安徽医药
安徽醫藥
안휘의약
ANHUI MEDICAL AND PHARMACEUTICAL JOURNAL
2015年
2期
284-287
,共4页
心搏骤停后综合征%血降钙素原%C反应蛋白%病情评估%预后
心搏驟停後綜閤徵%血降鈣素原%C反應蛋白%病情評估%預後
심박취정후종합정%혈강개소원%C반응단백%병정평고%예후
post-Cardiac arrest syndrome%blood procalcitonin%C-reactive protein%condition evaluation%prognosis
目的：探索心搏骤停后综合征患者血降钙素原及C-反应蛋白对早期病情评估及预后的价值。方法收集2012年6月至2014年2月入住该院急诊重症监护室（ EICU）成功心肺复苏自主循环恢复（存活≥24 h）并排除发病时未满18周岁、资料不完全、早期家属放弃抢救以及处于疾病终末期引起心搏骤停等病例，共113例。于患者入院0时及24时行血降钙素原（ PCT）及C反应蛋白（ CRP）检测。根据APACHEⅡ评分（入院0 h及24 h）将入选患者分为低、中、高危三组，根据患者出院存活预后情况分为存活组和死亡组，根据三种感染定义方法将入选患者分为感染组和非感染组。采用相关统计学方法分析血降钙素原和C-反应蛋白与APACHEⅡ评分相关性及与预后的关系，分析心搏骤停后综合征患者早期血降钙素原水平与感染相关性。结果（1）血PCT24 h、PCT24 h－0 h及CRP24 h值均与APACHEⅡ评分显著正相关，相关系数分别为0．87、0．88、0．85，而CRP0 h与APACHEⅡ评分无相关性（r＝0．25，P＞0．05）。（2）血PCT0 h、PCT24 h及PCT24 h－0 h均是死亡预后的独立危险因素，三者ROC曲线下面积（AUC）分别为0．80、0．687、0．94，最佳预警戒值分别为8．35、20．06、15．84μg· L－1，对死亡预后的敏感度分别为88．80％、70．02％、89．10％，特异度分别为80．20％、72．00％、95．25％。（3）心搏骤停后综合征患者早期血PCT水平升高与感染无关。结论（1）心搏骤停后综合征患者血降钙素原（ PCT）在入院时即开始升高，而C反应蛋白（ CRP）升高较晚，且两者水平与病情严重程度正相关，可用于早期病情评估。（2）患者入院时PCT0 h升高大于8．35μg· L－1提示不良预后，病程24 h内持续升高，且PCT24 h－0 h ＞15．84μg· L－1对死亡预后预测效能最高。可作为心搏骤停后综合征患者死亡预后的标志物。
目的：探索心搏驟停後綜閤徵患者血降鈣素原及C-反應蛋白對早期病情評估及預後的價值。方法收集2012年6月至2014年2月入住該院急診重癥鑑護室（ EICU）成功心肺複囌自主循環恢複（存活≥24 h）併排除髮病時未滿18週歲、資料不完全、早期傢屬放棄搶救以及處于疾病終末期引起心搏驟停等病例，共113例。于患者入院0時及24時行血降鈣素原（ PCT）及C反應蛋白（ CRP）檢測。根據APACHEⅡ評分（入院0 h及24 h）將入選患者分為低、中、高危三組，根據患者齣院存活預後情況分為存活組和死亡組，根據三種感染定義方法將入選患者分為感染組和非感染組。採用相關統計學方法分析血降鈣素原和C-反應蛋白與APACHEⅡ評分相關性及與預後的關繫，分析心搏驟停後綜閤徵患者早期血降鈣素原水平與感染相關性。結果（1）血PCT24 h、PCT24 h－0 h及CRP24 h值均與APACHEⅡ評分顯著正相關，相關繫數分彆為0．87、0．88、0．85，而CRP0 h與APACHEⅡ評分無相關性（r＝0．25，P＞0．05）。（2）血PCT0 h、PCT24 h及PCT24 h－0 h均是死亡預後的獨立危險因素，三者ROC麯線下麵積（AUC）分彆為0．80、0．687、0．94，最佳預警戒值分彆為8．35、20．06、15．84μg· L－1，對死亡預後的敏感度分彆為88．80％、70．02％、89．10％，特異度分彆為80．20％、72．00％、95．25％。（3）心搏驟停後綜閤徵患者早期血PCT水平升高與感染無關。結論（1）心搏驟停後綜閤徵患者血降鈣素原（ PCT）在入院時即開始升高，而C反應蛋白（ CRP）升高較晚，且兩者水平與病情嚴重程度正相關，可用于早期病情評估。（2）患者入院時PCT0 h升高大于8．35μg· L－1提示不良預後，病程24 h內持續升高，且PCT24 h－0 h ＞15．84μg· L－1對死亡預後預測效能最高。可作為心搏驟停後綜閤徵患者死亡預後的標誌物。
목적：탐색심박취정후종합정환자혈강개소원급C-반응단백대조기병정평고급예후적개치。방법수집2012년6월지2014년2월입주해원급진중증감호실（ EICU）성공심폐복소자주순배회복（존활≥24 h）병배제발병시미만18주세、자료불완전、조기가속방기창구이급처우질병종말기인기심박취정등병례，공113례。우환자입원0시급24시행혈강개소원（ PCT）급C반응단백（ CRP）검측。근거APACHEⅡ평분（입원0 h급24 h）장입선환자분위저、중、고위삼조，근거환자출원존활예후정황분위존활조화사망조，근거삼충감염정의방법장입선환자분위감염조화비감염조。채용상관통계학방법분석혈강개소원화C-반응단백여APACHEⅡ평분상관성급여예후적관계，분석심박취정후종합정환자조기혈강개소원수평여감염상관성。결과（1）혈PCT24 h、PCT24 h－0 h급CRP24 h치균여APACHEⅡ평분현저정상관，상관계수분별위0．87、0．88、0．85，이CRP0 h여APACHEⅡ평분무상관성（r＝0．25，P＞0．05）。（2）혈PCT0 h、PCT24 h급PCT24 h－0 h균시사망예후적독립위험인소，삼자ROC곡선하면적（AUC）분별위0．80、0．687、0．94，최가예경계치분별위8．35、20．06、15．84μg· L－1，대사망예후적민감도분별위88．80％、70．02％、89．10％，특이도분별위80．20％、72．00％、95．25％。（3）심박취정후종합정환자조기혈PCT수평승고여감염무관。결론（1）심박취정후종합정환자혈강개소원（ PCT）재입원시즉개시승고，이C반응단백（ CRP）승고교만，차량자수평여병정엄중정도정상관，가용우조기병정평고。（2）환자입원시PCT0 h승고대우8．35μg· L－1제시불량예후，병정24 h내지속승고，차PCT24 h－0 h ＞15．84μg· L－1대사망예후예측효능최고。가작위심박취정후종합정환자사망예후적표지물。
