中国医药
中國醫藥
중국의약
CHINA MEDICINE
2012年
11期
1345-1347
,共3页
余雪涛%刘美描%邱文冰%吴召熙%方伟强%李恩民
餘雪濤%劉美描%邱文冰%吳召熙%方偉彊%李恩民
여설도%류미묘%구문빙%오소희%방위강%리은민
中性粒细胞明胶蛋白酶相关载脂蛋白%休克%序贯性器官衰竭估计
中性粒細胞明膠蛋白酶相關載脂蛋白%休剋%序貫性器官衰竭估計
중성립세포명효단백매상관재지단백%휴극%서관성기관쇠갈고계
Neutrophil gelatinase associated lipocalin%Shock%Sequential organ failure assessment
目的 探讨休克患者血浆中性粒细胞明胶蛋白酶相关载脂蛋白(NGAL)的浓度及其临床意义.方法 人选ICU内38例危重患者作为观察对象.动态检测血浆中NGAL浓度,同时进行急性生理和慢性健康评分Ⅱ(APACHEⅡ)及序贯性器官衰竭估计(SOFA)评分,并记录预后.血浆NGAL浓度的测定采用酶联免疫吸附测定.用受试者工作特征曲线评价血浆NGAL水平对死亡的预测作用,计算ROC曲线下面积及其95％置信区间(CI).结果 38例危患者入ICU时出现休克10例(休克组),未出现休克患者28例(非休克组)；住院期间恶化17例(恶化组),好转21例(好转组).入ICU时,休克组血浆NGAL浓度、血清肌酐、血糖和凝血酶原时间国际标准化比值均高于非休克组[分别为(147±113) μg/L比(59±64)μg/L,(201±93) μmol/L比(132±106)μmol/L,(13.5±6.1)mmol/L比(9.0±3.0) mmol/L,(1.23±0.33)比(1.00±0.12)]；差异均有统计学意义(P ＜0.05或P＜0.01)；HCO3-和血小板计数明显低于非休克患者[分别为(18±5)mmol/L比(25±6) mmol/L,(115±61)× 109/L比(161±57) ×109/L],差异均有统计学意义(P＜0.05).恶化组血浆NGAL浓度、APACHEⅡ和SOFA评分均明显高于好转组[分别为(113±105) μg/L比(51±35) μg/L,(26±7)分比(19±6)分,(10.2±3.0)分比(6.6±3.0)分],差异均有统计学意义(P＜0.05或P＜0.01).血浆NGAL水平、APACHEⅡ和SOFA评分对患者死亡预测的受试者工作特征曲线下面积分别为0.717(95％CI为0.550 ～0.884,P＜0.05)、0.770(95％CI为0.616～0.925,P＜0.01)和0.796(95％ CI为0.650 ～0.937,P＜0.01),以NGAL=79.56 μg/L作为预测死亡临界点,其敏感度为52.9％、特异度为90.5％.结论 联合血浆NGAL水平和APACHEⅡ或SOFA评分可能有助于评价休克患者病情严重度及预后.
目的 探討休剋患者血漿中性粒細胞明膠蛋白酶相關載脂蛋白(NGAL)的濃度及其臨床意義.方法 人選ICU內38例危重患者作為觀察對象.動態檢測血漿中NGAL濃度,同時進行急性生理和慢性健康評分Ⅱ(APACHEⅡ)及序貫性器官衰竭估計(SOFA)評分,併記錄預後.血漿NGAL濃度的測定採用酶聯免疫吸附測定.用受試者工作特徵麯線評價血漿NGAL水平對死亡的預測作用,計算ROC麯線下麵積及其95％置信區間(CI).結果 38例危患者入ICU時齣現休剋10例(休剋組),未齣現休剋患者28例(非休剋組)；住院期間噁化17例(噁化組),好轉21例(好轉組).入ICU時,休剋組血漿NGAL濃度、血清肌酐、血糖和凝血酶原時間國際標準化比值均高于非休剋組[分彆為(147±113) μg/L比(59±64)μg/L,(201±93) μmol/L比(132±106)μmol/L,(13.5±6.1)mmol/L比(9.0±3.0) mmol/L,(1.23±0.33)比(1.00±0.12)]；差異均有統計學意義(P ＜0.05或P＜0.01)；HCO3-和血小闆計數明顯低于非休剋患者[分彆為(18±5)mmol/L比(25±6) mmol/L,(115±61)× 109/L比(161±57) ×109/L],差異均有統計學意義(P＜0.05).噁化組血漿NGAL濃度、APACHEⅡ和SOFA評分均明顯高于好轉組[分彆為(113±105) μg/L比(51±35) μg/L,(26±7)分比(19±6)分,(10.2±3.0)分比(6.6±3.0)分],差異均有統計學意義(P＜0.05或P＜0.01).血漿NGAL水平、APACHEⅡ和SOFA評分對患者死亡預測的受試者工作特徵麯線下麵積分彆為0.717(95％CI為0.550 ～0.884,P＜0.05)、0.770(95％CI為0.616～0.925,P＜0.01)和0.796(95％ CI為0.650 ～0.937,P＜0.01),以NGAL=79.56 μg/L作為預測死亡臨界點,其敏感度為52.9％、特異度為90.5％.結論 聯閤血漿NGAL水平和APACHEⅡ或SOFA評分可能有助于評價休剋患者病情嚴重度及預後.
