中华危重病急救医学
中華危重病急救醫學
중화위중병급구의학
Chinese Critical Care Medicine
2015年
2期
97-101
,共5页
脓毒症%降钙素原%C-反应蛋白%急性生理学与慢性健康状况评分系统Ⅱ评分%序贯器官衰竭评分%预后
膿毒癥%降鈣素原%C-反應蛋白%急性生理學與慢性健康狀況評分繫統Ⅱ評分%序貫器官衰竭評分%預後
농독증%강개소원%C-반응단백%급성생이학여만성건강상황평분계통Ⅱ평분%서관기관쇠갈평분%예후
Sepsis%Procalcitonin%C-reactive protein%Acute physiology and chronic health evaluationⅡ score%Sequential organ failure assessment score%Prognosis
目的：探讨脓毒症患者血中降钙素原（PCT）和C-反应蛋白（CRP）与急性生理学与慢性健康状况评分系统Ⅱ（APACHEⅡ）评分及序贯器官衰竭评分（SOFA）的相关性，以及PCT和CRP对脓毒症预后的评估价值。方法回顾性分析2011年1月至2014年6月入住第二军医大学附属长征医院重症监护病房（ICU）患者的临床资料，纳入入院24 h内行PCT、 CRP检测以及APACHEⅡ、 SOFA评分的脓毒症患者201例。分析死亡（65例）和存活（136例）患者的PCT、 CRP、 APACHEⅡ、 SOFA评分差异以及不同APACHEⅡ、SOFA评分分层组间PCT和CRP的差异； PCT、 CRP与APACHEⅡ、 SOFA评分的相关性用Spearman相关分析；绘制受试者工作特征曲线（ROC），评价PCT、 CRP对脓毒症患者预后的判断价值。结果与存活组比较，死亡组PCT〔μg/L：11.03（19.17）比1.39（2.61），Z＝-4.572，P＜0.001〕、 APACHEⅡ评分（分：19.16±5.32比10.01±3.88，t＝-13.807，P＜0.001）、 SOFA评分（分：9.66±4.28比4.27±3.19，t＝-9.993，P＜0.001）均明显升高，而CRP升高差异无统计学意义〔mg/L：75.22（110.94）比56.93（100.75），Z＝-0.731，P＝0.665〕。PCT与APACHEⅡ、 SOFA评分均呈显著正相关（r1＝0.373，r2＝0.392，均P＜0.001），而CRP与APACHEⅡ、 SOFA评分均无相关性（r1＝-0.073、P1＝0.411，r2＝-0.106、P2＝0.282）。随APACHEⅡ、 SOFA评分升高，PCT水平逐渐升高，而CRP水平无明显变化；APACHEⅡ分值0～10分、11～20分、＞20分3组的PCT分别为1.45（2.62）、1.96（9.04）、7.41（28.9）μg/L，CRP分别为57.50（83.40）、59.00（119.70）、77.60（120.00） mg/L；SOFA分值0～5分、6～10分、＞10分3组的PCT分别为1.43（3.09）、3.41（9.75）、5.43（29.60）μg/L，CRP分别为49.30（86.20）、76.00（108.70）、75.60（118.10） mg/L；PCT在APACHEⅡ和SOFA评分各分层组间两两比较差异均有统计学意义（P＜0.05或P＜0.01），而CRP差异则无统计学差异。PCT评价预后的ROC曲线下面积（AUC）明显大于CRP评价预后的AUC〔0.872（95%可信区间0.811～0.943）比0.512（95%可信区间0.427～0.612），P＜0.001〕；当PCT截断值为3.36μg/L时，敏感度为66.8%，特异度为45.4%；当CRP截断值为44.50 mg/L时，敏感度为82.2%，特异度为80.3%。结论 PCT较CRP与APACHEⅡ和SOFA评分更具有相关性，且能更好地反映脓毒症患者的病情严重程度以及预后情况。
目的：探討膿毒癥患者血中降鈣素原（PCT）和C-反應蛋白（CRP）與急性生理學與慢性健康狀況評分繫統Ⅱ（APACHEⅡ）評分及序貫器官衰竭評分（SOFA）的相關性，以及PCT和CRP對膿毒癥預後的評估價值。方法迴顧性分析2011年1月至2014年6月入住第二軍醫大學附屬長徵醫院重癥鑑護病房（ICU）患者的臨床資料，納入入院24 h內行PCT、 CRP檢測以及APACHEⅡ、 SOFA評分的膿毒癥患者201例。分析死亡（65例）和存活（136例）患者的PCT、 CRP、 APACHEⅡ、 SOFA評分差異以及不同APACHEⅡ、SOFA評分分層組間PCT和CRP的差異； PCT、 CRP與APACHEⅡ、 SOFA評分的相關性用Spearman相關分析；繪製受試者工作特徵麯線（ROC），評價PCT、 CRP對膿毒癥患者預後的判斷價值。結果與存活組比較，死亡組PCT〔μg/L：11.03（19.17）比1.39（2.61），Z＝-4.572，P＜0.001〕、 APACHEⅡ評分（分：19.16±5.32比10.01±3.88，t＝-13.807，P＜0.001）、 SOFA評分（分：9.66±4.28比4.27±3.19，t＝-9.993，P＜0.001）均明顯升高，而CRP升高差異無統計學意義〔mg/L：75.22（110.94）比56.93（100.75），Z＝-0.731，P＝0.665〕。PCT與APACHEⅡ、 SOFA評分均呈顯著正相關（r1＝0.373，r2＝0.392，均P＜0.001），而CRP與APACHEⅡ、 SOFA評分均無相關性（r1＝-0.073、P1＝0.411，r2＝-0.106、P2＝0.282）。