中华急诊医学杂志
中華急診醫學雜誌
중화급진의학잡지
CHINESE JOURNAL OF EMERGENCY MEDICINE
2012年
8期
858-862
,共5页
半胱氨酸蛋白酶抑制剂C%APACHE Ⅱ评分%全身炎症反应综合征%脓毒症%病死率
半胱氨痠蛋白酶抑製劑C%APACHE Ⅱ評分%全身炎癥反應綜閤徵%膿毒癥%病死率
반광안산단백매억제제C%APACHE Ⅱ평분%전신염증반응종합정%농독증%병사솔
Serum cysteine proteinase inhibitor C%Acute physiology and chronic health evaluation Ⅱ score%Systemic inflammatory response syndrome%Sepsis%Mortality
目的 探讨急诊抢救室脓毒症( sepsis)、全身炎症反应总综合征(systemicinflammatory response syndrome,SIRS)与非SIRS患者半胱氨酸蛋白酶抑制剂C(cystainC,Cys-C)阳性检出率的差异；Cys-C与APACHE(acute physiology and chronic health evaluation)Ⅱ评分的相关性及对于死亡预后的意义.方法 选取2008年10月到2009年10月在北京朝阳医院急诊抢救室救治的患者250例,排除存活不足24 h者.将所有入选病例分为3组:非SIRS组(n=74)、SIRS组(n=121)及脓毒症组(n=55),检测3组病例的Cys-C水平并评估APACHEⅡ评分,计算Cys-C＞830 ng/ml的检出率并进行比较.统计3组病例的28 d病死率,研究Cys-C、APACHEⅡ评分对于3组病例28 d病死率的预测价值.结果 Cys-C的阳性检出率在脓毒症组与非SIRS组之间差异有统计学意义(41.38％ vs.13.57％,P=0.007),SIRS组与非SIRS组之间比较,差异具有统计学意义(32.79％ vs.13.57％,P=0.005),但在脓毒症组与SIRS组之间差异无统计学意义(41.38％vs.32.79％,P=0.346).脓毒症组、SIRS组患者28 d病死率与非SIRS组比较,差异具有统计学意义(41.6％ vs.17.2％,P＜0.01；36.91％ vs. 17.2％,P＜0.05).脓毒症组患者Cys-C与APACHEⅡ评分有良好正相关(P＜0.0001).Cys-C与APACHEⅡ评分是脓毒症组28 d死亡的独立预测因素.结论 SIRS患者和脓毒症患者Cys-C阳性率较非SIRS患者明显升高,并且脓毒症患者Cys-C是预后不良的指标.
目的 探討急診搶救室膿毒癥( sepsis)、全身炎癥反應總綜閤徵(systemicinflammatory response syndrome,SIRS)與非SIRS患者半胱氨痠蛋白酶抑製劑C(cystainC,Cys-C)暘性檢齣率的差異；Cys-C與APACHE(acute physiology and chronic health evaluation)Ⅱ評分的相關性及對于死亡預後的意義.方法 選取2008年10月到2009年10月在北京朝暘醫院急診搶救室救治的患者250例,排除存活不足24 h者.將所有入選病例分為3組:非SIRS組(n=74)、SIRS組(n=121)及膿毒癥組(n=55),檢測3組病例的Cys-C水平併評估APACHEⅡ評分,計算Cys-C＞830 ng/ml的檢齣率併進行比較.統計3組病例的28 d病死率,研究Cys-C、APACHEⅡ評分對于3組病例28 d病死率的預測價值.結果 Cys-C的暘性檢齣率在膿毒癥組與非SIRS組之間差異有統計學意義(41.38％ vs.13.57％,P=0.007),SIRS組與非SIRS組之間比較,差異具有統計學意義(32.79％ vs.13.57％,P=0.005),但在膿毒癥組與SIRS組之間差異無統計學意義(41.38％vs.32.79％,P=0.346).膿毒癥組、SIRS組患者28 d病死率與非SIRS組比較,差異具有統計學意義(41.6％ vs.17.2％,P＜0.01；36.91％ vs. 17.2％,P＜0.05).膿毒癥組患者Cys-C與APACHEⅡ評分有良好正相關(P＜0.0001).Cys-C與APACHEⅡ評分是膿毒癥組28 d死亡的獨立預測因素.結論 SIRS患者和膿毒癥患者Cys-C暘性率較非SIRS患者明顯升高,併且膿毒癥患者Cys-C是預後不良的指標.
