AVpH联合血清sCD14-ST、LDH预测感染性休克严重程度及预后的临床意义  

Clinical significance of AVpH combined with serum sCD14-ST and LDH in predicting the disease severity and prognosis of septic shock

作　　者：柴华[1] 赵婷 杨福顺[1] 张玲[1] CHAI Hua;ZHAO Ting;YANG Fushun;ZHANG Ling(Department of Emergency,People’s Hospital of Ningxia Hui Autonomous Region,Yinchuan 750002,China)

机构地区：[1]宁夏回族自治区人民医院急诊科,宁夏银川750002

出　　处：《宁夏医学杂志》2022年第5期432-435,共4页Ningxia Medical Journal

摘　　要：目的研究动-静脉血pH差值(AVpH)联合血清可溶性脂多糖受体亚型(sCD14-ST)及乳酸脱氢酶(LDH),在预测感染性休克严重程度及预后中的价值。方法将35例脓毒症休克患者纳为观察组,53例脓毒症未发生休克患者纳为对照组。采集被研究者进入ICU第1天外周血,检测血清sCD14-ST、LDH及降钙素原(PCT)水平,监测患者中心静脉血气,检测AVpH水平。分析以上指标在评估脓毒症休克患者病情严重程度及预后中的价值。结果观察组急性生理与慢性健康状况评分(APACHEⅡ)、序贯器官衰竭评分(SOFA)及血清PCT水平均显著高于对照组(t=7.294,13.812,7.958,P<0.05);观察组患者AVpH及血清sCD14-ST、LDH水平均显著高于对照组(t=3.518,6.533,3.912,P<0.05)。相关性分析提示,观察组AVpH及血清sCD14-ST、LDH水平与其APACHEⅡ及SOFA评分、血清PCT水平均呈正相关(P<0.05)。观察组28d死亡率为57.14%,显著高于对照组的30.19%(χ^(2)=6.335,P<0.05),35例观察组中死亡者AVpH及血清sCD14-ST、LDH水平均显著高于存活者(t=7.978、7.787、2.972,P<0.05)。绘制ROC曲线提示,AVpH及血清sCD14-ST、LDH单独应用时,以血清sCD14-ST预测脓毒症休克患者28d内死亡的效能最高,AUC=0.869,95%CI(0.789~0.948),而AVpH与LDH在预测脓毒症休克死亡中的效能相似。三者联合应用可有效提高各指标单独应用时的效能,AUC=0.905,95%CI(0.841~0.970)。结论AVpH、血清sCD14-ST及LDH水平在反映脓毒症休克患者病情严重程度及预后中均具有良好价值。Objective To investigate the clinical significance of arteriovenous pH(AVpH)combined with serum soluble lipopolysaccharide receptor CD14 subtype(sCD14-ST)and lactate dehydrogenase(LDH)in predicting the disease severity and prognosis of septic shock.Methods Thirty-five patients with sepsis(shock observation group)and 53 patients with sepsis(control group)in ICU were prospectively enrolled.Peripheral blood was collected at the first day after the patients entered the ICU,serum sCD14-ST,LDH and procalcitonin(PCT)levels were detected;The patients’central venous blood was collected to detect AVpH level and then the value of the above indicators in evaluating the severity and prognosis of patients with septic shock were analyzed.Results Acute Physiology and Chronic Health EvaluationⅡ(APACHEⅡ)score,Sequential Organ Failure Assessment(SOFA)score and serum PCT levels of observation group were significantly higher than those in control group(t=7.294,13.812,7.958,all P<0.05).The AVpH,serum sCD14-ST and LDH levels of observation group were significantly higher than those in control group(t=3.518,6.533,3.912,P<0.05).Correlation analysis showed that AVpH,serum sCD14-ST and LDH levels in observation group were positively correlated with their APACHEⅡscore,SOFA score and serum PCT levels(P<0.05).The 28d mortality rate of observation group was significantly higher than that of control group(57.14%vs 30.19%,χ^(2)=6.335,P<0.05).In observation group,the AVpH,serum sCD14-ST and LDH levels of the dead patients were significantly higher than those of the survivors(t=7.978,7.787,2.972,all P<0.05).Among the single detection,serum sCD14-ST had the highest efficacy in predicting the 28d mortality rate of sepsis shock patients[AUC=0.869,95%CI(0.789~0.948)],and the predictive efficacy of AVpH and LDH was similar,meanwhile,the predictive efficacy of combined detection was significantly higher than that of single detection[AUC=0.905,95%CI(0.841~0.970)].Conclusion AVpH,serum sCD14-ST and LDH are of great value in reflecting the severit

关 键 词：动-静脉血pH差值 血清可溶性脂多糖受体亚型 乳酸脱氢酶 感染性休克 预后分析 

分 类 号：R441.9[医药卫生—诊断学]