中华危重病急救医学
中華危重病急救醫學
중화위중병급구의학
Chinese Critical Care Medicine
2013年
8期
467-470
,共4页
黄伟平%黄澄%温妙云%江稳强%曾红科
黃偉平%黃澄%溫妙雲%江穩彊%曾紅科
황위평%황징%온묘운%강은강%증홍과
降钙素原%脓毒性休克%预后%感染
降鈣素原%膿毒性休剋%預後%感染
강개소원%농독성휴극%예후%감염
Procalcitonin%Septic shock%Prognosis%Infection
目的 探讨脓毒性休克患者降钙素原(PCT)的变化规律及其与预后的关系.方法 选取本院符合脓毒性休克诊断的63例患者,于入住重症监护病房(ICU)1、3、5、7d检测PCT、C-反应蛋白(CRP)及白细胞计数(WBC).并按患者28 d预后分为生存组和死亡组,比较两组患者上述各项参数的差异,用多水平线性模型分析两组参数随住院时间变化的特征及与预后的关系.结果 生存组41例,死亡组22例.入ICU后生存组PCT、CRP随时间延长呈下降趋势,死亡组则呈上升趋势；死亡组入ICU 3、5、7 d PCT(μg/L)水平明显高于生存组(3 d:8.7±3.7比5.6±1.7,5 d:10.3±1.3比4.8±2.3,7 d:12.7±2.3比0.8±0.3,P＜0.05或P＜0.01),入ICU5d、7 d CRP(mg/L)水平明显高于生存组(5 d:447±63比355±91,7 d:439±45比364±63,均P＜0.05).两组WBC无明显变化,且两组间各时间点比较差异均无统计学意义.效应分析显示:PCT随住ICU天数延长而有显著变化(F=10.91,P=0.00),且生存者与死亡者间也有显著差异(F=7.58,P=0.00)；而CRP仅随住ICU天数延长而有显著变化(F=4.17,P=0.03).结论 与CRP、WBC相比,PCT反映预后的敏感性更高,PCT水平的持续升高提示患者预后不良,血清PCT可作为预测脓毒性休克患者预后的指标.
目的 探討膿毒性休剋患者降鈣素原(PCT)的變化規律及其與預後的關繫.方法 選取本院符閤膿毒性休剋診斷的63例患者,于入住重癥鑑護病房(ICU)1、3、5、7d檢測PCT、C-反應蛋白(CRP)及白細胞計數(WBC).併按患者28 d預後分為生存組和死亡組,比較兩組患者上述各項參數的差異,用多水平線性模型分析兩組參數隨住院時間變化的特徵及與預後的關繫.結果 生存組41例,死亡組22例.入ICU後生存組PCT、CRP隨時間延長呈下降趨勢,死亡組則呈上升趨勢；死亡組入ICU 3、5、7 d PCT(μg/L)水平明顯高于生存組(3 d:8.7±3.7比5.6±1.7,5 d:10.3±1.3比4.8±2.3,7 d:12.7±2.3比0.8±0.3,P＜0.05或P＜0.01),入ICU5d、7 d CRP(mg/L)水平明顯高于生存組(5 d:447±63比355±91,7 d:439±45比364±63,均P＜0.05).兩組WBC無明顯變化,且兩組間各時間點比較差異均無統計學意義.效應分析顯示:PCT隨住ICU天數延長而有顯著變化(F=10.91,P=0.00),且生存者與死亡者間也有顯著差異(F=7.58,P=0.00)；而CRP僅隨住ICU天數延長而有顯著變化(F=4.17,P=0.03).結論 與CRP、WBC相比,PCT反映預後的敏感性更高,PCT水平的持續升高提示患者預後不良,血清PCT可作為預測膿毒性休剋患者預後的指標.
목적 탐토농독성휴극환자강개소원(PCT)적변화규률급기여예후적관계.방법 선취본원부합농독성휴극진단적63례환자,우입주중증감호병방(ICU)1、3、5、7d검측PCT、C-반응단백(CRP)급백세포계수(WBC).병안환자28 d예후분위생존조화사망조,비교량조환자상술각항삼수적차이,용다수평선성모형분석량조삼수수주원시간변화적특정급여예후적관계.결과 생존조41례,사망조22례.입ICU후생존조PCT、CRP수시간연장정하강추세,사망조칙정상승추세；사망조입ICU 3、5、7 d PCT(μg/L)수평명현고우생존조(3 d:8.7±3.7비5.6±1.7,5 d:10.3±1.3비4.8±2.3,7 d:12.7±2.3비0.8±0.3,P＜0.05혹P＜0.01),입ICU5d、7 d CRP(mg/L)수평명현고우생존조(5 d:447±63비355±91,7 d:439±45비364±63,균P＜0.05).량조WBC무명현변화,차량조간각시간점비교차이균무통계학의의.효응분석현시:PCT수주ICU천수연장이유현저변화(F=10.91,P=0.00),차생존자여사망자간야유현저차이(F=7.58,P=0.00)；이CRP부수주ICU천수연장이유현저변화(F=4.17,P=0.03).결론 여CRP、WBC상비,PCT반영예후적민감성경고,PCT수평적지속승고제시환자예후불량,혈청PCT가작위예측농독성휴극환자예후적지표.
Objective To investigate procalcitonin (PCT) change pattern in patients with septic shock and its relationship with prognosis.Methods Sixty-three septic shock patients were enrolled,and levels of PCT,C-reactive protein (CRP) as well as white blood cell (WBC) on 1st,3rd,5th,7th day after admission to intensive care unit (ICU)were checked.Patients were divided into survival group and death group according to 28-day survival result.Differences in parameters between two groups were compared.The change regulation of parameters along with in-hospital period and its relationship with prognosis were analyzed by multilevel linear model.Results There were 41 patients in survival group and 22 patients in death group.PCT and CRP level decreased in survival group with time dependency pattern,while death group increased.The PCT (μg/L) at 3,5,7 days after admission to ICU in death group were significantly higher than those in survivors (3 days:8.7 ± 3.7 vs.5.6 ± 1.7,5 days:10.3 ± 1.3 vs.4.8 ± 2.3,7 days:12.7 ± 2.3 vs.0.8 ± 0.3,P＜0.05 or P＜0.01),and CRP (mg/L) at 5 days and 7 days was significantly higher than those in survival group (5 days:447 ± 63 vs.355 ± 91,7 days:439 ± 45 vs.364 ± 63,both P＜0.05).Two groups of WBC did not change significantly,and there were no statistical significance difference at each time point between the two groups.What's more,the effect analysis results showed that there were significant changes in PCT as ICU day prolonged (F=10.91,P=0.00),and there was a significant difference between the survivor and the dead (F=7.58,P=0.00),while CRP changed only with ICU stays (F=4.17,P=0.03).Conclusion Compared with CRP and WBC,PCT had higher sensitivity in predicting prognosis,sustainable elevation of PCT level indicates poor prognosis,serum PCT can be used as one of indexes predicting prognosis of septic shock.
