血清乳酸脱氢酶及红细胞分布宽度对老年脓毒症患者预后的影响  

Effect of serum lactate dehydrogenase and red blood cell distribution width on the prognosis of elderly patients with sepsis

作　　者：段金旗 马丽琼[2] 林艳 徐昌富 赵芹芳 Duan Jin-qi;Ma Li-qiong;Lin Yan;Xu Chang-fu;Zhao Qin-fang(Medical College of Zhangjiakou University,Zhangjiakou 075000,China)

机构地区：[1]张家口学院医学院,河北张家口075000 [2]中国人民解放军第81集团军医院重症医学科,河北张家口075000 [3]张家口学院护理学院,河北张家口075000

出　　处：《中国急救医学》2020年第5期432-437,共6页Chinese Journal of Critical Care Medicine

摘　　要：目的探讨血清乳酸脱氢酶(lactate dehydrogenase,LDH)及红细胞分布宽度(red blood cell distribution width,RDW)在老年脓毒症患者近期预后评估中的价值。方法采用回顾性研究方法,选取2016年3月至2018年9月张家口学院附属人民医院收治103例老年脓毒症患者,符合研究纳入及排除标准98例,入院6 h内检测患者血清LDH、血乳酸(Lac)、RDW、血白细胞计数(WBC)、血清降钙素原(procalcitonin,PCT)及C-反应蛋白(C-reactive protein,CRP),并计算12 h乳酸清除率及24 h内急性生理学及慢性健康状况评估系统Ⅱ(acute physiology and chronic health evaluation scoring systemⅡ,APACHEⅡ),根据患者28 d预后分为存活组及死亡组,比较两组一般资料及各项指标,使用Cox生存分析确定老年脓毒症患者预后独立危险因素,分析血清LDH及RDW与独立危险因素的相关性,建立受试工作特征(ROC)曲线,评价血清LDH及RDW对老年脓毒症患者预后的预测价值,并绘制Kaplan-Meier生存曲线。结果死亡组APACHEⅡ评分以及血RDW、血清LDH、血Lac、PCT高于存活组,死亡组12 h乳酸清除速率低于存活组(P<0.05);血清LDH与APACHEⅡ评分、血Lac、血清PCT呈正相关(r=0.542、0.653、0.469),RDW与APACHEⅡ评分、血Lac、血清PCT、CRP呈正相关(r=0.651、0.357、0.601、0.301,P<0.05);APACHEⅡ评分、RDW、血清LDH、血Lac、血清PCT是老年脓毒症患者死亡独立危险因素(OR=1.172、1.259、1.015、1.172、1.004,P<0.05);经ROC曲线评估,RDW及血清LDH的曲线下面积(AUC,0.849、0.826)与APACHEⅡ评分、血Lac、血清PCT比较差异无统计学意义(P>0.05),当RDW截断值为16.18时,敏感度为87.8%,特异度为88.7%;当血清LDH截断值为286.59时,敏感度为90.7%,特异度为血清90.1%;以28 d预后为结局,RDW正常组平均生存时间(27.85±0.08)d高于RDW高水平组(24.84±0.64)d,血清LDH正常组平均生存时间(27.61±0.16)d高于血清LDH高水平组[(24.00±0.84)d,P<0.05]。结论血清LDH及RDW与炎症因子�Objective To explore the value of serum lactate dehydrogenase(LDH)and red blood cell distribution width(RDW)in evaluating the short-term prognosis of elderly patients with sepsis.Methods A retrospective study was conducted to select 103 elderly patients with sepsis from March 2016 to September 2018.98 patients met the inclusion and exclusion criteria.LDH,lactic acid(Lac),RDW,white blood cells(WBC),procalcitonin(PCT)and C-reactive protein(CRP)were detected within 6 hours after admission.12-hour lactate clearance rates and 24-hour acute physiology and chronic health evaluation scoring systemⅡ(APACHEⅡ)score were calculated.The patients were divided into survival group and dead group according to the 28-day prognosis.Cox survival analysis was used to determine the independent risk factors of sepsis prognosis in the elderly.The correlation of LDH and RDW with independent risk factors was analyzed.ROC curve was established to evaluate the predictive value of LDH and RDW for sepsis prognosis,and its Kaplan-Meier survival curve was drawn.Results APACHEⅡscore,RDW,LDH,Lac and PCT in the dead group were higher than those in the survival group,and 12-hour lactic acid clearance rate in the death group was lower than that in the survival group(P<0.05);LDH was positively correlated with APACHEⅡscore,Lac and PCT(r=0.542,0.653,0.469);RDW was positively correlated with APACHEⅡscore,Lac,PCT,CRP(r=0.651,0.357,0.601,0.301,P<0.05);APACHEⅡ,RDW,LDH,Lac and PCT were independent risk factors for death in elderly patients with sepsis(OR=1.172,1.259,1.015,1.172,1.004,P<0.05).There was no significant difference in AUC when RDW and LDH(0.849,0.826)compared with APACHEⅡscore,Lac and PCT(P>0.05).When the cutoff value of RDW=16.18,the sensitivity was 87.8%,the specificity was 88.7%,and when the cutoff value of LDH=286.59,the sensitivity was 90.7%,the specificity was 90.1%.The average survival time of normal RDW group[(27.85±0.08)d]were higher than those of high RDW group[(24.84±0.64)d],and normal LDH group[(27.61±0.16)d]was high

关 键 词：脓毒症 乳酸脱氢酶(LDH) 红细胞分布宽度(RDW) 老年 

分 类 号：R459.7[医药卫生—急诊医学]