灌注边界区域联合快速序贯器官衰竭评分对脓毒症的早期诊断价值  

Early diagnostic value of PBR combined with qSOFA in sepsis

作　　者：罗许 刘善收 王欢 龚阳 代峥 栗裕 李文秀 付传庆 尹文 Luo Xu;Liu Shanshou;Wang Huan;Gong Yang;Dai Zheng;Li Yu;Li Wenxiu;Fu Chuanqing;Yin Wen(Emergency Department,the First Affiliated Hospital of Air Force Military Medical University,Xi'an 710032,China)

机构地区：[1]空军军医大学第一附属医院急诊科,陕西西安710032

出　　处：《中国急救医学》2023年第11期880-886,共7页Chinese Journal of Critical Care Medicine

基　　金：国家自然科学基金项目(81871587)。

摘　　要：目的 评估灌注边界区域(PBR)联合快速序贯器官衰竭评分(qSOFA)对脓毒症的早期诊断价值。方法 空军军医大学西京医院急诊科收治的58例感染或疑诊感染患者为研究对象,按照在观察期间是否符合脓毒症诊断标准,分为脓毒症组(n=30)和非脓毒症组(n=28),同时入选10名健康志愿者为健康对照组。各组患者均在入院24小时内通过舌下微循环成像系统获取舌下微循环图像以评估PBR,留取外周血样用于检测相关炎症及糖萼损伤标志物,并收集患者24小时人口统计学变量、实验室检查数据和生理指标。结果 采用倾向评分匹配年龄分布不均衡后,保留样本58例,其中脓毒症组30例,非脓毒症组28例;同时设置健康对照组10例。ROC曲线评估qSOFA(AUC为0.731,95%CI 0.599~0.863,P=0.003)诊断脓毒症的敏感度为53.3%,特异度为92.9%。Kruskal-Wallis检验显示,脓毒症组PBR较非脓毒症组显著增高[2.87(2.75,2.96) vs.2.63(2.35,2.77),P=0.004]。ROC曲线评估PBR(AUC为0.783,95%CI 0.663~0.903,P=0.000)对脓毒症有一定诊断价值,计算样本截断点为2.685μm,敏感度为86.7%,特异度为64.3%。PBR联合qSOFA(AUC为0.851%,95%CI 0.753~948,P=0.000)的诊断价值较qSOFA有一定提升(Z=-2.756,P=0.006),诊断敏感度为83.3%,特异度为71.4%。结论 脓毒症患者早期PBR较非脓毒症患者显著增高,PBR联合qSOFA有助于更准确识别脓毒症,利于临床医生及时干预。Objective To evaluate the early diagnostic value of perfusion boundary region(PBR)combined with quick sequential organ failure assessment(qSOFA)in sepsis.Methods 58 patients with infection or suspected infection admitted to emergency department of Xijing Hospital of Air Fore Military Medical University were selected as the research objects.According to whether they met the diagnostic criteria of sepsis during the observation period,the patients were divided into sepsis group(n=30)and non-sepsis group(n=28),and 10 healthy volunteers were selected as the healthy control group.Sublingual microcirculation images were obtained by sublingual microcirculation imaging system within 24 hours of admission in all groups to evaluate PBR.Peripheral blood samples were also collected to detect the markers of inflammation and glycocalyx damage.24-hour demographic variables,laboratory test data and physiological indicators were collected.Results After matching age distribution with propensity score,58 cases were retained,including 30 cases in sepsis group and 28 cases in non-sepsis group.At the same time,10 healthy control cases were set up.The diagnostic value of qSOFA(AUC=0.731,95%CI 0.599-0.863,P=0.003)was evaluated by ROC curve.The diagnostic sensitivity and specificity were 53.3%and 92.9%respectively.Kruskal-Wallis test indicated that PBR in sepsis group was significantly higher than that in non-sepsis group[2.87(2.75,2.96)vs.2.63(2.35,2.77)P=0.004].PBR evaluated by ROC curve(AUC=0.783,95%CI 0.663-0.903,P=0.000)has certain diagnostic value for sepsis,with sample cut-off point of 2.685μm,the sensitivity of 86.7%,the specificity of 64.3%.The ROC curve of PBR combined with qSOFA showed that the diagnostic value of PBR+qSOFA(AUC=0.851,95%CI 0.753-948,P=0.000)was improved compared with qSOFA(Z=-2.756,P=0.006),the diagnostic sensitivity was 83.3%,and the specificity was 71.4%.Conclusions The PBR of sepsis patients is significantly higher than that of non-sepsis patients at the early stage.PBR combined with qSOFA is helpful to ide

关 键 词：脓毒症 早期诊断 灌注边界区域(PBR) 快速序贯器官衰竭评分(qSOFA) 

分 类 号：R459.7[医药卫生—急诊医学]