血浆纤溶酶原激活剂抑制物-1联合C反应蛋白与白蛋白比值对老年脓毒症患者28天预后的评估价值  

Evaluation value of plasminogen activator inhibitor-1 combined with C-reactive protein to albumin ratio for 28-day prognosis in elderly patients with sepsis

作　　者：张雅静 韩雪[1] ZHANG Yajing;HAN Xue(Department of Emergency,Beijing Jingmei Group General Hospital,Beijing 102300,China)

机构地区：[1]北京京煤集团总医院急诊科,北京102300

出　　处：《贵州医科大学学报》2024年第1期134-138,144,共6页Journal of Guizhou Medical University

基　　金：北京京煤集团总医院院级科研基金项目(2020-16)。

摘　　要：目的 探讨纤溶酶原激活剂抑制物-1(PAI-1)联合C反应蛋白与白蛋白比值(CAR)对老年脓毒症患者28 d预后的预测价值。方法 90例老年脓毒症患者作为研究组,30名同期老年体检健康者作为对照组;比较研究组入院次日、对照组体检当日的血浆PAI-1水平和CAR,记录研究组的白细胞计数、血小板计数及淋巴细胞计数,计算序贯器官衰竭评分(SOFA)和急性生理学与慢性健康状况评分Ⅱ(APACHEⅡ);分析老年脓毒症患者血浆PAI-1水平和CAR与病情严重程度的相关性,不同预后(根据患者28 d的生存结局分为生存组和死亡组)老年脓毒症患者一般资料、实验室指标及血浆PAI-1水平和CAR,采用多因素logistic回归分析影响老年脓毒症患者28 d预后的独立危险因素,采用受试者工作特征(ROC)曲线下面积(AUC)评价血浆PAI-1、CAR对老年脓毒症患者入院28 d预后的预测价值。结果 研究组血浆PAI-1水平和CAR均高于对照组,差异有统计学意义(P<0.05);老年脓毒症患者血浆PAI-1、CAR与SOFA评分、APACHEⅡ评分分别呈正相关关系(P<0.05);28天内,老年脓毒症患者死亡31例(34.44%)、存活59例(65.56%),生存组的淋巴细胞计数高于死亡组,SOFA评分、血浆PAI-1水平及CAR低于死亡组(P<0.05);多因素logistic回归分析结果表明血浆PAI-1水平和CAR是影响老年脓毒症患者28 d预后的独立危险因素(P<0.05),ROC曲线分析结果显示,血浆PAI-1、CAR及两者联合预测老年脓毒症患者28 d内死亡的AUC分别为0.752(95%CI为0.642~0.862,P<0.001),0.842(95%CI为0.745~0.939,P<0.001)及0.887(95%CI为0.796~0.977,P<0.001)。结论 老年脓毒症患者的血浆PAI-1水平和CAR升高,两者联合对患者28 d预后具有较好的预测价值。Objective To investigate predictive value of plasminogen activator inhibitor-1(PAI-1)combined with C-reactive protein to albumin ratio(CAR)for 28-day prognosis in elderly patients with sepsis.Methods A total of 90 elderly patients with sepsis were selected as study group,and 30 healthy elderly individuals who underwent physical examinations during the same period were selected as control group.Plasma PAI-1 level and CAR were compared between study group on the day after admission and control group on the day of physical examination.Leukocyte count,platelet count and lymphocyte count of study group were recorded.Sequential Organ Failure Score(SOFA)and Acute Physiology and Chronic Health EvaluationⅡ(APACHEⅡ)score were calculated.The association of plasma PAI-1 levels and CAR with the severity of the elderly patients with sepsis were analyzed.Using general information of survival and death groups of the elderly patients with sepsis(based on their 28-day survival outcome),laboratory indexes,plasma PAI-1,and CAR,multiple logistic regression analysis was used to identify independent risk factors affecting the 28-day prognosis of elderly sepsis patients.The predictive values of plasma PAI-1 and CAR on the 28-day prognosis of the elderly patients with sepsis were evaluated using the area under the receiver operating characteristic(ROC)curve(AUC).Results Plasma PAI-1 level and CAR in study group were higher than those in control group(P<0.05).There were significantly positive associations of plasma PAI-1,CAR,and SOFA score with APACHEⅡscore in the elderly patients with sepsis,respectively(P<0.05).Within 28 days,31 elderly patients with sepsis died(34.44%)and 59 survived(65.56%).Lymphocyte count in survival group was higher than that in death group,while SOFA score,plasma PAI-1 level and CAR were lower than those in death group(P<0.05).Multivariate logistic regression analysis showed that plasma PAI-1 level and CAR were independent risk factors affecting the 28-day prognosis of the elderly patients with sepsis(P<0.05

关 键 词：老年患者 脓毒症 纤溶酶原激活剂抑制物-1 C反应蛋白/白蛋白比值 预后 

分 类 号：R466.11[医药卫生—临床医学]