细胞因子、经皮氧分压/吸入氧浓度联合危重评分对脓毒症患者进展为脓毒性休克及预后的预测价值  

Predictive value of cytokine,TcPO_(2)/FiO_(2) combined with critical score for septic shock and prognosis in sepsis patients

作　　者：周思颖 顾国嵘 慕婉晴 俞尧 陈东旭 孙湛 周燕南 姚晨玲 ZHOU Si-ying;GU Guo-rong;MU Wan-qing;YU Yao;CHEN Dong-xu;SUN Zhan;ZHOU Yan-nan;YAO Chen-ling(Department of Emergency,Zhongshan Hospital,Fudan University,Shanghai 200032,China)

机构地区：[1]复旦大学附属中山医院急诊科,上海200032

出　　处：《中国临床医学》2023年第3期426-431,共6页Chinese Journal of Clinical Medicine

基　　金：上海市卫生和计划生育委员会基金(201840031)。

摘　　要：目的探讨细胞因子、经皮氧分压(TcPO_(2))/吸入氧浓度(FiO_(2))及危重评分等对脓毒症患者短期进展为脓毒性休克及其28 d预后的预测价值。方法前瞻性选择2018年7月至2018年12月复旦大学附属中山医院急诊科收治的96例脓毒症患者,患者入院时均未休克。记录入院当天首次测定的TcPO_(2)/FiO_(2)、细胞因子、炎症标志物、肾功能、血乳酸等炎症及灌注相关指标;记录患者入院时急性生理学与慢性健康状况评分系统Ⅱ(APACHEⅡ)评分和序贯性器官功能衰竭评估(SOFA)评分。根据入院后7 d内是否进展为脓毒性休克分为休克组(n=14)和非休克组(n=82)。根据入院后28 d内是否死亡分为生存组(n=63)和死亡组(n=33)。采用logistic回归分析筛查脓毒症患者短期内进展为脓毒性休克和28 d内预后的危险因素,并采用受试者工作特征(ROC)曲线分析相关指标对脓毒症患者进展为脓毒性休克及28 d预后的预测价值。结果脓毒性休克组患者血白细胞计数、白介素(IL)-6、IL-8、IL-10、乳酸、血肌酐、TcPO_(2)/FiO_(2)均高于非休克组(P<0.05)。Logistic多因素回归结果显示,IL-6升高和Tc PO_(2)/FiO_(2)降低是脓毒性休克发生的独立危险因素。IL-6、Tc PO_(2)/FiO_(2)预测脓毒性休克的ROC曲线下面积(AUC)分别为0.760(95%CI 0.610~0.911)和0.813(95%CI 0.681~0.944);IL-6、TcPO_(2)/FiO_(2)联合SOFA评分预测脓毒性休克的AUC为0.937(95%CI 0.884~0.991),IL-6、TcPO_(2)/FiO_(2)联合APACHEⅡ评分预测脓毒性休克的AUC为0.880(95%CI 0.793~0.968)。白介素2受体(IL-2R)升高是脓毒症患者入院后28 d死亡的独立危险因素,其预测脓毒症患者28 d内死亡的AUC为0.705(95%CI 0.597~0.814);IL-2R联合SOFA评分预测28 d内死亡的AUC为0.702(95%CI 0.593~0.810),IL-2R联合APACHEⅡ评分预测28 d内死亡的AUC为0.729(95%CI 0.626~0.833)。结论IL-6和TcPO_(2)/FiO_(2)检测有助于早期预测脓毒性休克的发生,与SOFA或APACHEⅡ评分联合可进Objective To investigate the values of cytokines,transcutaneous partial pressure of oxygen(TcPO_(2))/fraction of inspiration oxygen(FiO_(2))and critical score in predicting short-term progression to septic shock and 28-day prognosis of patients with sepsis.Methods A total of 96 patients with sepsis admitted to the Emergency Department of Zhongshan Hospital,Fudan University from July 2018 to December 2018 were prospectively screened.According to the inclusion and exclusion criteria,96 patients with sepsis without shock at admission were enrolled.TcPO_(2)/FiO_(2),cytokines,inflammatory markers,renal function,blood lactic acid and other inflammation-related and perfusion-related indicators were detected on the day of admission.Systematic scoring was performed using the acute physiology and chronic health score Ⅱ(APACHEⅡ)system and the sequential organ failure assessment(SOFA).According to septic shock occurrence within 7 days after admission,the patients were divided into shock group(n=14)and nonshock group(n=82).According to death within 28 days after admission,the patients were divided into survival group(n=63)and death group(n=33).Logistic regression was used to analyze the influencing factors of shock and 28-day prognosis in patients with sepsis,and the receiver operating characteristic(ROC)curve was used to analyze the evaluation value of related indicators for the prognosis of patients with sepsis.Results The WBC count,cytokines(IL-6,IL-8,IL-10),lactic acid,serum creatinine,and TcPO_(2)/FiO_(2) in septic shock group were all higher than those in non-shock group(P<0.05).Multivariate logistic regression results showed that higher IL-6 and lower TcPO_(2)/FiO_(2) were independent risk factors for septic shock.The areas under curve(AUC)of IL-6 and TcPO_(2)/FiO_(2) for predicting shock in septic patients were 0.760(95%CI 0.610-0.911)and 0.813(95%CI 0.681-0.944),respectively.The AUC of IL-6,TcPO_(2)/FiO_(2) combined SOFA score to predict septic shock was 0.937(95%CI 0.884-0.991),and the AUC of IL-6,TcPO_(2)/FiO_(

关 键 词：脓毒症 脓毒性休克 经皮氧分压/吸入氧浓度 白介素6 白介素2受体 预后 

分 类 号：R631.2[医药卫生—外科学]