Objective to explore condition evaluation and prediction value of blood procalcitonin and C-reactive protein in Post-Cardi-ac arrest syndrome patients .Methods Review from June 2012 to February 2014 transferred into EICU ward,successful cardiopulmo-nary resuscitation (CPR) spontaneous circulation restoration≥24 hours.Excluded under 18 years of age at onset,the data is not com-plete,rescue abandoned after the onset of early cases and in families with end-stage disease caused by cardiac arrest.Finally selected 113 cases.Detect blood procalcitonin ( PCT) and C-reactive protein ( CRP) after patients admitted to hospital and 24 hours.According to the APACHEⅡscores ( admission 0 h and 24 h) ,divided into low,medium and high risk groups.According to patients'prognosis, divided into survival group and death group,Three definitions of infection were used to classified patients as infected group and non-in-fected group.Using related statistical methods to analyze the correlation of blood procalcitonin and C -reactive protein with the A-PACHE Ⅱscores and prognosis.analyzing the correlation of serum PCT levels in patients early post cardiac arrest syndrome with infec-tion.Result (1) The plasma levels of PCT24 h ,PCT24 h-0 h ,CRP24 h and APACHEII scores was significantly positive correlation, coeffi-cient respectively was 0.87,0.88,0.85,but CRP0 h have no correlation with APACHEⅡscores(r =0.25,P=0.54).(2)PCT0 h, PCT24 hand PCT24 h-0 hwere independent prognostic factors of death,the areas under the ROC curve (AUC) were 0.80,0.687,0.94,the best warning plasma levels were 8.35,20.06,15.84μg· L-1 ,the prognosis of death sensitivity was 88.80%,70.02%,89.10%,spe-cificity was 80.20%,72.00%,95.25%.(3) Serum PCT levels in patients with early post cardiac arrest syndrome has nothing to do with infection.Conclusions (1)The blood procalcitonin (PCT)of Cardiac arrest syndrome patients began to increase at the time of admission,in contrast,C-reactive protein ( CRP) rises later.Both levels positively correlated with the severity.So,can be used for early condition evaluation.(2) PCT0 h on admission higher than 8.35 μg· L-1 predicts poor prognosis,ongoing to rise within 24 hours,and PCT24 h-0 h>15.84 μg· L-1 is the highest prediction prognosis of death.PCT can be used as died prognostic markers of Post-Cardiac arrest syndrome patients.
