动态演变的血清PCT、LPH对评估脓毒症患者病情及预后的临床价值  

The clinical value of dynamically changes of serum PCT and LPH in the evaluation of sepsis patients′condition and prognosis

作　　者：唐小刚[1] 梁滨琦 黄萍[2] 陈治中[3] 黄寨[1] 秦文波[1] 陆政[1] TANG Xiaogang;LIANG Binqi;HUANG Ping;CHEN Zhizhong;HUANG Zhai;QIN Wenbo;LU Zheng(Department of Intensive Care Unit,Guangxi Zhuang Autonomous Region People′s Hospital,Nanning,Guangxi 530001,China;Department of Pediatrics,Guangxi Zhuang Autonomous Region People′s Hospital,Nanning,Guangxi 530001,China;Department of Clinical Laboratory,Guangxi Zhuang Autonomous Region People′s Hospital,Nanning,Guangxi 530001,China)

机构地区：[1]广西壮族自治区人民医院重症医学科,广西南宁530001 [2]广西壮族自治区人民医院儿科,广西南宁530001 [3]广西壮族自治区人民医院检验科,广西南宁530001

出　　处：《检验医学与临床》2020年第15期2164-2167,2171,共5页Laboratory Medicine and Clinic

摘　　要：目的探讨动态演变的血清降钙素原(PCT)、淋巴细胞计数(LPH)对评估脓毒症患者病情及预后的临床价值。方法采用回顾性研究,收集该院重症医学科收治的48例严重感染患者的临床资料,根据2016年最新脓毒症诊断标准分为脓毒症组(24例)和脓毒症休克组(24例),分析2组患者入院时PCT、LPH、急性生理与慢性健康Ⅱ评分(APACHE-Ⅱ评分)、血小板计数等指标的差异。随访28 d,根据转归情况分为死亡组(8例)与存活组(40例),观察2组患者入院第1、3、7天PCT、LPH的动态演变过程并比较组间差异。采用Pearson相关进行相关性分析,采用受试者工作特征曲线(ROC曲线)评估PCT、LPH、APACHE-Ⅱ评分对脓毒症预后的预测价值。结果脓毒症休克组患者入院时PCT、APACHE-Ⅱ评分、乳酸、肌酐水平均显著高于脓毒症组(P<0.05),而LPH、血小板计数显著低于脓毒症组(P<0.05)。Pearson相关分析显示,脓毒症患者入院时PCT与APACHE-Ⅱ评分呈正相关(r=0.355,P<0.05),PCT与LPH呈负相关(r=-0.363,P<0.05),LPH与APACHE-Ⅱ评分无明显相关性(P>0.05)。死亡组患者入院治疗后第1、3、7天PCT均明显高于存活组(P<0.05);死亡组患者入院治疗后第3、7天LPH均低于存活组(P<0.05)。ROC曲线显示,脓毒症患者入院时PCT、LPH、APCHE-Ⅱ评分曲线下面积分别为0.956(95%CI:0.854~0.994)、0.850(95%CI:0.717~0.937)、0.792(95%CI:0.651~0.896)。结论动态监测血清PCT、LPH的变化对评估脓毒症患者病情及预后具有一定的临床价值。Objective To explore the clinical value of dynamic changes of serum procalcitonin(PCT)and lymphocyte count(LPH)in evaluating the condition and prognosis of patients with sepsis.Methods A retrospective study was conducted to collect the clinical data of 48 patients with severe infection in the Department of Intensive Care Unit of the hospital.According to the latest diagnosis standard of sepsis in 2016,they were divided into sepsis group(24 cases)and sepsis shock group(24 cases).The differences of PCT,LPH,acute physiology and chronic healthⅡscore(APACHE-Ⅱscore)and platelet count between the two groups were analyzed.After 28 days follow-up,the patients were divided into death group(8 cases)and survival group(40 cases)according to the outcome,the dynamic evolution of PCT and LPH in the 1st,3th and 7th day after admission was observed and the differences between the two groups were compared.Meanwhile,Pearson correlation analysis was used,the ROC curve was used to evaluate the value of PCT,LPH and APACHE-Ⅱscores in predicting the prognosis of sepsis.Results The level of PCT,APACHE-Ⅱscores,lactate aicd and creatinine in septic shock group were significantly higher than those in septic group(P<0.05),while LPH and platelet count were significantly lower than those in septic group(P<0.05).Pearson correlation analysis showed that PCT was positively correlated with APACHE-Ⅱscores(r=0.355,P<0.05),PCT was negatively correlated with LPH(r=-0.363,P<0.05),LPH was not significantly correlated with APACHE-Ⅱscores(P>0.05).PCT in the death group was significantly higher than that in the survival group on the 1st,3th and 7th day of admission(P<0.05);LPH in the death group was lower than that in the survival group on the 3th and 7th day of admission(P<0.05).The ROC curve showed that the area under the curve of PCT,LPH,and APCHE-Ⅱscores of patients with sepsis was 0.956(95%CI:0.854-0.994),0.850(95%CI:0.717-0.937),and 0.792(95%CI:0.651-0.896).Conclusion The dynamic monitoring of serum PCT and LPH has certain clinical value

关 键 词：降钙素原 淋巴细胞计数 脓毒症 脓毒症休克 

分 类 号：R631[医药卫生—外科学]