自然科学基金(182300410369);河南省卫生计生科技创新型人才"51282"工程项目(2016-32);河南省医学科技攻关计划项目(SBGJ2018020);河南省郑州市科技惠民计划项目(2019KJHM0001)。

摘　　要：目的探讨血清胆碱酯酶(SChE)水平与感染性休克(SS)患者预后的关系。方法选择2013年6月至2017年6月郑州大学第一附属医院收治的594例SS患者。记录患者的性别、年龄、急性生理学与慢性健康状况评分Ⅱ(APACHEⅡ)等一般资料,以及SS确诊48 h内血常规、降钙素原(PCT)、肝功能、肾功能、凝血功能和血气分析指标极值。于2019年9月至10月进行电话随访,记录患者结局指标,主要结局指标为出院后28 d全因死亡;次要结局指标为重症监护病房(ICU)全因死亡、2年全因死亡及ICU住院时间。根据28 d预后将患者分为存活组和死亡组,比较两组临床资料;采用多因素Cox回归分析筛选影响SS患者28 d预后的相关因素;绘制受试者工作特征曲线(ROC),评估肝功能指标SChE对SS患者28 d预后的预测价值。根据SChE水平将患者分为低SChE组(SChE≤4000 U/L)和正常SChE组(SChE>4000 U/L),采用Kaplan-Meier生存曲线比较两组无终点事件发生的累积存活率。结果根据纳入、排除标准共纳入385例SS患者,其中成功随访356例,随访率92.5%(356/385);28 d存活142例,死亡214例,28 d病死率60.1%(214/356);2年存活116例,死亡240例,2年病死率67.4%(240/356)。与28 d存活组比较,死亡组患者年龄较大,APACHEⅡ评分、部分肝肾功能指标及血乳酸(Lac)水平较高,白细胞计数(WBC)、血小板计数(PLT)、SChE水平较低,差异均有统计学意义。多因素Cox回归分析显示,年龄〔相对危险度(RR)=1.444,95%可信区间(95%CI)为1.090~1.914,P=0.010〕、APACHEⅡ评分(RR=2.249,95%CI为1.688~2.997,P=0.000)、SChE(RR=1.469,95%CI为1.057~2.043,P=0.022)和Lac(RR=2.190,95%CI为1.636~2.931,P=0.000)为影响SS患者28 d死亡的独立危险因素。ROC曲线分析显示,SChE单独预测SS患者28 d预后的价值较弱〔ROC曲线下面积(AUC)为0.574〕,但与APACHEⅡ评分和Lac联合预测的AUC则大于APACHEⅡ评分或Lac单独预测(AUC:0.807比0.785、0.697),敏感度为79.9%,特异度为Objective To investigate the relationship between serum cholinesterase(SChE)level and the prognosis of patients with septic shock(SS).Methods A total of 594 patients with SS admitted to the First Affiliated Hospital of Zhengzhou University from June 2013 to June 2017 were enrolled.General data such as gender,age,acute physiology and chronic health evaluationⅡ(APACHEⅡ)score were recorded as well as routine blood test,procalcitonin(PCT),hepatic function,renal function,coagulation function and blood gas analysis parameters within 48 hours of SS diagnosis.The patients were followed by telephone from September to October in 2019,and the outcome was recorded.The primary outcome was all-cause death 28 days after discharge.The secondary outcomes were all-cause death in intensive care unit(ICU)and 2 years after discharge,and the length of ICU stay.The patients were divided into two groups according to prognosis of 28 days:the survival group and the death group.The clinical data of the two groups were compared.Multivariate Cox regression analysis was used to screen prognostic risk factors of 28 days in patients with SS.The receiver operating characteristic(ROC)curve was used to explore predictive value of liver function parameter SChE for 28-day prognosis of patients with SS.The patients were divided into two groups according to the levels of SChE:the low SChE group(SChE≤4000 U/L)and the normal SChE group(SChE>4000 U/L).Kaplan-Meier survival curves were used to compare the cumulative survival rates without endpoint event of patients with different SChE levels.Results A total of 385 patients with SS were enrolled according to the inclusion and exclusion criteria,and a total of 356 patients were followed up successfully,with a follow-up rate of 92.5%(356/385).There were 142 survival patients and 214 death patients at 28 days,with a 28-day mortality rate of 60.1%(214/356).There were 116 survival patients and 240 death patients at 2 years,with a 2-year mortality rate of 67.4%(240/356).Compared with the 28-day survival gr

关 键 词：感染性休克 血清胆碱酯酶 预后 

分 类 号：R459.7[医药卫生—急诊医学]