隨APACHEⅡ、 SOFA評分升高，PCT水平逐漸升高，而CRP水平無明顯變化；APACHEⅡ分值0～10分、11～20分、＞20分3組的PCT分彆為1.45（2.62）、1.96（9.04）、7.41（28.9）μg/L，CRP分彆為57.50（83.40）、59.00（119.70）、77.60（120.00） mg/L；SOFA分值0～5分、6～10分、＞10分3組的PCT分彆為1.43（3.09）、3.41（9.75）、5.43（29.60）μg/L，CRP分彆為49.30（86.20）、76.00（108.70）、75.60（118.10） mg/L；PCT在APACHEⅡ和SOFA評分各分層組間兩兩比較差異均有統計學意義（P＜0.05或P＜0.01），而CRP差異則無統計學差異。PCT評價預後的ROC麯線下麵積（AUC）明顯大于CRP評價預後的AUC〔0.872（95%可信區間0.811～0.943）比0.512（95%可信區間0.427～0.612），P＜0.001〕；噹PCT截斷值為3.36μg/L時，敏感度為66.8%，特異度為45.4%；噹CRP截斷值為44.50 mg/L時，敏感度為82.2%，特異度為80.3%。結論 PCT較CRP與APACHEⅡ和SOFA評分更具有相關性，且能更好地反映膿毒癥患者的病情嚴重程度以及預後情況。
목적：탐토농독증환자혈중강개소원（PCT）화C-반응단백（CRP）여급성생이학여만성건강상황평분계통Ⅱ（APACHEⅡ）평분급서관기관쇠갈평분（SOFA）적상관성，이급PCT화CRP대농독증예후적평고개치。방법회고성분석2011년1월지2014년6월입주제이군의대학부속장정의원중증감호병방（ICU）환자적림상자료，납입입원24 h내행PCT、 CRP검측이급APACHEⅡ、 SOFA평분적농독증환자201례。분석사망（65례）화존활（136례）환자적PCT、 CRP、 APACHEⅡ、 SOFA평분차이이급불동APACHEⅡ、SOFA평분분층조간PCT화CRP적차이； PCT、 CRP여APACHEⅡ、 SOFA평분적상관성용Spearman상관분석；회제수시자공작특정곡선（ROC），평개PCT、 CRP대농독증환자예후적판단개치。결과여존활조비교，사망조PCT〔μg/L：11.03（19.17）비1.39（2.61），Z＝-4.572，P＜0.001〕、 APACHEⅡ평분（분：19.16±5.32비10.01±3.88，t＝-13.807，P＜0.001）、 SOFA평분（분：9.66±4.28비4.27±3.19，t＝-9.993，P＜0.001）균명현승고，이CRP승고차이무통계학의의〔mg/L：75.22（110.94）비56.93（100.75），Z＝-0.731，P＝0.665〕。PCT여APACHEⅡ、 SOFA평분균정현저정상관（r1＝0.373，r2＝0.392，균P＜0.001），이CRP여APACHEⅡ、 SOFA평분균무상관성（r1＝-0.073、P1＝0.411，r2＝-0.106、P2＝0.282）。수APACHEⅡ、 SOFA평분승고，PCT수평축점승고，이CRP수평무명현변화；APACHEⅡ분치0～10분、11～20분、＞20분3조적PCT분별위1.45（2.62）、1.96（9.04）、7.41（28.9）μg/L，CRP분별위57.50（83.40）、59.00（119.70）、77.60（120.00） mg/L；SOFA분치0～5분、6～10분、＞10분3조적PCT분별위1.43（3.09）、3.41（9.75）、5.43（29.60）μg/L，CRP분별위49.30（86.20）、76.00（108.70）、75.60（118.10） mg/L；PCT재APACHEⅡ화SOFA평분각분층조간량량비교차이균유통계학의의（P＜0.05혹P＜0.01），이CRP차이칙무통계학차이。PCT평개예후적ROC곡선하면적（AUC）명현대우CRP평개예후적AUC〔0.872（95%가신구간0.811～0.943）비0.512（95%가신구간0.427～0.612），P＜0.001〕；당PCT절단치위3.36μg/L시，민감도위66.8%，특이도위45.4%；당CRP절단치위44.50 mg/L시，민감도위82.2%，특이도위80.3%。결론 PCT교CRP여APACHEⅡ화SOFA평분경구유상관성，차능경호지반영농독증환자적병정엄중정도이급예후정황。
ObjectiveTo investigate the correlation between procalcitonin (PCT), C-reactive protein (CRP) and acute physiology and chronic health evaluationⅡ (APACHEⅡ) score and sequential organ failure assessment (SOFA) score, and to investigate the value in assessment of PCT and CRP in prognosis in patients with sepsis.Methods Clinical data of patients admitted to intensive care unit (ICU) of Changzheng Hospital Affiliated to the Second Military Medical University from January 2011 to June 2014 were retrospectively analyzed. 