목적 탐토휴극환자혈장중성립세포명효단백매상관재지단백(NGAL)적농도급기림상의의.방법 인선ICU내38례위중환자작위관찰대상.동태검측혈장중NGAL농도,동시진행급성생리화만성건강평분Ⅱ(APACHEⅡ)급서관성기관쇠갈고계(SOFA)평분,병기록예후.혈장NGAL농도적측정채용매련면역흡부측정.용수시자공작특정곡선평개혈장NGAL수평대사망적예측작용,계산ROC곡선하면적급기95％치신구간(CI).결과 38례위환자입ICU시출현휴극10례(휴극조),미출현휴극환자28례(비휴극조)；주원기간악화17례(악화조),호전21례(호전조).입ICU시,휴극조혈장NGAL농도、혈청기항、혈당화응혈매원시간국제표준화비치균고우비휴극조[분별위(147±113) μg/L비(59±64)μg/L,(201±93) μmol/L비(132±106)μmol/L,(13.5±6.1)mmol/L비(9.0±3.0) mmol/L,(1.23±0.33)비(1.00±0.12)]；차이균유통계학의의(P ＜0.05혹P＜0.01)；HCO3-화혈소판계수명현저우비휴극환자[분별위(18±5)mmol/L비(25±6) mmol/L,(115±61)× 109/L비(161±57) ×109/L],차이균유통계학의의(P＜0.05).악화조혈장NGAL농도、APACHEⅡ화SOFA평분균명현고우호전조[분별위(113±105) μg/L비(51±35) μg/L,(26±7)분비(19±6)분,(10.2±3.0)분비(6.6±3.0)분],차이균유통계학의의(P＜0.05혹P＜0.01).혈장NGAL수평、APACHEⅡ화SOFA평분대환자사망예측적수시자공작특정곡선하면적분별위0.717(95％CI위0.550 ～0.884,P＜0.05)、0.770(95％CI위0.616～0.925,P＜0.01)화0.796(95％ CI위0.650 ～0.937,P＜0.01),이NGAL=79.56 μg/L작위예측사망림계점,기민감도위52.9％、특이도위90.5％.결론 연합혈장NGAL수평화APACHEⅡ혹SOFA평분가능유조우평개휴극환자병정엄중도급예후.
Objective To detect the concentration of plasma neutrophil gelatinase associated lipocalin (NGAL) and it's clinical significance in shock patients.Methods All 38 patients in intensive care unit (ICU)were enrolled.Serial blood samples were drawn from patients for NGAL measuring and acute physiology and chronic health evaluation (APACHE) Ⅱ and sequential organ failure assessment (SOFA) score were performed.Plasma NGAL concentration was measured by enzyme-linked immunosorbent assay (ELISA).Results Of 38 cases,10 patients were shock cases,another 28 cases with non-shock when admitted to the hospital,and 17 patients got worse and 21 patients were improved in hospital.Compared with non-shock patients,plasma NGAL,serum creatinine,blood glucose and prothrombin time-international normal ration (PT-INR) of shock patients were higher [(147 ±113) μg/L vs (59 ± 64) μg/L,(201 ± 93) μmol/L vs (132 ± 106) μmol/L,(13.5 ± 6.1) mmol/L vs (9.0 ±3.0) mmol/L,(1.23 ± 0.33) vs (1.00 ± 0.12),respectively] ; bicarbonate radical (HCO3-) and platelet were lower [(18±5)mmol/L vs(25±6)mmol/L,(115±61) × 109/L vs(161 ±57) × 109/L,respectively] when admitted to ICU (P ＜0.05 or P ＜0.01).Areas under the receiver operating characteristic curves (ROC curves) of NGAL,APACHE Ⅱ and SOFA scores for hospital mortality were 0.717 [95％ confident interval(CI) 0.550-0.884,P ＜0.05],0.770 (95％ CI 0.616-0.925,P ＜ 0.01) and 0.796 (95％ CI 0.650-0.937,P ＜ 0.01).Plasma NGAL concentration greater than 79.56 μg/L was an indicator for mortality; the sensitivity and the specificity was 52.9％and 90.5％ respectively.Conclusion Combining the plasma NGAL levels with APACHE Ⅱ or SOFA score may contribute to evaluation of the severity and prognosis of shock patients.
