肾上腺髓质中段肽联合危重症评分在脓毒症患者预后评价中的作用  

The role of mid-regional proadrenomedullin combined with critical illness score in prognosis evaluation of patients with sepsis

作　　者：王娜[1,2] 李俊玉[1,2] 商娜 刘芦姗[1,2] 席修明 Wang Na;Li Jun-yu;Shang Na;Liu Lu-shan;Xi Xiu-ming(School of Rehabilitation Medicine,Capital Medical University,Beijing 100068,China)

机构地区：[1]首都医科大学康复医学院,北京100068 [2]中国康复研究中心急诊科,北京100068 [3]首都医科大学北京复兴医院重症医学科,北京100038

出　　处：《中国急救医学》2022年第3期204-208,共5页Chinese Journal of Critical Care Medicine

基　　金：国家科技支撑计划(2012BAI11B05);北京市丰台区卫计委课题(2018-71)。

摘　　要：目的比较肾上腺髓质中段肽(mid-regional proadrenomedullin,MR-proADM)、C-反应蛋白(C-reactive protein,CRP)、血乳酸(lactic acid,Lac)、白细胞介素-6(interleukin-6,IL-6)及序贯器官衰竭评分(sequential organ failure assessment,SOFA)、急性生理学及慢性健康状况评估系统Ⅱ(acute physiology and chronic health evaluationⅡ,APACHEⅡ)评分对脓毒症患者28 d死亡的预测能力。方法以2018年12月1日至2020年12月1日中国康复研究中心急诊科收治的脓毒症患者为研究对象。根据患者28 d是否存活分为存活组和死亡组,比较两组的临床特征。采用Logistic回归分析探讨脓毒症患者28 d死亡的危险因素。分别绘制各指标及MR-proADM联合SOFA评分或APACHEⅡ评分对患者28 d死亡的受试者工作特征(receiver operating characteristic,ROC)曲线,计算相应的曲线下面积(area under curve,AUC)。结果共纳入205例脓毒症患者,28 d病死率为40.1%(84/205)。与存活组比较,死亡组患者MR-proADM浓度明显升高。多元回归分析显示,MR-proADM、机械通气(mechanical ventilation,MV)、SOFA评分及APACHEⅡ评分是脓毒症患者28 d死亡的独立危险因素。ROC曲线分析提示,MR-proADM对患者28 d死亡的预测能力最强,当MR-proADM分别与SOFA评分或APACHEⅡ评分相结合,预测能力明显提高。结论MR-proADM联合危重症评分能有效评估脓毒症患者的预后,优化患者早期治疗策略。Objective To compare the predictive ability of mid-regional proadrenomedullin(MR-proADM),C-reactive protein(CRP),lactic acid(Lac),interleukin-6(IL-6),sequential organ failure assessment(SOFA)score,acute physiological and chronic health evaluation(APACHE)Ⅱscore on 28-day death in the patients with sepsis.Methods Sepsis patients admitted in emergency department of China Rehabilitation Research Center from December 1,2018 to December 1,2020 were taken as the research objects.According to 28-day prognosis,they were divided into survival group and death group,and the clinical characteristics of two groups were compared.Logistic regression analysis was used to explore the risk factors of 28-day death in the patients with sepsis.The receiver operating characteristic(ROC)curves of each indicator and MR-proADM combined with SOFA score or APACHEⅡscore for 28-day prognosis of patients were drawn respectively and the corresponding areas under the curve(AUC)were calculated.Results 205 patients with sepsis were included,and the 28-day mortality was 40.1%(84/205).The concentration of MR-proADM in the death group was significantly higher than that in the survival group.Multivariate regression analysis showed that MR-proADM,mechanical ventilation(MV),SOFA score and APACHEⅡscore were independent risk factors for 28-day death in the patients with sepsis.ROC curve analysis showed that MR-proADM had the strongest predictive ability for 28-day death.When MR-proADM was combined with SOFA score and APACHEⅡscore respectively,the predictive ability was significantly improved.Conclusions MR-proADM combined with SOFA score or APACHEⅡscore can effectively evaluate the prognosis of patients with sepsis and optimize the early treatment strategy for the patients.

关 键 词：肾上腺髓质中段肽(MP-proADM) 序贯器官衰竭评分(SOFA) 急性生理学及慢性健康状况评估系统Ⅱ(APACHEⅡ) 脓毒症 预后 

分 类 号：R459.7[医药卫生—急诊医学]