血清钙联合降钙素原对脓毒症并发急性呼吸窘迫综合征患者病情及预后评估的作用  

Serum Calcium Combined with Procalcitonin Complicates Sepsis Assessment and Prognosis of Patients with Acute Respiratory Distress Syndrome

作　　者：张烨 王历 汤冬玲[1] 张平安[1] ZHANG Ye;WANG Li;TANG Dong-ling;ZHANG Ping’an(Department of Clinical Laboratory,Renmin Hospital of Wuhan University,Wuhan 430060,China)

机构地区：[1]武汉大学人民医院检验科,武汉430060

出　　处：《微循环学杂志》2024年第4期56-61,共6页Chinese Journal of Microcirculation

基　　金：湖北省卫健委面上科研项目(WJ2023M073)。

摘　　要：目的:探讨脓毒症合并不同严重程度急性呼吸窘迫综合征(ARDS)患者血清钙和降钙素原(PCT)水平变化和临床价值。方法:收集2022-01-2023-12武汉大学人民医院重症医学科、呼吸重症科及感染科的199例脓毒症合并ARDS患者的临床资料进行回顾性分析。依据入院28天内的生存情况将患者分为生存组(n=98)和死亡组(n=101),根据ARDS严重程度分为轻度组(n=63)、中度组(n=73)和重度组(n=63)。比较死亡组和生存组的临床资料及实验室检测指标,不同严重程度ARDS患者的脓毒症指标、ARDS指标及血清钙水平,并运用受试者工作特征(ROC)曲线分析血清钙和PCT水平对脓毒症合并ARDS患者预后预测的价值。结果:死亡组序贯器官衰竭估计(SOFA)评分、PCT及氨基端前脑钠素(NT-proBNP)高于生存组,氧合指数(OI)、血氧分压(PaO_(2))、碳酸氢根离子(HCO_(3)^(-))、白细胞计数(WBC)及血清钙均明显低于生存组,且死亡组与生存组脓毒性休克占比差异有统计学意义(均P<0.05)。方差分析显示,轻度组组患者血清钙、PaO_(2)和OI水平低于中度组和重度组,重度组PCT和SOFA评分高于中度组和轻度组(P<0.05)。多因素Logistic回归分析表明,血清钙水平降低(OR=0.032,95%CI 0.002-0.662,P=0.026)、SOFA评分升高(OR=1.328,95%CI 1.097-1.607,P=0.004)是脓毒症并发ARDS患者死亡的独立危险因素(均P<0.05)。ROC曲线分析提示,血清钙、PCT以及两者联合预测脓毒症合并ARDS患者预后不良的曲线下面积(AUC)依次为0.650、0.689、0.721。结论:脓毒症并发ARDS患者血清钙水平降低,PCT水平升高,二者对脓毒症并发ARDS患者的严重程度及预后评估有一定价值。Objective:To investigate the expression and clinical value of serum calcium and procalcitonin(PCT)in patients with acute respiratory distress syndrome(ARDS)of different severity in sepsis.Method:The clinical data of 199 patients with sepsis complicated with ARDS from Department of Intensive Care Medicine,Department of Respiratory Intensive Care and Department of Infectious Diseasefrom 2022 to 2020 were retrospectively analyzed.The patients were divided into survival group(n=98)and death group(n=101)according to the survival conditions within 28 days after admission,and were divided into mild group(n=63),moderate group(n=73)and severe group(n=63)according to the severity of ARDS.The clinical data,laboratory indicators,sepsis indicators,ARDS indicators and serum calcium levels of ARDS patients with different severity were compared between the death group and the survival group.The value of serum calcium and PCT levels in predicting prognosis of ARDS patients with sepsis was analyzed by receiver operating characteristic(ROC)curve.Results:SOFA score,PCT and NT-proBNP in the death group were higher than those in the survival group,oxygenation index(OI),blood oxygen partial pressure(PaO_(2)),bicarbonate ion(HCO_(3)^(-)),WBC and serum calcium were significantly lower than those in the survival group.There was significant difference in the proportion of septic shock between the death group and the survival group(all P<0.05).The levels of serum calcium,PaO_(2) and OI in mild group were significantly lower than those in moderate and severe groups,and the scores of PCT and SOFA in severe group were significantly higher than those in moderate and mild groups(P<0.05).Multivariate Logistic regression analysis showed that serum calcium levels decreased(OR=0.032,95%CI 0.002-0.662,P=0.026)and SOFA scores increased(OR=1.328,95%CI 1.097-1.607,P=0.004)was an independent risk factor for death in patients with sepsis complicated with ARDS(all P<0.05).ROC curve analysis indicated that the AUC of serum calcium,PCT and their combination

关 键 词：急性呼吸窘迫综合征 脓毒症 血清钙 降钙素原 

分 类 号：R515.3[医药卫生—内科学]