中华急诊医学杂志
中華急診醫學雜誌
중화급진의학잡지
CHINESE JOURNAL OF EMERGENCY MEDICINE
2013年
6期
630-633
,共4页
崔晓莉%王忠勇%赵宏胜%张彬%王林华%陆洋
崔曉莉%王忠勇%趙宏勝%張彬%王林華%陸洋
최효리%왕충용%조굉성%장빈%왕림화%륙양
降钙素原%危重病%细菌感染%APACHEⅡ%预后
降鈣素原%危重病%細菌感染%APACHEⅡ%預後
강개소원%위중병%세균감염%APACHEⅡ%예후
Procalcitonin%Critical illness%Bacterial infection%Acute physiology and chronic health evaluation Ⅱ%Prognosis
目的 探讨血清降钙素原(PCT)对重症患者细菌感染性疾病预后评估和病情严重程度判断的价值.方法 采用前瞻性方法进行研究,选取2012年2月至2012年11月期间收住南通大学附属医院重症医学科符合入选条件的116例细菌感染性疾病患者为研究对象,采用免疫色谱法检测入院后24 h内的血清PCT水平,记录患者24 h急性生理学与慢性健康状况Ⅱ(APACHEⅡ)评分.根据28 d临床结局,分为死亡组(36例)和存活组(80例),用成组t检验或秩和检验比较两组间PCT、APACHEⅡ评分的差异,采用Spearman's相关检验分析血清PCT水平与APACHEⅡ评分的相关性,用受试者工作特征曲线(ROC)下面积(AUC)评估PCT单独应用及联合PCT和APACHEⅡ评分预测28 d生存情况的效能.用U检验对PCT和APACHEⅡ评分预测28 d生存情况的效能进行比较.结果 死亡组PCT水平明显高于存活组[5.38 (2.08,25) vs.0.23 (1.00,2.12)] (Z=5.598,P＜0.001),死亡组APACHEⅡ评分亦显著高于存活组(24.32±6.72) vs.(16.05±7.24),t=6.148,P＜0.01.PCT与APACHEⅡ评分存在显著正相关(r=0.388,P＜0.001),PCT和APACHEⅡ评分预测重症患者细菌感染性疾病28 d生存情况的AUC分别为0.804和0.792,PCT的AUC值高于APACHEⅡ评分,但差异无统计学意义(U=0.2073,P=0.802).联合PCT和APACHEⅡ评分预测28 d生存情况的AUC较单一指标高,为0.817,敏感度90.7％,特异度75.2％,均优于单一指标的预测效能.结论 血清PCT能反映重症患者细菌感染性疾病病情严重程度及预后,是预测28 d生存情况的有效指标,联合PCT检测和APACHEⅡ评分可提高预测效能.
目的 探討血清降鈣素原(PCT)對重癥患者細菌感染性疾病預後評估和病情嚴重程度判斷的價值.方法 採用前瞻性方法進行研究,選取2012年2月至2012年11月期間收住南通大學附屬醫院重癥醫學科符閤入選條件的116例細菌感染性疾病患者為研究對象,採用免疫色譜法檢測入院後24 h內的血清PCT水平,記錄患者24 h急性生理學與慢性健康狀況Ⅱ(APACHEⅡ)評分.根據28 d臨床結跼,分為死亡組(36例)和存活組(80例),用成組t檢驗或秩和檢驗比較兩組間PCT、APACHEⅡ評分的差異,採用Spearman's相關檢驗分析血清PCT水平與APACHEⅡ評分的相關性,用受試者工作特徵麯線(ROC)下麵積(AUC)評估PCT單獨應用及聯閤PCT和APACHEⅡ評分預測28 d生存情況的效能.用U檢驗對PCT和APACHEⅡ評分預測28 d生存情況的效能進行比較.結果 死亡組PCT水平明顯高于存活組[5.38 (2.08,25) vs.0.23 (1.00,2.12)] (Z=5.598,P＜0.001),死亡組APACHEⅡ評分亦顯著高于存活組(24.32±6.72) vs.(16.05±7.24),t=6.148,P＜0.01.PCT與APACHEⅡ評分存在顯著正相關(r=0.388,P＜0.001),PCT和APACHEⅡ評分預測重癥患者細菌感染性疾病28 d生存情況的AUC分彆為0.804和0.792,PCT的AUC值高于APACHEⅡ評分,但差異無統計學意義(U=0.2073,P=0.802).聯閤PCT和APACHEⅡ評分預測28 d生存情況的AUC較單一指標高,為0.817,敏感度90.7％,特異度75.2％,均優于單一指標的預測效能.結論 血清PCT能反映重癥患者細菌感染性疾病病情嚴重程度及預後,是預測28 d生存情況的有效指標,聯閤PCT檢測和APACHEⅡ評分可提高預測效能.
