降钙素原、乳酸联合APACHEⅡ评分对脓毒性休克合并弥散性血管内凝血的预测价值  

Predictive values of procalcitonin and lactate combined with APACHEⅡscore in patients with disseminated intravascular coagulation induced by septic shock

作　　者：何习斯 陈燕宏 文莎 李豪丽 吴明[2,3] 冯永文 He Xi-Si;Chen Yan-Hong;Wen-Sha;Li Hao-Li;Wu Ming;Feng Yong-Wen(Graduate School,Guangzhou Medical University,Guangzhou 511400,China;Department of Critical Care Medicine,Shenzhen Second People's Hospital,Shenzhen,Guangdong 518037,China;Graduate School,Guangdong Medical University,Zhanjiang,Guangdong 524023,China)

机构地区：[1]广州医科大学研究生院,广州511400 [2]深圳市第二人民医院重症医学科,广东深圳518037 [3]广东医科大学研究生院,广东湛江524023

出　　处：《解放军医学杂志》2020年第10期1057-1061,共5页Medical Journal of Chinese People's Liberation Army

基　　金：深圳市卫生健康委员会临床研究项目(SZLY2017007)。

摘　　要：目的探讨降钙素原(PCT)、乳酸联合急性生理学与慢性健康状况评分Ⅱ(APACHEⅡ评分)对脓毒性休克患者发生弥散性血管内凝血(DIC)的预测价值。方法回顾性分析2015年1月1日-2018年12月31日于深圳市第二人民医院重症医学科就诊的164例脓毒性休克患者的临床资料。根据国际血栓与止血协会(ISTH)评分标准将患者分为DIC组(n=58,35.4%)与非DIC组(n=106,64.6%)。比较两组患者的临床资料,建立受试者工作特征曲线(ROC),确定PCT、乳酸和APACHEⅡ评分对脓毒性休克患者发生DIC的敏感度和特异度,计算最佳截点。结果PCT预测脓毒性休克合并DIC的ROC曲线下面积(AUC)为0.701(95%CI 0.619~0.784,P<0.001),最佳截点为41.18 ng/ml,敏感度为60.34%,特异度为72.64%。乳酸预测脓毒性休克合并DIC的AUC为0.669(95%CI 0.579~0.759,P<0.001),最佳截点为4.2 mmol/L,敏感度为51.70%,特异度为77.40%。APACHEⅡ评分预测脓毒性休克合并DIC的AUC为0.643(95%CI 0.550~0.736,P=0.002),最佳截点为28.5分,敏感度为53.45%,特异度为74.53%。三者联合预测脓毒性休克合并DIC的AUC为0.772(95%CI 0.697~0.848,P<0.001),敏感度为65.50%,特异度为80.20%。结论PCT、乳酸和APACHEⅡ评分可作为预测脓毒性休克合并DIC的早期诊断指标,三者联合可提高早期预测的准确性。Objective To explore the predictive values of procalcitonin(PCT)and lactate combined with acute physiology and chronic health evaluationⅡ(APACHEⅡ)score for disseminated intravascular coagulation(DIC)in patients with septic shock.Methods The clinical data of 164 patients with septic shock admitted to the Department of Critical Care Medicine of Shenzhen Second People's Hospital from January 1,2015 to December 30,2018 were analyzed retrospectively.According to International Society on Thrombosis and Haemostasis(ISTH)scoring criteria,the patients were divided into DIC group(n=58,35.4%)and non-DIC group(n=106,64.6%).Comparing the differences in clinical data of patients,we can establish a ROC curve to determine the sensitivity and specificity of DIC patients with septic shock for PCT,lactate and APACHEⅡscore,and calculate the best cut-off point.Results The AUC of PCT in predicting septic shock with DIC was 0.701(95%CI 0.619-0.784,P<0.001),the cut-off was 41.18 ng/ml,the sensitivity and specificity were 60.34%and 72.64%,respectively.The AUC of lactate was 0.669(95%CI 0.579-0.759,P<0.001),the cut-off was 4.2 mmol/L,the sensitivity and specificity were 51.70%and 77.40%,respectively.The AUC of APACHEⅡwas 0.643(95%CI 0.550-0.736,P=0.002),the cut-off of APACHEⅡscore was 28.5,the sensitivity and specificity were 53.45%and 74.53%,respectively.The AUC of the three parameters combined was 0.772(95%CI 0.697-0.848,P<0.001),the sensitivity and specificity were 65.50%and 80.20%respectively.Conclusions PCT,lactate and APACHEⅡscore can be used to predict the early diagnosis of disseminated intravascular coagulation induced by septic shock,and the combination of the three parameters can improve the accuracy of early prediction.

关 键 词：降钙素原 乳酸 APACHEⅡ评分 脓毒性休克 弥散性血管内凝血 

分 类 号：R459.7[医药卫生—急诊医学]