목적 탐토급진창구실농독증( sepsis)、전신염증반응총종합정(systemicinflammatory response syndrome,SIRS)여비SIRS환자반광안산단백매억제제C(cystainC,Cys-C)양성검출솔적차이；Cys-C여APACHE(acute physiology and chronic health evaluation)Ⅱ평분적상관성급대우사망예후적의의.방법 선취2008년10월도2009년10월재북경조양의원급진창구실구치적환자250례,배제존활불족24 h자.장소유입선병례분위3조:비SIRS조(n=74)、SIRS조(n=121)급농독증조(n=55),검측3조병례적Cys-C수평병평고APACHEⅡ평분,계산Cys-C＞830 ng/ml적검출솔병진행비교.통계3조병례적28 d병사솔,연구Cys-C、APACHEⅡ평분대우3조병례28 d병사솔적예측개치.결과 Cys-C적양성검출솔재농독증조여비SIRS조지간차이유통계학의의(41.38％ vs.13.57％,P=0.007),SIRS조여비SIRS조지간비교,차이구유통계학의의(32.79％ vs.13.57％,P=0.005),단재농독증조여SIRS조지간차이무통계학의의(41.38％vs.32.79％,P=0.346).농독증조、SIRS조환자28 d병사솔여비SIRS조비교,차이구유통계학의의(41.6％ vs.17.2％,P＜0.01；36.91％ vs. 17.2％,P＜0.05).농독증조환자Cys-C여APACHEⅡ평분유량호정상관(P＜0.0001).Cys-C여APACHEⅡ평분시농독증조28 d사망적독립예측인소.결론 SIRS환자화농독증환자Cys-C양성솔교비SIRS환자명현승고,병차농독증환자Cys-C시예후불량적지표.
Objective The difference of Cys-C ( serum cysteine proteinase inhibitor C) among sepsis group,systemic inflammatory response syndrome (SIRS) group,and non -SIRS group were explored in this study.The significance of mortality and the relationship between Cys-C and acute physiology and chronic health evaluation (APACHE) Ⅱ score were under discussed. Methods After excluding the individual whose survival less than 24 hours,two hundred and fifty patients sought medical care in the emergency department of Beijing Chaoyang Hospital of the Capital Medical University were selected as samples from October 2008 to October 2009.They were classified into three groups:SIRS group ( n =121 ),non-SIRS group (n =74) and sepsis group ( n =55 ).The serum Cys-C level and APACHE Ⅱ score were determined for each patient.The positive detection rate of Cys-C ( ＞ 830 ng/ml) was calculated and then a 28-day mortality was recorded according to this study result.The positive detection rate and 28-day mortality were also compared with chi-square test.The prognostic values of Cys-C,APACHE Ⅱ score for the 28-daymortality were evaluated by logistic regression analysis.Results There was significant change observed between sepsis group and non-SIRS group (41.38％ vs. 13.57％,P =0.007 ) for the positive detection rate of Cys-C,as well as that between SIRS group and non-SIRS group ( 32.79％ vs. 13.57％,P =0.005).However,a contrary result was obtained when compared sepsis group with SIRS group (41.38％ vs.32.79％,P =0.346) ).Significant difference was noticed in the 28-day mortality of the patients from sepsis group and SIRS group in comparison to those of non-SIRS group (41.6％ vs. 17.2％,P ＜ 0.01 ;36.91％ vs. 17.2％,P ＜ 0.05).Cys-C level in patient with sepsis indicated a positive correlation to APACHE Ⅱ score ( P ＜0.0001 ).Conclusions The positive rate of Cys-C in SIRS group and septic group were significantly higher than that of non-SIRS patients,and this is an index for poor prognosis in sepsis patients.
