CAJ | 학술논문

目的探讨降钙素原(PCT)对脓毒症患者病情评估和预后判断的价值.方法回顾性分析2011年10月至2012年9月武汉大学人民医院急诊监护室、重症监护室、呼吸监护室收治的脓毒症患者278例,其中免疫功能正常患者122例,免疫功能异常患者156例.根据APACHEⅡ评分将患者分为低、中、高危3组.分析PCT质量浓度与APACHEⅡ评分,首次PCT质量浓度与入院7d病死率之间的相关性.并比较首次PCT质量浓度与动态监测PCT对患者预后的预测价值.结果 Pearson相关分析结果显示,患者PCT质量浓度与即时APACHEⅡ评分存在显著正相关性(r =0.979,P＜0.05).患者首次PCT质量浓度与入院7d病死率也存在显著正相关性(r=0.826,P＜0.05).多因素logistic回归分析显示入院首次PCT质量浓度和APACHEⅡ评分与脓毒症患者7d预后差异具有统计学意义(首次PCT值浓度OR=1.77,95％CI=1.28,3.83,P=0.0023).与动态监测PCT比较,分别以免疫功能正常患者PCT≥7.18 ng/ml,免疫功能异常患者PCT≥3.52 ng/ml为脓毒症患者入院7d死亡的最佳预警界值,敏感性差异无统计学意义,特异性低于动态监测PCT.结论 PCT质量浓度并且不受糖皮质激素或免疫抑制剂的影响可以鉴别免疫功能异常的患者是否合并细菌感染.入院首次PCT值浓度是预测脓毒症患者7d死亡的独立危险因素.与免疫功能正常的患者比较,免疫功能异常患者提示短期恶性预后的PCT预警界值更低.
목적 탐토강개소원(PCT)대농독증환자병정평고화예후판단적개치.방법 회고성분석2011년10월지2012년9월무한대학인민의원급진감호실、중증감호실、호흡감호실수치적농독증환자278례,기중면역공능정상환자122례,면역공능이상환자156례.근거APACHEⅡ평분장환자분위저、중、고위3조.분석PCT질량농도여APACHEⅡ평분,수차PCT질량농도여입원7d병사솔지간적상관성.병비교수차PCT질량농도여동태감측PCT대환자예후적예측개치.결과 Pearson상관분석결과현시,환자PCT질량농도여즉시APACHEⅡ평분존재현저정상관성(r =0.979,P＜0.05).환자수차PCT질량농도여입원7d병사솔야존재현저정상관성(r=0.826,P＜0.05).다인소logistic회귀분석현시입원수차PCT질량농도화APACHEⅡ평분여농독증환자7d예후차이구유통계학의의(수차PCT치농도OR=1.77,95％CI=1.28,3.83,P=0.0023).여동태감측PCT비교,분별이면역공능정상환자PCT≥7.18 ng/ml,면역공능이상환자PCT≥3.52 ng/ml위농독증환자입원7d사망적최가예경계치,민감성차이무통계학의의,특이성저우동태감측PCT.결론 PCT질량농도병차불수당피질격소혹면역억제제적영향가이감별면역공능이상적환자시부합병세균감염.입원수차PCT치농도시예측농독증환자7d사망적독립위험인소.여면역공능정상적환자비교,면역공능이상환자제시단기악성예후적PCT예경계치경저.
Objective To evaluate the diagnostic and predict value of procalcitonin (PCT) levels in patients diagnosis of sepsis with immune system defect in the intensive care unit (ICU).Methods This is a retrospective analysis.We enrolled 278 patients diagnosis of sepsis in Emergency ICU,general ICU and Respiratory ICU in Renmin Hospital of Wuhan University from October 2011 to September 2012.Among them,122 patients have normal immune function and 156 patients have auto-immune system diseases or/and requiring corticosteroids or chemotherapy.According to the APACHE Ⅱ score,patients were divided into low-risk group,middle-risk group and high-risk group,and their PCT levels were compared.Logistic regression analysis of the multiple factors was used to screen independent risk factors for predicting 7 days' mortality.The predictive ability was also evaluated and compared between the first time of PCT concentration after admission and dynamic change of PCT within the first week with area under receiver operator's characteristic curve (ROC curve,AUC).Result The results of Spearman correlation analysis showed that there was a significant positive correlation between the patients' PCT concentration and APACHE Ⅱ score (r =0.979,P ＜ 0.05).And there was a positive correlation between the first PCT concentration after admission and 7 days' mortality in-hospital (r =0.826,P ＜ 0.05).Multiple factors logistic regression analysis indicated that both the first time PCT concentration after admission and APACHE Ⅱ score of patients were independent risk factors for predicting 7 days' mortality (PCT OR =1.77,95％ CI =1.28-3.83,P =0.0023).The warning value of 7 days' mortality for patients with normal immune function was PCT≥7.18 ng/ml and for those with abnormal immune function was PCT ≥ 3.52 ng/ml.Compared to dynamic monitoring of PCT,there was no significant difference in sensitivity but specificity is less than the dynamic monitoring of PCT.Conclusions The diagnostic and predict value of procalcitonin (PCT) levels were not affected by the immuno-suppressive therapy.The first time PCT concentration after admission was an independent risk factor for predict of 7 days' mortality in ICU patients with sepsis.The PCT warning value of the sepsis patients with abnormal immune function was much lower compared to those with normal immune function.