严重多发伤患者Lac、PCT、WBC、IL-6水平变化特点及其与继发脓毒症的关系  

Characteristics of changes in Lac,PCT,WBC and IL-6 levels in patients with severe multiple injuries and relationship to secondary sepsis

作　　者：张维 李竺娟 项涛[1] ZHANG Wei;LI Zhujuan;XIANG Tao(Department of Emergency Medicine,Chengdu Third People′s Hospital,Chengdu,Sichuan 610074,China)

机构地区：[1]四川省成都市第三人民医院急诊医学科,四川成都610074

出　　处：《检验医学与临床》2024年第24期3686-3691,共6页Laboratory Medicine and Clinic

基　　金：四川省成都市科技项目(2021-YF05-00823-SN)。

摘　　要：目的探讨严重多发伤患者乳酸(Lac)、降钙素原(PCT)、白细胞计数(WBC)、白细胞介素-6(IL-6)水平变化特点及其与继发脓毒症的关系。方法选取120例严重多发伤患者为研究对象,均于创伤后6、12、24、48、72 h检测Lac、PCT、WBC、IL-6水平。统计120例严重多发伤患者继发脓毒症情况,将继发脓毒症患者纳入脓毒症组,未继发脓毒症患者纳入非脓毒症患者,比较脓毒症组与非脓毒症组临床资料及Lac、PCT、WBC、IL-6水平,采用受试者工作特征(ROC)曲线评价急性生理与慢性健康评分系统Ⅱ(APACHEⅡ)评分、创伤严重程度(ISS)评分及Lac、PCT、WBC、IL-6水平对严重多发伤患者继发脓毒血症的预测价值。结果120例严重多发伤患者脓毒症发生率为17.50%(21/120),创伤至感染发生的时间为[44.9(29.12,73.84)]h;脓毒症组与非脓毒症组性别、年龄、受伤至入院时间及体质量指数(BMI)比较,差异均无统计学意义(P>0.05),脓毒症组APACHEⅡ及ISS评分均明显高于非脓毒症组,差异均有统计学意义(P<0.05);重复测量方差分析结果显示,脓毒症组与非脓毒症组创伤后6、12、24、48、72 h血清Lac、PCT、WBC、IL-6存在组间、时间及交互效应(P<0.05);多变量方差分析结果显示,创伤后6、12、24、48、72 h,脓毒症组Lac、PCT、WBC、IL-6水平均较非脓毒症组高,差异均有统计学意义(P<0.05)。ROC曲线分析结果显示,APACHEⅡ评分、ISS评分及创伤后24 h血清Lac、PCT、WBC、IL-6水平预测曲线下面积(AUC)均在0.7以上;创伤后24 h血清Lac、PCT、WBC、IL-6水平联合预测严重多发伤患者继发脓毒症的AUC最大,为0.949。结论严重多发伤患者脓毒症的发生率为17.50%,创伤早期血清Lac、PCT、WBC、IL-6水平明显升高,且创伤后24 h血清Lac、PCT、WBC、IL-6预测脓毒症效能较高,为脓毒症重要预测因子。Objective To explore the change characteristics of the blood latic acid(Lac),procalcitonin(PCT),white blood cell count(WBC),interleukin-6(IL-6)levels and their relationship between secondary sepsis in patients with severe multiple injuries.Methods A total of 120 patients with severe multiple injuries were selected as the research subjects,and their blood Lac,PCT,WBC and IL-6 levels were measured at 6,12,24,48 and 72 hours after trauma.Statistical analysis was conducted on the incidence of sepsis in 120 patients with severe multiple injuries.Patients with secondary sepsis were included in the sepsis group,while those without secondary sepsis were included in the non sepsis group.Clinical data and levels of Lac,PCT,WBC,and IL-6 were compared between the sepsis group and the non sepsis group.Receiver operating characteristic(ROC)curve was used to evaluate the predictive value of acute physiology and chronic health scoreⅡ(APACHEⅡ)score,trauma severity(ISS)score,and levels of Lac,PCT,WBC and IL-6 for sepsis in patients with severe multiple injuries.Results The incidence of sepsis in 120 patients with severe multiple injuries was 17.50%(21/120),and the time from trauma to infection was[44.9(29.12,73.84)]hours.There was no statistically significant difference on gender,age,time from injury to admission and body mass index(BMI)between the sepsis group and the non sepsis group(P>0.05).The APACHEⅡand ISS scores of the sepsis group were significantly higher than those of the non sepsis group,the differences were statistically significant(P<0.05).The repeated measures analysis of variance showed that there were inter group,time and interaction effects in peripheral blood Lac,PCT,WBC,and IL-6 at 6,12,24,48 and 72 hours after trauma between the sepsis group and the non sepsis group(P<0.05).The results of multivariate analysis of variance showed that at 6,12,24,48 and 72 hours after trauma,the levels of Lac,PCT,WBC and IL-6 in the sepsis group were higher than those in the non sepsis group,and the differences were statist

关 键 词：多发伤 脓毒症 乳酸 降钙素原 白细胞计数 白细胞介素-6 

分 类 号：R446.9[医药卫生—诊断学]