CAJ | 학술논문

目的：比较急诊脓毒症病死率评分（ MEDS）和血清降钙素原（ PCT）对急诊重症监护病房中脓毒症的早期诊断和预后价值。方法采用前瞻性、临床病例观察及诊断试验研究。入选病例分为全身炎症反应综合征（systemic inflammatory response syndrome ，SIRS）组、非严重脓毒症组、严重脓毒症组、非SIRS对照组。测定24 h内的炎症指标、MEDS评分及PCT浓度并进行相关分析。结果198例患者入选，其中对照组59例，SIRS组57例，非严重脓毒症组52例，严重脓毒症组30例。根据受试者工作特征曲线（ROC曲线）分析，诊断脓毒症中PCT 的ROC曲线下面积（AUC）为0．936±0．02。根据重症脓毒症组和非重症脓毒症组的 PCT、APACHE Ⅱ评分和 MEDS 评分数值绘制ROC曲线，由ROC曲线计算上述各指标的曲线下面积（AUC），PCT的AUC面积为0．586±0．065，显著低于APACHE Ⅱ评分0．941±0．023和MEDS评分0．791±0．049。结论 PCT是早期诊断脓毒症并能与SIRS鉴别的特异性较高的炎症指标；但PCT 不能将脓毒症进行危险分层，结合 MEDS评分和PC T可以预测脓毒症的发病概率及客观判断脓毒症病情的严重性。
목적：비교급진농독증병사솔평분（ MEDS）화혈청강개소원（ PCT）대급진중증감호병방중농독증적조기진단화예후개치。방법채용전첨성、림상병례관찰급진단시험연구。입선병례분위전신염증반응종합정（systemic inflammatory response syndrome ，SIRS）조、비엄중농독증조、엄중농독증조、비SIRS대조조。측정24 h내적염증지표、MEDS평분급PCT농도병진행상관분석。결과198례환자입선，기중대조조59례，SIRS조57례，비엄중농독증조52례，엄중농독증조30례。근거수시자공작특정곡선（ROC곡선）분석，진단농독증중PCT 적ROC곡선하면적（AUC）위0．936±0．02。근거중증농독증조화비중증농독증조적 PCT、APACHE Ⅱ평분화 MEDS 평분수치회제ROC곡선，유ROC곡선계산상술각지표적곡선하면적（AUC），PCT적AUC면적위0．586±0．065，현저저우APACHE Ⅱ평분0．941±0．023화MEDS평분0．791±0．049。결론 PCT시조기진단농독증병능여SIRS감별적특이성교고적염증지표；단PCT 불능장농독증진행위험분층，결합 MEDS평분화PC T가이예측농독증적발병개솔급객관판단농독증병정적엄중성。
Objective To study the diagnostic and prognostic value of procalcitonin (PCT ) ,com-bining with mortality in emergency department sepsis (MEDS) scores in patients with sepsis in early stage .Methods According to the definition of ACCP/SCCM Consensus Conference ,patients were clas-sified into 4 groups which were non-systemic inflammatory response syndrome (SIRS) group ,SIRS group ,non-severe sepsis group ,and severe sepsis group .APACHE ,MEDS and concentration of PCT were determined at 24 hours ,and their correlations were analyzed .Results Total of 198 patients were enrolled ,including 59 in non-SIRS group(control group) ,57 in SIRS group ,52 in sepsis group , 30 in severe sepsis group .There was highly difference in PCT concentrations between Sepsis group and SIRS group .ROC curves were drawn and area under these curves (AUC) was calculated .In the diagnosis of sepsis ,AUC values were 0 .936 ± 0 .02 for PCT .While in the diagnosis of sever sepsis AUC values were only 0 .586 ± 0 .065 for PCT and 0 .791 ± 0 .049 for MEDS score ,0 .941 ± 0 .023 for APACHE .Conclusion PCT can be used to predict the incidence of sepsis while APACHE and MEDS score are the more reliable prognostic indicator of sepsis .