多炎性因子动态分析对腹部外伤病人脓毒症风险的预测价值  

Predictive value of dynamic analysis of multiple inflammatory factors for the risk of sepsis in patients with abdominal trauma

作　　者：葛新义 裴守科 聂玉松 汪超 GE Xinyi;PEI Shouke;NIE Yusong;WANG Chao(Department of General surgery,Guangling District Maternal and Child Health hospital,Yangzhou City,Jiangsu Province,Yangzhou 225000,China;不详)

机构地区：[1]江苏省扬州市广陵区妇幼保健院普外科,225000 [2]武警江苏总队医院普外科

出　　处：《临床外科杂志》2024年第12期1299-1303,共5页Journal of Clinical Surgery

基　　金：江苏省医学重点人才计划项目(201704221329);江苏省医院协会创新研究课题项目(JSYGY-3-2018-74)。

摘　　要：目的分析多炎性因子动态变化对早期筛查腹部外伤病人脓毒症风险的预测价值。方法2018年1月~2022年1月武警江苏省总队医院普外科收治的腹部外伤病人360例。根据病人是否发生脓毒症分为脓毒症组和对照组。比较两组的一般资料和炎症指标动态变化。采用多因素Logistic回归分析影响腹部外伤病人发生脓毒症的相关因素,应用ROC曲线分析多炎症因子动态变化等因素筛查腹部外伤病人发生脓毒症的价值。结果纳入研究的病人中有13例病例脱落,剩余347例,其中51例发生脓毒症为脓毒症组,296例未发生脓毒症为对照组。脓毒症的发生率为14.70%。两组病人年龄、血糖、入院时白细胞等比较,差异无统计学意义(P>0.05)。但脓毒症组SOFA评分为(1.86±0.45)分,大于对照组的(1.54±0.36)分,脓毒症组C反应蛋白(CRP)变化差值为(5.67±1.17)mg/L、72小时后降钙素原(PCT)为(0.12±0.05)ng/ml、PCT变异率为(36.43±8.02)%、血清淀粉酶A蛋白(SAA)变化差值为(8.62±1.05)mg/L、中性粒细胞百分比变化差值为(9.31±1.09)%,均高于对照组的(4.79±0.63)mg/L、(0.10±0.04)ng/ml、(28.04±6.21)%、(7.11±0.84)mg/L、(8.41±0.92)%,差异有统计学意义(P<0.05)。多因素Logistic回归分析显示,SOFA评分(OR=1.648)、CRP变化差值(OR=2.338)、PCT变异率(OR=1.096)、SAA变化差值(OR=6.043)、中性粒细胞百分比变化差值(OR=3.355)是腹部外伤病人发生脓毒症风险的独立危险因素。ROC曲线显示,SAA变化差值预测腹部外伤病人发生脓毒症风险的诊断效能高于CRP变化差值、PCT变异率、中性粒细胞百分比变化差值和SOFA评分。结论多种炎症因子的动态分析对早期筛查腹部外伤病人发生脓毒症风险有较高价值,监测炎症因子的变化有助于早期调整治疗方案。Objective To analyze the predictive value of dynamic changes of multiple inflammatory factors in early screening of sepsis risk in patients with abdominal trauma.Methods A total of 360 patients with abdominal trauma admitted to the Department of Surgery of Jiangsu Provincial Corps Hospital of the Chinese People’s Armed Police Force from January 2018 to January 2022 were studied.Patients were divided into sepsis group and control group according to whether sepsis occurred.The general data and dynamic changes of inflammatory indicators were compared between the two groups.Multivariate Logistic regression was used to analyze the related factors of sepsis in patients with abdominal trauma,and ROC curve was used to analyze the value of dynamic changes of multiple inflammatory factors in predicting sepsis in patients with abdominal trauma.Results Among the patients included in the study,13 cases fell out,leaving 347 cases,of which 51 patients with sepsis were classified as sepsis group,and the remaining 296 cases were classified as control group.The incidence of sepsis was 14.70%.There was no significant difference in age,blood glucose and white blood cell at admission between the two groups(P>0.05).But the SOFA score in sepsis group(1.86±0.45)was higher than that in control group(1.54±0.36).In sepsis group,the difference of C-reactive protein(CRP)was(5.67±1.17)mg/L,the PCT was(0.12±0.05)ng/ml,the PCT variation rate was(36.43±8.02)%,and the difference of serum amylase A protein(SAA)was(8.62±1.05)m g/L,the difference of neutrophil percentage was(9.31±1.09)%,which was higher than that of control group[(4.79±0.63)mg/L,(0.10±0.04)ng/ml,(28.04±6.21)%,(7.11±0.84)mg/L,(8.41±0.92)%],the difference was statistically significant(P<0.05).Multivariate Logistic regression analysis showed that:SOFA score(OR=1.648),CRP change difference(OR=2.338),PCT variation rate(OR=1.096),SAA change difference(OR=6.043),neutrophil percentage change difference(OR=3.355)were independent risk factors for sepsis in patients with abdomina

关 键 词：炎症因子 动态变化 腹部外伤 脓毒症 

分 类 号：R47[医药卫生—护理学]