목적 탐토혈청강개소원(PCT)대중증환자세균감염성질병예후평고화병정엄중정도판단적개치.방법 채용전첨성방법진행연구,선취2012년2월지2012년11월기간수주남통대학부속의원중증의학과부합입선조건적116례세균감염성질병환자위연구대상,채용면역색보법검측입원후24 h내적혈청PCT수평,기록환자24 h급성생이학여만성건강상황Ⅱ(APACHEⅡ)평분.근거28 d림상결국,분위사망조(36례)화존활조(80례),용성조t검험혹질화검험비교량조간PCT、APACHEⅡ평분적차이,채용Spearman's상관검험분석혈청PCT수평여APACHEⅡ평분적상관성,용수시자공작특정곡선(ROC)하면적(AUC)평고PCT단독응용급연합PCT화APACHEⅡ평분예측28 d생존정황적효능.용U검험대PCT화APACHEⅡ평분예측28 d생존정황적효능진행비교.결과 사망조PCT수평명현고우존활조[5.38 (2.08,25) vs.0.23 (1.00,2.12)] (Z=5.598,P＜0.001),사망조APACHEⅡ평분역현저고우존활조(24.32±6.72) vs.(16.05±7.24),t=6.148,P＜0.01.PCT여APACHEⅡ평분존재현저정상관(r=0.388,P＜0.001),PCT화APACHEⅡ평분예측중증환자세균감염성질병28 d생존정황적AUC분별위0.804화0.792,PCT적AUC치고우APACHEⅡ평분,단차이무통계학의의(U=0.2073,P=0.802).연합PCT화APACHEⅡ평분예측28 d생존정황적AUC교단일지표고,위0.817,민감도90.7％,특이도75.2％,균우우단일지표적예측효능.결론 혈청PCT능반영중증환자세균감염성질병병정엄중정도급예후,시예측28 d생존정황적유효지표,연합PCT검측화APACHEⅡ평분가제고예측효능.
Objective To explore the value of procalcitonin (PCT) in the prediction of the prognosis and severity of bacterial infection in critically ill patients.Methods A total of 116 eligible patients with bacterial infection admitted in the intensive care unit were enrolled in this prospective study from February,2012 through November,2012.Within 24 hours after admission,the serum PCT was determined with immune-chromatography and acute physiology and chronic health evaluation Ⅱ (APACHE Ⅱ) score of patients was calculated.Based on the 28-day clinical outcome of patients,the patients were divided into fatal group (n =36) and survival group (n =80).The differences in PCT and APACHE Ⅱ score between the two groups were compared with t test or rank-sum test.The correlation between PCT and APACHE Ⅱ score was determined with Spearman's correlation analysis.Both PCT and APACHE Ⅱ score were analyzed separately and jointly with area under receiver operator characteristic curve (ROC curve,AUC) to predict 28-day survival.Comparison of prediction performance for predicting 28-day survival of patients with bacterial infection between PCT and APACHE Ⅱ was made with U test.Results PCT concentration was significantly higher in fatal group than that in survival group [5.36 (2.07,25) vs.0.24 (1.00,2.14)] (Z =5.596,P ＜0.01).APACHE Ⅱ score within 24 hour after admission was significantly higher in fatal group than that in survival group (24.30 ± 6.71) vs.(16.03 ± 7.23),t =6.147,P ＜ 0.01.Positive correlation between PCT and APACHE Ⅱscore was found to be statistical significance (r =0.388,P＜ 0.01).When rates of 28-day survival in patients were predicted by using PCT and APACHE Ⅱ score,the areas of under curve were 0.804 and 0.792,respectively.AUC of PCT was tenuously larger than that of APACHE Ⅱ score (U =0.2073,P =0.802).Using PCT and APACHE Ⅱ score together to predict 28-day survival,AUC (0.817) was increased.The joint prediction performance was higher than that of either alone,increasing the sensitivity to 90.7％ and the specificity to 75.2％.Conclusions Serum PCT can reflect the severity of the illness and prognosis of infectious disease in the intensive care unit.It can serve as a sensitive marker of predicting 28-day survival.Combining PCT and APACHE Ⅱ score together can increase the prognostic value.
