感染性休克患者血管加压素水平变化与病情程度及预后的关系  

Relationship between the changes in vasopressin level and disease severity and prognosis in patients with septic shock

作　　者：王春玲[1] 张卓[2] 赵景[1] 周庆明[3] 王莉莎 WANG Chunling;ZHANG Zhuo;ZHAO Jing;ZHOU Qingming;WANG Lisha(Center of Clinical Laboratory,the First Hospital of Hebei Medical University,Shijiazhuang,Hebei 050030,China;Department of Pharmacy,the First Hospital of Hebei Medical University,Shijiazhuang,Hebei 050030,China;Department of Critical Care Medicine,the First Hospital of Hebei Medical University,Shijiazhuang,Hebei 050030,China)

机构地区：[1]河北医科大学第一医院检验中心,河北石家庄050030 [2]河北医科大学第一医院药剂科,河北石家庄050030 [3]河北医科大学第一医院重症医学科,河北石家庄050030

出　　处：《国际检验医学杂志》2024年第16期1952-1956,1961,共6页International Journal of Laboratory Medicine

基　　金：2021年度河北省医学科学研究重点课题(20210226)。

摘　　要：目的探讨感染性休克(SS)患者血管加压素(VP)水平变化与病情程度及预后的关系。方法选取2021年12月至2022年12月该院SS患者96例作为研究组,另选取同期该院的健康志愿者95例作为对照组。比较两组血浆VP水平,分析其与多器官功能障碍综合征(MODS)评分、急性生理学与慢性健康状况评分系统Ⅱ(APACHEⅡ)评分、血清C反应蛋白(CRP)、降钙素原(PCT)水平相关性。研究组接受纠正休克治疗,依据住院治疗28 d后的预后情况分为预后良好组、预后不良组,并比较两组临床资料。多因素Logistic回归分析预后不良的影响因素。分别构建新预测方案与常规预测方案,采用曲线下面积(AUC)、净重新分类指数、综合判别改善指数评价不同预测方案的预测效能。结果与对照组比较,研究组血浆VP水平明显降低,MODS评分、APACHEⅡ评分、血清CRP、PCT水平明显升高,差异有统计学意义(P<0.05)。Pearson相关性分析显示,研究组血浆VP水平与MODS评分、APACHEⅡ评分、血清CRP、PCT水平呈负相关(r=-0.426、-0.519、-0.483、-0.395,P<0.05)。预后不良组糖尿病占比、并发急性呼吸窘迫综合征(ARDS)占比、并发急性肾损伤(AKI)占比及MODS评分、APACHEⅡ评分、血清CRP、PCT水平高于预后良好组,而血浆VP水平低于预后良好组,差异有统计学意义(P<0.05)。Logistic回归分析显示,并发ARDS、并发AKI、血浆VP、MODS评分、APACHEⅡ评分、血清CRP、PCT均为SS患者预后不良的影响因素(P<0.05)。血浆VP预测SS患者预后不良的AUC为0.752,新预测方案预测SS患者预后不良的AUC大于常规预测方案预测SS患者预后不良的AUC(P<0.05)。结论SS患者血浆VP水平降低,且与病情程度密切相关,基于Logistic回归分析结果建立新预测方案,该方案对预后不良具有一定预测价值。Objective To investigate the relationship between the changes in vasopressin(VP)level and disease severity and prognosis in patients with septic shock(SS).Methods A total of 96 patients with SS in the hospital from December 2021 to December 2022 were selected as the study group,and 95 healthy volunteers in the hospital during the same period were selected as the control group.The plasma VP levels of the two groups were compared,and their correlation with multiple organ dysfunction syndrome(MODS)score,acute physiology and chronic health evaluationⅡ(APACHEⅡ)score,serum C-reactive protein(CRP),and procalcitonin(PCT)levels were analyzed.The study group received shock treatment,and was divided into a good prognosis group and a poor prognosis group based on the prognosis after 28 days of hospitalization.The clinical data of the two groups were compared.Multivariate Logistic regression analysis was used to analyze the factors affecting poor prognosis.A new prediction scheme and a conventional prediction scheme were constructed,and the predictive efficacy of different prediction schemes was evaluated using area under the curve(AUC),net reclassification index and comprehensive discrimination improvement index.Results Compared with the control group,the plasma VP level in the study group was significantly decreased,and MODS score,APACHEⅡscore,the levels of serum CRP and PCT were significantly increased,with statistical significance(P<0.05).Pearson correlation analysis showed that plasma VP level was negatively correlated with MODS score,APACHEⅡscore,serum CRP and PCT level(r=-0.426,-0.519,-0.483,-0.395,P<0.05).The proportion of diabetes mellitus,acute respiratory distress syndrome(ARDS),acute kidney injury(AKI),MODS score,APACHEⅡscore,serum CRP and PCT levels in the poor prognosis group were higher than those in the good prognosis group,while the plasma VP level was lower than that in the good prognosis group,with statistical significance(P<0.05).Logistic regression analysis showed that concurrent ARDS,concurrent

关 键 词：感染性休克 血管加压素 预后 多器官功能障碍综合征 

分 类 号：R459.7[医药卫生—急诊医学]