摘要
目的探讨降钙素原（PCT）对急性呼吸窘迫综合征（ARDS）患者早期病情评估和预后的判断价值。方法采用前瞻性观察性研究方法，选择2012年10月至2016年4月江苏大学附属人民医院重症加强治疗病房（ICU）收治的113例需行机械通气的ARDS患者，按柏林标准根据氧合指数（Pa02／FiO2）分为轻、中、重度3组；选择同期25例健康体检者作为对照组。记录受试者一般情况、急性生理学与慢性健康状况评分系统Ⅱ（APACHEⅡ）评分和肺损伤评分（Murray评分）。于确诊ARDS24h内，采用酶联荧光分析法检测血清PCT水平，采用散射免疫比浊法检测血清C-反应蛋白（CRP）水平。记录随访28d后患者生存情况，比较存活组与死亡组的临床资料。各指标间相关性采用非参数Spearman等级相关分析；绘制受试者工作特征曲线（ROC），分析各指标对28d预后的预测价值；采用Kaplan—Meier生存曲线分析比较不同PCT水平患者的28d累积存活率。结果排除和失访共24例，最终89例ARDS患者纳入分析，其中轻度27例，中度34例，重度28例。ARDS组与健康对照组年龄、性别差异无统计学意义；感染和创伤仍是并发ARDS的主要原因（分别占55．1％和34．8％）。ARDS组血清CRP和PCT水平均较健康对照组显著升高[CRP（mg／L）：146．32（111．31，168．49）比6．08（4．47，7．89），PCT（μg／L）：3．46（1．98，5．56）比0．02（0．01，0．04），均P〈0．01]，且随ARDS病程加重持续升高；重度组APACHEⅡ、Murray评分均明显高于轻度组。Spearman相关分析显示，ARDS患者血清PCT、CRP水平与APACHEⅡ评分均有较好的相关性（r值分别为0．669、0．601，均P〈0．001）；PCT与Murray评分存在弱相关（r=0．294，P=0．005），CRP与Murray评分则无相关性（r=0．203，P=0．052）。死亡组（38例）ARDS患者APACHEⅡ评分和血清PCT水平均明显高于存活组（51例）�
Objective To investigate the value of procalcitonin （PCT） on predicting the severity and prognosis in patients with early acute respiratory distress syndrome （ARDS）. Methods A prospective observation study was conducted. A total of 113 patients with ARDS undergoing mechanical ventilation admitted to intensive care unit （ICU） of Affiliated People＇s Hospital of Jiangsu University from October 2012 to April 2016 were enrolled. Based on oxygenation index （PaO2/FiO2）, the patients were classified into mild, moderate, and severe groups according to Berlin Definition. Twenty-five healthy volunteers were served as controls. Demographics, acute physiology and chronic health evaluation Ⅱ （APACHE Ⅱ） score, and Murray lung injury score were recorded. Within 24 hours after diagnosis of ARDS, the serum levels of PCT and C-reactive protein （CRP） were determined by enzyme-linked fluorescence analysis （ELFA） and immune turbidimetric method, respectively. The patients were also divided into survival and non-survival groups according to clinical outcome within 28-day follow-up, and the clinical data were compared between the two groups. Spearman rank correlation was applied to determine the correlation between variables. The predictive value of the parameters on 28-day mortality was evaluated with receiver operating characteristic curve （ROC）. Kaplan-Meier survival curve analysis was used to compare different PCT levels of patients with 28-day cumulative survival rate. Results After excluding patients who did not meet the inclusion criteria and loss to follow-up, the final 89 patients were enrolled in the analysis. Among 89 ARDS patients analyzed, 27 of them were mild, 34 moderate, and 28 severe ARDS. No significant differences were found in age and gender between ARDS and healthy control groups. Infection and trauma were the most common etiology of ARDS （55.1% and 34.8%, respectively）. Compared with healthy control group, both CRP and PCT in serum of ARDS group were higher [CRP （mg/L）�
出处
《中华危重病急救医学》
CAS
CSCD
北大核心
2017年第1期34-38,共5页
Chinese Critical Care Medicine
基金
江苏省自然科学基金（BK20160547）