201 sepsis patients who received PCT and CRP tests, and evaluation of APACHEⅡ score and SOFA score were enrolled. The values of PCT, CRP, APACHEⅡ score and SOFA score between survivals (n = 136) and non-survivals (n = 65) were compared. The values of PCT and CRP among groups with different APACHEⅡ scores and SOFA scores were compared. The relationships between PCT, CRP and APACHEⅡ score and SOFA score were analyzed by Spearman correlation analysis. Receiver operating characteristic (ROC) curve was plotted to assess the prognostic value of PCT and CRP for prognosis of patients with sepsis.Results Compared with survival group, the values of PCT [μg/L: 11.03 (19.17) vs. 1.39 (2.61), Z= -4.572,P< 0.001], APACHEⅡ score (19.16±5.32 vs. 10.01±3.88,t = -13.807,P< 0.001) and SOFA score (9.66±4.28 vs. 4.27±3.19,t = -9.993,P< 0.001) in non-survival group were significantly increased, but the value of CRP was not significantly different between non-survival group and survival group [mg/L: 75.22 (110.94) vs. 56.93 (100.75),Z = -0.731,P = 0.665]. The values of PCT were significantly correlated with APACHEⅡ score and SOFA score (r1 = 0.373,r2 = 0.392, bothP< 0.001), but the values of CRP were not significantly correlated with APACHEⅡscore and SOFA score (r1 = -0.073,P1 = 0.411;r2 = -0.106,P2 = 0.282). The values of PCT rose significantly as the APACHEⅡ score and SOFA score became higher, but the value of CRP was not significantly increased. When APACHEⅡ score was 0-10, 11-20, and> 20, the value of PCT was 1.45 (2.62), 1.96 (9.04), and 7.41 (28.9)μg/L, respectively, and the value of CRP was 57.50 (83.40), 59.00 (119.70), and 77.60 (120.00) mg/L, respectively. When SOFA score was 0-5, 6-10, and> 10, the value of PCT was respectively 1.43 (3.09), 3.41 (9.75), and 5.43 (29.60)μg/L, and the value of CRP was 49.30 (86.20), 76.00 (108.70), and 75.60 (118.10) mg/L, respectively. There was significant difference in PCT between any two groups with different APACHEⅡ and SOFA scores (P< 0.05 orP<0.01), but no significant differences in CRP were found. The area under the ROC curve (AUC) of PCT for prognosis was significantly greater than that of CRP [0.872 (95% confidence interval 0.811-0.943) vs. 0.512 (95% confidence interval 0.427-0.612),P< 0.001]. When the cut-off value of PCT was 3.36μg/L, the sensitivity was 66.8%, and the specificity was 45.4%. When the cut-off value of CRP was 44.50 mg/L, the sensitivity was 82.2%, and the specificity was 80.3%.Conclusions Compared with CRP, PCT was more significantly correlated with APACHEⅡ score and SOFA score. PCT can be a better indicator for evaluation of degree of severity, and also prognosis in sepsis patients.
