摘要
目的观察降钙素原(procalcitonin,PCT)、D-二聚体(D-dimer)、抗凝血酶Ⅲ(antithrombinⅢ)与脓毒血症病人病情的关系,探讨其在评估预后中的价值。方法回顾性分析2019年1月至2020年12月在青岛市市立医院住院期间诊断为脓毒症212例病人基本信息、入院24 h内PCT、D-二聚体、抗凝血酶Ⅲ,应用入院24 h最差指标计算急性生理学与慢性健康状况评分Ⅱ(APACHEⅡ评分)、序贯器官衰竭评分(SOFA评分),依据病人28 d转归情况分为死亡组和存活组。分析PCT、D-二聚体、抗凝血酶Ⅲ在评估脓毒症病人预后中的预测价值。结果死亡组PCT、D-二聚体水平高于存活组,其中死亡组PCT为(40.92±32.62)μg/L,高于存活组(30.67±32.34)μg/L,死亡组D-二聚体为(8.54±6.82)mg/L,高于存活组(6.25±6.06)mg/L(均P<0.05),抗凝血酶Ⅲ水平低于存活组,其中死亡组凝血酶Ⅲ为(60.75±19.71)%,低于存活组(67.97±16.16)%(P<0.05);logistic回归分析显示,年龄、APACHEⅡ评分、SOFA评分是脓毒症病人死亡的独立危险因素,但PCT、D-二聚体、抗凝血酶Ⅲ不能作为死亡的独立危险因素[OR 95%CI分别为:年龄1.05(1.02,1.88);APACHEⅡ评分1.11(1.03,1.19);SOFA评分1.14(1.03,1.27);PCT 1.00(0.99,1.02);D-二聚体1.01(0.96,1.07);抗凝血酶Ⅲ0.99(0.97,1.01)]。ROC曲线分析显示,APACHEⅡ评分、SOFA评分、PCT、D-二聚体、抗凝血酶Ⅲ预测脓毒症病人28天死亡的ROC曲线下面积(AUC)分别是0.79、0.78、0.61、0.62、0.59,联合检测时AUC为0.82,显著高于单一指标:SOFA评分、PCT、D-二聚体、抗凝血酶Ⅲ(Z_(1)=2.42,Z_(2)=4.32,Z_(3)=4.08,Z_(4)=4.73,均P<0.05)。结论检测PCT、D-二聚体、抗凝血酶Ⅲ水平有助于评估脓毒症病人病情严重程度,联合检测有助于提高预后评估的准确性。
Objective To observe the relationship of procalcitonin(PCT),D-Dimer,antithrombinⅢwith sepsis patients,and to explore its value in evaluating the prognosis.Methods A total of 212 patients diagnosed with sepsis in Qingdao Municipal Hospital from January 2019 to December 2020 were analyzed retrospectively.The basic information of patients,PCT,D-dimer and antithrombinⅢwithin 24 hours of admission were collected,and APACHEⅡscore and SOFA score were calculated by the worst index in 24 hours after admission.According to the outcome of 28 days,the patients were divided into death group and survival group.The predictive value of PCT,D-dimer and antithrombinⅢin prognosis of patients with sepsis was analyzed.Results The levels of PCT and D-dimer in the death group were higher than those in the survival group,PCT in the death group was(40.92±32.62)μg/L,which was higher than that in the survival group(30.67±32.34)μg/L,D-dimer in the death group was(8.54±6.82)mg/L,which was higher than that in the survival group(6.25±6.06)mg/L,P<0.05;and the level of antithrombinⅢwas lower than those in the survival group,the level of antithrombinⅢin the death group was(60.75±19.71)%,which was lower than that in the survival group(67.97±16.16)%,P<0.05.Logistic regression analysis showed that age,APACHEⅡscore and SOFA score were independent risk factors for death in patients with sepsis,but PCT,D-dimer and antithrombinⅢcould not be used as independent risk factors for death[OR 95%CI:age odds ratio1.05(1.02,1.88);APACHEⅡscore1.11(1.03,1.19);SOFA score:1.14(1.03,1.27);PCT:1.00(0.99,1.02);D-dimer 1.01(0.96,1.07).AntithrombinⅢ:0.99(0.97,1.01)].The ROC curve analysis showed that the area under the ROC curve(AUC)of APACHEⅡscore,SOFA score,PCT,Ddimer and antithrombinⅢto predict the 28 day death of patients with sepsis were 0.79,0.78,0.61,0.62 and 0.59,respectively.The AUC of combined detection was 0.82,which was significantly higher than that of single index:SOFA score,PCT,D-dimer and antithrombinⅢ(Z_(1)=2.42,Z_(2)=4.32,Z_(3)=4.08,Z_(4)=4.73,all P<0.05).Conclusion Detection of PCT,D-dimer and antithrombinⅢlevels is helpful to evaluate the severity of sepsis,and combined detection is helpful to improve the accuracy of prognosis evaluation.
作者
曾庆华
陈家萍
白云朵
司君利
ZENG Qinghua;CHEN Jiaping;BAI Yunduo;SI Junli(Emergency Department,Qingdao Municipal Hospital,Qingdao,Shandong 266071,China;Gastroenterology Department,Qingdao Municipal Hospital,Qingdao,Shandong 266071,China)
出处
《安徽医药》
CAS
2023年第4期797-800,共4页
Anhui Medical and Pharmaceutical Journal
