血浆游离DNA和降钙素原及序贯器官衰竭评分对脓毒性休克患者预后的预测价值  

Predictive value of plasma cell-free DNA,procalcitonin and sepsis related organ failure assessment score in the prognosis of patients with septic shock

作　　者：黄天宝[1] 杨志燕[1] 陈少剑[1] 杜清珍 王文源 陈金图[1] Huang Tianbao;Yang Zhiyan;Chen Shaojian;Du Qingzhen;Wang Wenyuan;Chen Jintu(Emergency Center,the First Hospital of Quanzhou Affiliated to Fujian Medical University,Quanzhou 362000,Fujian,China)

机构地区：[1]福建医科大学附属泉州第一医院急救中心,福建泉州362000

出　　处：《中国中西医结合急救杂志》2022年第1期27-30,共4页Chinese Journal of Integrated Traditional and Western Medicine in Intensive and Critical Care

基　　金：福建省泉州市科技计划项目(2015Z96)。

摘　　要：目的 探讨血浆游离DNA(cf-DNA)、降钙素原(PCT)、序贯器官衰竭评分(SOFA)对脓毒性休克患者预后的预测能力.方法 选择2016年6月至2021年6月福建医科大学附属泉州第一医院急救中心收治的180例脓毒症患者为研究对象,收集患者入院时的cf-DNA、PCT及入院24 h内的SOFA评分.采用Bivariate法分析cf-DNA与PCT、SOFA评分的相关性;绘制受试者工作特征曲线(ROC曲线),分析cf-DNA、PCT、SOFA评分单独及联合预测脓毒性休克预后的能力.结果 180例患者中,脓毒症组122例,脓毒性休克组58例;脓毒性休克患者中,存活组39例,死亡组19例.脓毒性休克组血浆cf-DNA、PCT和SOFA评分均明显高于脓毒症组 〔cf-DNA(μg/L):3009(2517,3520)比1949(1692,2323),PCT(μg/L):21.90(16.13,27.14)比12.95(9.69,17.23),SOFA评分(分):9.56(7.91,11.77)比5.07(2.97,7.15),均P<0.05〕.脓毒性休克存活组患者血浆cf-DNA、PCT、SOFA评分均明显低于死亡组〔cf-DNA(μg/L):2589(1971,2756)比3519(3301,3840),PCT(μg/L):16.46(14.26,19.94)比26.60(22.88,31.26),SOFA评分(分):8.27(7.47,9.60)比11.14(9.83,12.37),均P<0.05〕.相关性分析显示,脓毒症患者cf-DNA与PCT呈强相关性〔r=0.697,95%可信区间(95%CI)为0.596~0.776,P<0.001〕,与SOFA呈强相关性(r=0.706,95%CI为0.607~0.783,P<0.001).ROC曲线分析显示,单独预测时,SOFA评分预测脓毒性休克患者预后的曲线下面积(AUC)最大,达0.938(95%CI为0.894~0.981);cf-DNA次之,AUC为0.923(95%CI为0.874~0.973);PCT的AUC为0.911(95%CI为0.860~0.962).联合预测时,cf-DNA联合PCT或SOFA评分可进一步增加AUC,且三者联合时的AUC最大,达0.993(95%CI为0.985~1.000).结论 血浆cf-DNA、PCT、SOFA评分对脓毒性休克患者的预后均具有一定预测价值,单独预测时cf-DNA与SOFA评分相当,而三者联合可进一步提高其预测能力.Objective To explore the predictive value of plasma cell-free DNA(cf-DNA),procalcitonin(PCT)and sequential organ failure assessment(SOFA)score in the prognosis of patients with septic shock.Methods A total of 180 sepsis patients admitted to the emergency center of Quanzhou First Hospital Affiliated to Fujian Medical University from June 2016 to June 2021 were selected as the research objects.The cf-DNA and PCT were collected immediately on admission,and the SOFA scores were collected within 24 hours after admission.Bivariate analysis was used to examine the correlations between cf-DNA and PCT,SOFA score,fhe receiver operator characteristic curve(ROC curve)was drawn,and the predictive powers of cf-DNA,PCT and SOFA for the prognosis of septic shock alone and in combination,were analyzed respectively.Results Among the 180 patients,122 were in the sepsis group and 58 in the septic*shock group;among the septic shock patients,39 were in the survival group and 19 in the death group.The plasma cf-DNA,PCT and SOFA scores in septic shock group were signifit anily higher than those in sepsis group[cf-DNA(μg/L):3009(2517,3520)vs.1949(1692,2323),PCT(μg/L):21.90(16.13,27.14)vs.12.95(9.69,17.23),SOFA:9.56(7.91,11.77)vs.5.07(2.97,7.15),all P<0.05].The plasma cf-DNA,PCT and SOFA scores in the survival group of septic shock were significantly lower than those in the death group[cf-DNA(μg/L):2589(1971,2756)vs.3519(3301.3840),PCT(μg/L):16.46(14.26,19.94)vs.26.60(22.88,31.26),SOFA:8.27(7.47,9.60)vs.11.14(9.83,12.37),all P<0.05].Correlation analysis showed that cf-DNA was strongly correlated with PCT[r=0.697.95%confidence interval(95%CZ)was 0.596-0.776,P<0.001]and SOFA(r=0.706,95%CI was 0.607-0.783,P<0.001).ROC curve analysis showed that when predicted alone,the AUC of SOFA score in predicting the prognosis of patients with septic shock was the largest,up to 0.938(95%CI was 0.894-0.981);the area under ROC curve(AUC)of cf-DNA was 0.923(95%CI was 0.874-0.973);the AUC of PCT was 0.911(95%CI was 0.860-0.962).When cf-DNA was combined w

关 键 词：脓毒性休克 血浆游离DNA 降钙素原 序贯器官衰竭评分 

分 类 号：R47[医药卫生—护理学]