| 范孟静,段美丽,林 瑾,刘景峰,刘 培.血清sTM、PCT、CRP/PAB比值与脓毒症患者APACHEⅡ评分、SOFA评分的相关性及其联合检测对预后的预测价值[J].,2023,(4):660-665 |
| 血清sTM、PCT、CRP/PAB比值与脓毒症患者APACHEⅡ评分、SOFA评分的相关性及其联合检测对预后的预测价值 |
| Correlation of Serum sTM, PCT, CRP / PAB Ratio with APACHEⅡ Score and SOFA Score in Patients with Sepsis and the Predictive Value of Combined Detection for Prognosis |
| 投稿时间：2022-07-24 修订日期：2022-08-21 |
| DOI：10.13241/j.cnki.pmb.2023.04.012 |
| 中文关键词: 脓毒症 sTM PCT CRP/PAB比值 APACHEⅡ评分 SOFA评分 预后 预测价值 |
| 英文关键词: Sepsis sTM PCT CRP/PAB ratio APACHEⅡ score SOFA score Prognosis Predictive value |
| 基金项目:北京市医院管理局重点医学专业发展计划项目（ZYLX201802） |
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| 中文摘要: |
| 摘要 目的：探讨血清可溶性血栓调节蛋白（sTM）、降钙素原（PCT）、C-反应蛋白与前白蛋白（CRP/PAB）比值与脓毒症患者急性生理和慢性健康评估Ⅱ（APACHEⅡ）评分、序贯器官衰竭评估（SOFA）评分的相关性及其联合检测对预后的预测价值。方法：选取2020年3月～2020年12月我院重症医学科收治的97例脓毒症患者，根据Sepsis-3.0诊断标准分为普通脓毒症组44例、脓毒性休克组53例，根据入院后30 d内预后情况分为死亡组35例和存活组62例。收集患者基线资料和APACHEⅡ评分、SOFA评分，并检测血清sTM、PCT、CRP/PAB比值。采用Spearman相关性分析脓毒症患者血清sTM、PCT、CRP/PAB比值与APACHEⅡ评分、SOFA评分的相关性，多因素Logistic回归分析脓毒症患者预后不良的影响因素，受试者工作特征（ROC）曲线分析血清sTM、PCT、CRP/PAB比值对脓毒症患者预后不良的预测价值。结果：脓毒性休克组血清sTM、PCT、CRP/PAB比值和APACHEⅡ评分、SOFA评分高于普通脓毒症组（P均＜0.05）。Spearman相关性分析显示，脓毒症患者血清sTM、PCT、CRP/PAB比值与APACHEⅡ评分、SOFA评分呈正相关（P＜0.05）。多因素Logistic回归分析显示，收缩压升高为脓毒症患者预后不良的独立保护因素（P＜0.05），脓毒性休克、合并器官损伤≥3个、机械通气时间延长、APACHEⅡ评分增加、SOFA评分增加、sTM升高、PCT升高、CRP/PAB比值升高为独立危险因素（P均＜0.05）。ROC曲线分析显示，血清sTM、PCT、CRP/PAB比值联合预测脓毒症患者预后不良的曲线下面积大于各指标单独预测。结论：脓毒症患者血清sTM、PCT、CRP/PAB比值升高与APACHEⅡ评分、SOFA评分增加密切相关，血清sTM、PCT、CRP/PAB比值联合检测对脓毒症患者预后不良的预测价值较高。 |
| 英文摘要: |
| ABSTRACT Objective: To investigate the correlation between serum soluble thrombomodulin (sTM), procalcitonin (PCT), C-reactive protein/prealbumin (CRP/PAB) ratio and acute physiology and chronic health evaluation Ⅱ (APACHE II) scores, sequential organ failure assessment (SOFA) scores in patients with sepsis and the predictive value of their combined tests on prognosis. Methods: 97 patients with sepsis who were admitted to the Department of critical care medicine of our hospital from March 2020 to December 2020 were selected. According to the Sepsis-3.0 diagnostic criteria, they were divided into 44 patients in the general sepsis group and 53 patients in the septic shock group. According to the prognosis within 30 days after admission, they were divided into 35 patients in the death group and 62 patients in the survival group. Baseline data, APACHEⅡ score and SOFA score were collected, and serum sTM, PCT and CRP/PAB ratio were detected. Spearman correlation was used to analyze the correlation between serum sTM, PCT, CRP/PAB ratio, APACHEⅡ score and SOFA score in patients with sepsis. Multivariate Logistic regression was used to analyze the influencing factors of poor prognosis in patients with sepsis. The predictive value of serum sTM, PCT, CRP/PAB ratio on poor prognosis in patients with sepsis was analyzed by receiver operating characteristic (ROC) curve. Results: The serum sTM, PCT, CRP/PAB ratio, APACHEⅡ score and SOFA score in septic shock group were higher than those in common sepsis group (all P<0.05). Spearman correlation analysis showed that the serum sTM, PCT, CRP/PAB ratio of patients with sepsis were positively correlated with APACHEⅡ score and SOFA score (P<0.05). Multivariate Logistic regression analysis showed that elevated systolic blood pressure was an independent protective factor for poor prognosis in patients with sepsis (P<0.05), septic shock, combined organ injury greater than or equal to 3, prolonged mechanical ventilation, increased APACHEⅡ score, increased SOFA score, elevated sTM, elevated PCT and elevated CRP/PAB ratio were independent risk factors (all P<0.05). ROC curve analysis showed that the area under curve of serum sTM, PCT, CRP/PAB ratio combined to predict the poor prognosis of patients with sepsis was larger than that predicted by each index alone. Conclusion: The elevate of serum sTM, PCT, CRP/PAB ratio in patients with sepsis is closely related to the increase of APACHEⅡ score and SOFA score, the combined detection of serum sTM, PCT, CRP/PAB ratio has a high predictive value for the poor prognosis of patients with sepsis. |
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