脓毒症血液净化疗法对血清PCT、FDP和HBP的影响及其预后评估  

Effect of blood purification therapy on serum PCT, FDP and HBP of sepsis patients and assessment of prognosis

作　　者：金丽英 戴淑露 孟叶彩 王益斐 刘丽娜 JIN Li-ying;DAI Shu-lu;MENG Ye-cai;WANG Yi-fei;LIU Li-na(Zhuji Hospital of Traditional Chinese Medicine,Zhuji,Zhejiang 311800,China;不详)

机构地区：[1]浙江省诸暨市中医医院血液净化中心,浙江诸暨311800 [2]浙江省诸暨市人民医院肾内科,浙江诸暨311800 [3]浙江省诸暨市中医医院肾内科,浙江诸暨311800 [4]浙江省诸暨市中医医院ICU,浙江诸暨311800

出　　处：《中华医院感染学杂志》2023年第8期1182-1186,共5页Chinese Journal of Nosocomiology

基　　金：浙江省中医药优秀青年人才基金资助项目(2019ZQ044)。

摘　　要：目的探讨血液净化治疗脓毒症患者早期血清降钙素原(PCT)、纤维蛋白降解产物(FDP)、肝素结合蛋白(HBP)变化及其对短期预后的预测价值。方法选择2019年1月-2020年12月浙江省诸暨市中医医院90例诊断为脓毒症患者作为研究对象,采用随机数字法平均分为净化组与常规组两组,其中净化组患者给予血液净化治疗,常规组给予常规治疗,比较两组患者临床疗效,于治疗前与治疗后1、5、7 d检测PCT、HBP、FDP水平。随访28 d根据是否出现短期死亡(28 d病死率)分为死亡组与存活组,采用受试者工作特征(ROC)曲线分析不同指标的预测价值。结果净化组从治疗后1 d开始WBC、PCT、HBP、CRP、FDP逐渐降低(P<0.05);常规组从治疗后5 d开始逐渐降低(P<0.05)。治疗后1、5、7 d净化组WBC、PCT、HBP、CRP、FDP均低于常规组(P<0.05)。两组患者SOFA评分及APACHEⅡ评分均从治疗后5 d开始逐渐降低(P<0.05);治疗后5、7 d净化组SOFA评分及APACHEⅡ评分均低于常规组(P<0.05)。90例脓毒症患者28 d内死亡26例,占28.89%,其中净化组死亡8例,常规组死亡18例。年龄、治疗后1 d PCT、HBP、CRP、FDP各指标联合预测的ROC曲线下面积(AUC)为0.881,灵敏度为91.22%,特异度为85.03%。结论积极采取血液净化治疗有利于进一步减轻脓毒症患者炎症反应,纠正凝血功能异常,从而促进患者的康复,提高存活率,延长生存时间,治疗中注意对各研究指标尤其是PCT、HBP、FDP及CRP进行监测,可能有助于血液净化效果评价及短期预后的预测及进一步指导临床治疗。OBJECTIVE To investigate the changes of serum procalcitonin(PCT), fibrin degradation products(FDP), and heparin binding protein(HBP) in the early stage of sepsis patients treated with blood purification and their predictive value in short-term prognosis. METHODS A total of 90 patients diagnosed with sepsis in Zhuji Hospital of Traditional Chinese Medicine in Zhejiang Province from Jan 2019 to Dec 2020 were recruited. They were equally divided into the purification group and the conventional group by using the random number method. The patients in the purification group were given blood purification treatment, and those in the conventional group were given conventional treatment. The clinical effects in the two groups were compared. The levels of PCT, HBP, and FDP were measured before treatment, on the 1st, 5th, and 7th days after treatment. The patients were followed up for 28 d and divided into the death group and survival group according to whether short-term death occurred(mortality of 28 d). The predictive value of different indicators were analyzed by using receiver operating characteristic(ROC) curve. RESULTS Levels of WBC, PCT, HBP, CRP, and FDP in the purification group gradually decreased one day after treatment(P<0.05). The level of serum IL-6 in the conventional group gradually decreased after 5 days of treatment(P<0.05). The levels of WBC, PCT, HBP, CRP, and FDP in the purification group were lower than those in the conventional group on the1st day, 5th day and 7th day after treatment(P<0.05). The SOFA score and APACHEⅡ score in the two groups gradually decreased on the 5th day after treatment(P<0.05). The SOFA and APACHEⅡ scores in the purification group were lower than those in the conventional group on the 5th and 7th day after treatment(P<0.05). Among the 90 sepsis patients, 26 cases(28.89%) died within 28 d, including 8 cases in the purification group and 18 cases in the routine group. The area under the ROC curve(AUC) of the combined detection of PCT, HBP, CRP and FDP was 0.881, with the sen

关 键 词：脓毒症 血液净化治疗 降钙素原 纤维蛋白降解产物 肝素结合蛋白 短期预后 预测价值 

分 类 号：R631.1[医药卫生—外科学]