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
9期
739-742
,共4页
李燕%卢彩兰%刘鸿%刘铮%窦伟
李燕%盧綵蘭%劉鴻%劉錚%竇偉
리연%로채란%류홍%류쟁%두위
前肾上腺髓质素%降钙素原%急性生理学与慢性健康状况评分系统Ⅱ评分%脓毒症
前腎上腺髓質素%降鈣素原%急性生理學與慢性健康狀況評分繫統Ⅱ評分%膿毒癥
전신상선수질소%강개소원%급성생이학여만성건강상황평분계통Ⅱ평분%농독증
Pro-adrenomedullin%Procalcitonin%Acute physiology and chronic health evaluationⅡ score%Sepsis
目的：探讨前肾上腺髓质素（pro-ADM）在脓毒症早期诊断中的临床价值。方法采用前瞻性研究方法，选择2013年4月至2014年3月山西医科大学第二医院急诊科收治的82例急性感染患者。根据入院时脓毒症诊断标准将患者分为一般感染组〔感染而无全身炎症反应综合征（SIRS），25例〕和脓毒症组〔感染合并SIRS，57例〕；根据脓毒症严重程度，再将后一组患者分为脓毒症组（22例）、严重脓毒症组（27例）和脓毒性休克组（8例）3个亚组。选择同期24例健康体检者作为对照组。所有研究对象于入院24 h内取静脉血，采用酶联免疫吸附试验（ELISA）检测血浆pro-ADM和降钙素原（PCT）水平，并进行急性生理学与慢性健康状况评分系统Ⅱ（APACHEⅡ）评分。采用Pearson相关分析法分析pro-ADM与PCT、APACHEⅡ评分的相关性；采用受试者工作特征曲线（ROC）评估pro-ADM、PCT对脓毒症的诊断价值。结果脓毒症组血浆pro-ADM、PCT 水平及APACHEⅡ评分均明显高于一般感染组和健康对照组〔pro-ADM（ng/L）：66.69±1.73比53.43±2.70、45.87±1.43；PCT（ng/L）：1336.49±40.26比1083.09±47.99、959.04±37.53；APACHEⅡ评分（分）：14.60±0.81比8.10±1.14、3.00±1.15；均P＜0.01〕。随着脓毒症病情加重，pro-ADM、PCT水平及APACHEⅡ评分逐渐升高，脓毒症、严重脓毒症、脓毒性休克组间比较差异均有统计学意义〔pro-ADM（ng/L）：64.91±2.50、73.56±2.80、84.67±4.52；PCT（ng/L）：1152.65±48.62、1233.93±63.06、1475.71±109.93；APACHEⅡ评分（分）：12.91±1.15、14.55±1.14、19.37±2.40；P＜0.05或P＜0.01〕。Pearson相关性分析结果显示：pro-ADM与PCT呈显著正相关（r＝0.473，P＝0.006），与APACHEⅡ评分亦呈显著正相关（r＝0.707， P＝0.008）。ROC曲线分析显示：pro-ADM诊断脓毒症时的ROC曲线下面积（AUC）为0.823（P＝0.003），截断值为59.40 ng/L时，敏感度为80.7%、特异度为68.0%、阳性预测值为85.2%、阴性预测值为60.7%；PCT的AUC为0.653（P＝0.043），截断值为1194.67 ng/L时，敏感度为68.4%、特异度为64.0%、阳性预测值为81.8%、阴性预测值为44.7%。说明pro-ADM对脓毒症的诊断价值优于PCT。结论血浆pro-ADM水平可作为脓毒症患者早期诊断及评估病情严重程度和预后的预警指标。
目的：探討前腎上腺髓質素（pro-ADM）在膿毒癥早期診斷中的臨床價值。方法採用前瞻性研究方法，選擇2013年4月至2014年3月山西醫科大學第二醫院急診科收治的82例急性感染患者。根據入院時膿毒癥診斷標準將患者分為一般感染組〔感染而無全身炎癥反應綜閤徵（SIRS），25例〕和膿毒癥組〔感染閤併SIRS，57例〕；根據膿毒癥嚴重程度，再將後一組患者分為膿毒癥組（22例）、嚴重膿毒癥組（27例）和膿毒性休剋組（8例）3箇亞組。選擇同期24例健康體檢者作為對照組。所有研究對象于入院24 h內取靜脈血，採用酶聯免疫吸附試驗（ELISA）檢測血漿pro-ADM和降鈣素原（PCT）水平，併進行急性生理學與慢性健康狀況評分繫統Ⅱ（APACHEⅡ）評分。採用Pearson相關分析法分析pro-ADM與PCT、APACHEⅡ評分的相關性；採用受試者工作特徵麯線（ROC）評估pro-ADM、PCT對膿毒癥的診斷價值。結果膿毒癥組血漿pro-ADM、PCT 水平及APACHEⅡ評分均明顯高于一般感染組和健康對照組〔pro-ADM（ng/L）：66.69±1.73比53.43±2.70、45.87±1.43；PCT（ng/L）：1336.49±40.26比1083.09±47.99、959.04±37.53；APACHEⅡ評分（分）：14.60±0.81比8.10±1.14、3.00±1.15；均P＜0.01〕。隨著膿毒癥病情加重，pro-ADM、PCT水平及APACHEⅡ評分逐漸升高，膿毒癥、嚴重膿毒癥、膿毒性休剋組間比較差異均有統計學意義〔pro-ADM（ng/L）：64.91±2.50、73.56±2.80、84.67±4.52；PCT（ng/L）：1152.65±48.62、1233.93±63.06、1475.71±109.93；APACHEⅡ評分（分）：12.91±1.15、14.55±1.14、19.37±2.40；P＜0.05或P＜0.01〕。