摘要
目的 探讨脓毒性休克患者降钙素原（PCT）的变化规律及其与预后的关系.方法 选取本院符合脓毒性休克诊断的63例患者,于入住重症监护病房（ICU）1、3、5、7d检测PCT、C-反应蛋白（CRP）及白细胞计数（WBC）.并按患者28 d预后分为生存组和死亡组,比较两组患者上述各项参数的差异,用多水平线性模型分析两组参数随住院时间变化的特征及与预后的关系.结果 生存组41例,死亡组22例.入ICU后生存组PCT、CRP随时间延长呈下降趋势,死亡组则呈上升趋势；死亡组入ICU 3、5、7 d PCT（μg/L）水平明显高于生存组（3 d：8.7±3.7比5.6±1.7,5 d：10.3±1.3比4.8±2.3,7 d：12.7±2.3比0.8±0.3,P＜0.05或P＜0.01）,入ICU5d、7 d CRP（mg/L）水平明显高于生存组（5 d：447±63比355±91,7 d：439±45比364±63,均P＜0.05）.两组WBC无明显变化,且两组间各时间点比较差异均无统计学意义.效应分析显示：PCT随住ICU天数延长而有显著变化（F=10.91,P=0.00）,且生存者与死亡者间也有显著差异（F=7.58,P=0.00）；而CRP仅随住ICU天数延长而有显著变化（F=4.17,P=0.03）.结论 与CRP、WBC相比,PCT反映预后的敏感性更高,PCT水平的持续升高提示患者预后不良,血清PCT可作为预测脓毒性休克患者预后的指标.
Objective To investigate procalcitonin （PCT） change pattern in patients with septic shock and its relationship with prognosis.Methods Sixty-three septic shock patients were enrolled,and levels of PCT,C-reactive protein （CRP） as well as white blood cell （WBC） on 1st,3rd,5th,7th day after admission to intensive care unit （ICU）were checked.Patients were divided into survival group and death group according to 28-day survival result.Differences in parameters between two groups were compared.The change regulation of parameters along with in-hospital period and its relationship with prognosis were analyzed by multilevel linear model.Results There were 41 patients in survival group and 22 patients in death group.PCT and CRP level decreased in survival group with time dependency pattern,while death group increased.The PCT （μg/L） at 3,5,7 days after admission to ICU in death group were significantly higher than those in survivors （3 days：8.7 ± 3.7 vs.5.6 ± 1.7,5 days：10.3 ± 1.3 vs.4.8 ± 2.3,7 days：12.7 ± 2.3 vs.0.8 ± 0.3,P＜0.05 or P＜0.01）,and CRP （mg/L） at 5 days and 7 days was significantly higher than those in survival group （5 days：447 ± 63 vs.355 ± 91,7 days：439 ± 45 vs.364 ± 63,both P＜0.05）.Two groups of WBC did not change significantly,and there were no statistical significance difference at each time point between the two groups.What＇s more,the effect analysis results showed that there were significant changes in PCT as ICU day prolonged （F=10.91,P=0.00）,and there was a significant difference between the survivor and the dead （F=7.58,P=0.00）,while CRP changed only with ICU stays （F=4.17,P=0.03）.Conclusion Compared with CRP and WBC,PCT had higher sensitivity in predicting prognosis,sustainable elevation of PCT level indicates poor prognosis,serum PCT can be used as one of indexes predicting prognosis of septic shock.
出处
《中华危重病急救医学》
CAS
CSCD
北大核心
2013年第8期467-470,共4页
Chinese Critical Care Medicine
基金
广东省医学科研基金项目（B2012004）
关键词
降钙素原
脓毒性休克
预后
感染
Procalcitonin
Septic shock
Prognosis
Infection
