中华急诊医学杂志
中華急診醫學雜誌
중화급진의학잡지
CHINESE JOURNAL OF EMERGENCY MEDICINE
2011年
7期
730-733
,共4页
血清胆碱酯酶%全身炎症反应综合征%预后%预测价值%老年
血清膽堿酯酶%全身炎癥反應綜閤徵%預後%預測價值%老年
혈청담감지매%전신염증반응종합정%예후%예측개치%노년
Cholinesterase%Systemic inflammatory response syndrome%Predictive value%Prognosis%Gerontal patients
目的 研究分析血清肌碱酯酶对老年全身炎症反应综合征患者病情发展转归的预测作用.方法 将124例入住浙江大学医学院附属第二医院中心监护室(ICU)的老年SIRS患者根据预后情况分为存活组和死亡组.检测所有入院患者24 h内的血清胆碱酯酶、白蛋白、D-二聚体、乳酸、C反应蛋白(CRP),并进行APACHEⅡ和GCS评分.结果 生存组和死亡组之间比较,在年龄、性别、APACHEⅡ评分、GCS评分方面差异无统计学意义(P＞0.05).血乳酸、血D-二聚体、白蛋白、CRP、ChE在两组间比较差异具有统计学意义(P值=0.011,0.011,0.007,0.008,0.000.).预后多因素回归分析结果显示性别、年龄、白蛋白、CRP、GCS评分、APACHEⅡ评分、乳酸、D-二聚体不是决定患者预后的独立危险因素(P值分别为0.401,0.165,0.446,0.841,0.615,0.120,0.502,0.184),但ChE有显著性相关(P=0.000).ROC曲线图分析显示血清ChE对老年SIRS患者预后的ROC曲线下面积(AUC)为0.797,SE=0.04,P=0.000;ChE=103.00U/L时,敏感度为:0.793;1-特异度为0.258,可作为诊断的切点.Kendall相关分析ChE与APACHEⅡ评分、CRP、白蛋白相关性非常弱,相关系数分别为0.061,0.231,-0.090,P值分别为0.161,0.000,0.069.结论 ChE可能参与了老年SIRS的发生和发展过程,对这类患者的病情发展转归有一定的预测作用,且指标稳定,受干扰因素少.
目的 研究分析血清肌堿酯酶對老年全身炎癥反應綜閤徵患者病情髮展轉歸的預測作用.方法 將124例入住浙江大學醫學院附屬第二醫院中心鑑護室(ICU)的老年SIRS患者根據預後情況分為存活組和死亡組.檢測所有入院患者24 h內的血清膽堿酯酶、白蛋白、D-二聚體、乳痠、C反應蛋白(CRP),併進行APACHEⅡ和GCS評分.結果 生存組和死亡組之間比較,在年齡、性彆、APACHEⅡ評分、GCS評分方麵差異無統計學意義(P＞0.05).血乳痠、血D-二聚體、白蛋白、CRP、ChE在兩組間比較差異具有統計學意義(P值=0.011,0.011,0.007,0.008,0.000.).預後多因素迴歸分析結果顯示性彆、年齡、白蛋白、CRP、GCS評分、APACHEⅡ評分、乳痠、D-二聚體不是決定患者預後的獨立危險因素(P值分彆為0.401,0.165,0.446,0.841,0.615,0.120,0.502,0.184),但ChE有顯著性相關(P=0.000).ROC麯線圖分析顯示血清ChE對老年SIRS患者預後的ROC麯線下麵積(AUC)為0.797,SE=0.04,P=0.000;ChE=103.00U/L時,敏感度為:0.793;1-特異度為0.258,可作為診斷的切點.Kendall相關分析ChE與APACHEⅡ評分、CRP、白蛋白相關性非常弱,相關繫數分彆為0.061,0.231,-0.090,P值分彆為0.161,0.000,0.069.結論 ChE可能參與瞭老年SIRS的髮生和髮展過程,對這類患者的病情髮展轉歸有一定的預測作用,且指標穩定,受榦擾因素少.
목적 연구분석혈청기감지매대노년전신염증반응종합정환자병정발전전귀적예측작용.방법 장124례입주절강대학의학원부속제이의원중심감호실(ICU)적노년SIRS환자근거예후정황분위존활조화사망조.검측소유입원환자24 h내적혈청담감지매、백단백、D-이취체、유산、C반응단백(CRP),병진행APACHEⅡ화GCS평분.결과 생존조화사망조지간비교,재년령、성별、APACHEⅡ평분、GCS평분방면차이무통계학의의(P＞0.05).혈유산、혈D-이취체、백단백、CRP、ChE재량조간비교차이구유통계학의의(P치=0.011,0.011,0.007,0.008,0.000.).예후다인소회귀분석결과현시성별、년령、백단백、CRP、GCS평분、APACHEⅡ평분、유산、D-이취체불시결정환자예후적독립위험인소(P치분별위0.401,0.165,0.446,0.841,0.615,0.120,0.502,0.184),단ChE유현저성상관(P=0.000).ROC곡선도분석현시혈청ChE대노년SIRS환자예후적ROC곡선하면적(AUC)위0.797,SE=0.04,P=0.000;ChE=103.00U/L시,민감도위:0.793;1-특이도위0.258,가작위진단적절점.Kendall상관분석ChE여APACHEⅡ평분、CRP、백단백상관성비상약,상관계수분별위0.061,0.231,-0.090,P치분별위0.161,0.000,0.069.결론 ChE가능삼여료노년SIRS적발생화발전과정,대저류환자적병정발전전귀유일정적예측작용,차지표은정,수간우인소소.
Objective To explore the predictive value of cholinesterase (ChE) in the prognosis of gerontal patients with systemic inflammatory response syndrome. Methods The clinical data of 124 elderly patients with systemic inflammatory response syndrome collected from September 2009 through September 2010 were retrospectively analyzed. All patients were divided into death group and survival group according to the outcome of patients. The cholinesterase ( ChE), albumin, D-Dime, lactic acid and C-reactive protein (CRP) were detected, and the APACHE Ⅱ and GCS scores were documented in the first 24 hours in the ICU. Results There were no significant differences in age, gender, APACHE Ⅱ score and GCS score of patients between death group and survival group ( all P ＞ 0. 05 ), but there were significant differences in lactic acid, D-Dime, albumin, CRP and ChE between two groups ( theP values were 0.011,0.011, 0. 007,0. 008, 0. 000, respectively) . The results of multiple factors regression analysis showed that age, gender,lactic acid, D-Dime, albumin, CRP, APACHE Ⅱ score, and GCS score were not the independent risk factors of prognosis of gerontal patients with SIRS ( the P = 0. 401, 0. 165, 0. 446, 0. 841,0. 615, 0. 120,0. 502, 0. 184, respectively) except ChE ( P = 0. 000) . The receiver operating characteristic curve (ROC) of ChE in the gerontal patients with SIRS showed the area under curve (AUC) = 0.797, SE =0.04, P=0. 000, and the ChE = 103.00 U/L could be a diagnosis point with sensitivity = 0.793, 1-specificity = 0. 258. The correlation analysis showed that the APACHE Ⅱ score, CRP, and albumin were poorly correlated with ChE ( Kendall coefficients were 0. 061, 0. 231, and -0. 090, and theP = 0. 161,0. 000, and 0. 069, respectively ) . Conclusions ChE maybe played a important role in the gerontal patients with SIRS, and could be a predictive index for the prognosis of gerontal patients with systemic inflammatory response syndrome.