Pearson相關性分析結果顯示：pro-ADM與PCT呈顯著正相關（r＝0.473，P＝0.006），與APACHEⅡ評分亦呈顯著正相關（r＝0.707， P＝0.008）。ROC麯線分析顯示：pro-ADM診斷膿毒癥時的ROC麯線下麵積（AUC）為0.823（P＝0.003），截斷值為59.40 ng/L時，敏感度為80.7%、特異度為68.0%、暘性預測值為85.2%、陰性預測值為60.7%；PCT的AUC為0.653（P＝0.043），截斷值為1194.67 ng/L時，敏感度為68.4%、特異度為64.0%、暘性預測值為81.8%、陰性預測值為44.7%。說明pro-ADM對膿毒癥的診斷價值優于PCT。結論血漿pro-ADM水平可作為膿毒癥患者早期診斷及評估病情嚴重程度和預後的預警指標。
목적：탐토전신상선수질소（pro-ADM）재농독증조기진단중적림상개치。방법채용전첨성연구방법，선택2013년4월지2014년3월산서의과대학제이의원급진과수치적82례급성감염환자。근거입원시농독증진단표준장환자분위일반감염조〔감염이무전신염증반응종합정（SIRS），25례〕화농독증조〔감염합병SIRS，57례〕；근거농독증엄중정도，재장후일조환자분위농독증조（22례）、엄중농독증조（27례）화농독성휴극조（8례）3개아조。선택동기24례건강체검자작위대조조。소유연구대상우입원24 h내취정맥혈，채용매련면역흡부시험（ELISA）검측혈장pro-ADM화강개소원（PCT）수평，병진행급성생이학여만성건강상황평분계통Ⅱ（APACHEⅡ）평분。채용Pearson상관분석법분석pro-ADM여PCT、APACHEⅡ평분적상관성；채용수시자공작특정곡선（ROC）평고pro-ADM、PCT대농독증적진단개치。결과농독증조혈장pro-ADM、PCT 수평급APACHEⅡ평분균명현고우일반감염조화건강대조조〔pro-ADM（ng/L）：66.69±1.73비53.43±2.70、45.87±1.43；PCT（ng/L）：1336.49±40.26비1083.09±47.99、959.04±37.53；APACHEⅡ평분（분）：14.60±0.81비8.10±1.14、3.00±1.15；균P＜0.01〕。수착농독증병정가중，pro-ADM、PCT수평급APACHEⅡ평분축점승고，농독증、엄중농독증、농독성휴극조간비교차이균유통계학의의〔pro-ADM（ng/L）：64.91±2.50、73.56±2.80、84.67±4.52；PCT（ng/L）：1152.65±48.62、1233.93±63.06、1475.71±109.93；APACHEⅡ평분（분）：12.91±1.15、14.55±1.14、19.37±2.40；P＜0.05혹P＜0.01〕。Pearson상관성분석결과현시：pro-ADM여PCT정현저정상관（r＝0.473，P＝0.006），여APACHEⅡ평분역정현저정상관（r＝0.707， P＝0.008）。ROC곡선분석현시：pro-ADM진단농독증시적ROC곡선하면적（AUC）위0.823（P＝0.003），절단치위59.40 ng/L시，민감도위80.7%、특이도위68.0%、양성예측치위85.2%、음성예측치위60.7%；PCT적AUC위0.653（P＝0.043），절단치위1194.67 ng/L시，민감도위68.4%、특이도위64.0%、양성예측치위81.8%、음성예측치위44.7%。설명pro-ADM대농독증적진단개치우우PCT。결론혈장pro-ADM수평가작위농독증환자조기진단급평고병정엄중정도화예후적예경지표。
ObjectiveTo explore the early diagnostic value of pro-adrenomedullin (pro-ADM) in sepsis. Methods A prospective study was conducted. Eighty-two patients with acute infection admitted to Department of Emergency of Shanxi Medical University Second Hospital from April 2013 to March 2014 were enrolled. According to the diagnostic criteria of sepsis, the patients with acute infection were divided into ordinary infection group [infection without systemic inflammatory response syndrome (SIRS),n = 25] and sepsis group (infection combined with SIRS, n = 57). According to degree of severity of sepsis, the latter group was subdivided into three subgroups: sepsis group (n = 22), severe sepsis group (n = 27) and septic shock group (n = 8). Twenty-four healthy persons were included to serve as healthy control group. The venous blood from all the research objects in hospital was collected within 24 hours. The levels of pro-ADM and procalcitonin ( PCT ) were determined by enzyme linked immunosorbent assay (ELISA), and acute physiology and chronic health evaluationⅡ (APACHEⅡ) score was recorded. The relationship between pro-ADM and PCT and also APACHEⅡ score was analyzed with Pearson correlation analysis. The receiver-operating characteristic curve (ROC) of pro-ADM and PCT were used to evaluate the diagnostic acuity of sepsis.Results The plasma levels of pro-ADM, PCT and APACHEⅡ score in sepsis group were significantly higher than those in ordinary infection group and healthy control group [pro-ADM (ng/L): 66.69±1.73 vs. 53.43±2.70, 45.87±1.43; PCT (ng/L):1 336.49±40.26 vs. 1 083.09±47.99, 959.04±37.53; APACHEⅡ score: 14.60±0.81 vs. 8.10±1.14, 3.00±1.15,allP< 0.01]. With the aggravation of sepsis, the levels of pro-ADM, PCT and APACHEⅡ score were gradually increased, and there were significant differences among sepsis, severe sepsis, and septic shock groups [pro-ADM (ng/L): 64.91±2.50, 73.56±2.80, 84.67±4.52; PCT (ng/L): 1 152.65±48.62, 1 233.93±63.06, 1 475.71±109.93;APACHEⅡ score: 12.91±1.15, 14.55±1.14, 19.37±2.40,P< 0.05 orP< 0.01]. Pearson correlation analysis results showed that the level of pro-ADM was positively related with PCT (r = 0.473,P = 0.006), and it was also positively correlated with APACHEⅡ score (r = 0.707,P = 0.008). ROC curve analysis showed that area under the ROC curve (AUC) of pro-ADM for diagnosis of sepsis was 0.823 (P = 0.003). When the cutoff value was 59.40 ng/L, the sensitivity was 80.7%, the specificity was 68.0%, the positive predictive value was 85.2%, and the negative predictive value was 60.7%. AUC of the PCT for diagnosis of sepsis was 0.653 (P = 0.043). When the cutoff value was 1 194.67 ng/L, the sensitivity was 68.4%, the specificity was 64.0%, the positive predictive value was 81.8%, and the negative predictive value was 44.7%. It was proved that the pro-ADM had a higher diagnostic value for sepsis than PCT.Conclusion The plasma levels of pro-ADM can be used as an early indicator in diagnosis and severity evaluation and prognosis in patients with sepsis .
