皮质醇水平轨迹分析识别脓毒症新亚型  

Identification of new subtypes of sepsis by cortisol level trajectory analysis

作　　者：冷斐 林世龙 韩霏 钟鸣 吴威 LENG Fei;LIN Shi-long;HAN Fei;ZHONG Ming;WU Wei(Department of Intensive Care Medicine,Zhongshan Hospital,Fudan University,Shanghai 200032,China)

机构地区：[1]复旦大学附属中山医院重症医学科,上海200032

出　　处：《中国临床医学》2022年第4期549-553,共5页Chinese Journal of Clinical Medicine

基　　金：上海市浦江人才计划(21PJD009).

摘　　要：目的采用纵向血浆皮质醇水平轨迹识别脓毒症患者的新亚型。方法回顾性选择2019年3月至2021年8月于复旦大学附属中山医院重症医学科住院治疗的成人脓毒症患者96例,在入组后第1~3个晨8时和第1、2个下午4时采集患者血液,分析皮质醇浓度变化轨迹。根据轨迹潜在类别分析结果将患者分组,比较不同组基础情况、疾病严重程度、实验室检查及临床结局(如住院时间、死亡率)等。结果96例脓毒症患者中位年龄68岁,以男性患者为主(68.8%)。诱发脓毒症的原发病以腹部感染为主(83.3%),而合并症以肿瘤居多(61.5%),特别是肠道肿瘤。根据皮质醇水平轨迹,将患者分为皮质醇水平由较高浓度逐渐回落组(回落组,n=33)和在正常范围且波动较为稳定组(稳定组,n=63)。回落组入组时病情更重,序贯器官衰竭评分(SOFA)分值[8(6,11)分vs 6(4,8)分]及APACHEⅡ评分[20(15,23)分vs 15(11,18)分]高于稳定组(P<0.01)。回落组28 d死亡率(42.4%vs 17.4%)和90 d死亡率(45.5%vs 22.2%)明显高于稳定组(P<0.05)。结论依据血浆皮质醇水平轨迹有助于建立新的脓毒症亚型,进而辅助诊治。Objective To explore the identification of new subtypes of sepsis by longitudinal plasma cortisol level trajectories.Methods 96 adult patients with sepsis who were hospitalized in the department of critical care medicine of Zhongshan Hospital,Fudan University from March 2019 to August 2021 were retrospectively selected.The blood of the patients was collected at 8:00 a.m.on the first,second and third day and 4:00 p.m.on the first and second day after enrollment,and the cortisol concentration change trajectory was analyzed.The patients were divided into groups according to the potential categories of cortisol level trajectories,and the basic conditions,disease severity,laboratory tests and clinical outcomes(hospitalization time,mortality,etc.)of different groups were compared.Results Among the 96 patients with sepsis,the majority were male(68.8%),with a median age of 68 years.Among the primary deseases inducing sepsis,abdominal infection was main(83.3%),while most of the complications were tumors(61.5%),especially intestinal tumors.According to the analysis result of cortisol level trajectories,the patients were divided into two groups:the cortisol level gradually decreased from a higher concentration(falling group,n=33)and the group with normal range and relatively stable fluctuation(stable group,n=63).The patients in the falling group were more serious when they were enrolled.The sequential organ failure assessment(SOFA)score(8[6,11]vs 6[4,8])and APACHEⅡscore(20[15,23]vs 15[11,18])were higher than those in the stable group(P<0.01).The mortality rate at 28 day(42.4%vs 17.4%)and at 90 day(45.5%vs 22.2%)in the falling group were significantly higher than those in the stable group(P<0.05).Conclusion According to plasma cortisol level trajectory,a new subtype of sepsis can be established,in further to assist diagnosis and treatment.

关 键 词：脓毒症 血浆皮质醇 群组轨迹建模 潜在类别分析 

分 类 号：R631.2[医药卫生—外科学]