降钙素原与乳酸水平对脓毒症风险分层及预后判断临床价值探讨(1)
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【摘要】目的：探讨血降钙素原(PCT)与乳酸2种生物标记物对脓毒症患者风险分层及预后判断的临床价值。方法：57例脓毒症患者按病情严重程度分为早期脓毒症组、严重脓毒症组和脓毒症休克组；回顾性研究将所有患者根据预后分为生存组及死亡组。分别比较组间PCT、乳酸水平和APACHEⅡ评分，观察标记物对风险分层及预后评估的临床价值。结果：不同严重程度的三组患者中，2种标记物水平组间比较差异均有统计学意义(P<0.05)，脓毒性休克组与其他组APACHEⅡ评分比较差异有统计学意义(P<0.05)。生存组与死亡组PCT、乳酸水平与APACHEⅡ评分比较差异均有统计学意义(P<0.05)。结论：血降钙素原与乳酸水平对脓毒症风险分层与预后判断有较好的预测意义，联合检测可提高预测的敏感性。
【关键词】脓毒症；降钙素原；乳酸；APACHEⅡ评分
The Value of Serum Procalcitonin and Two Biomarkers of Lactate on Risk Stratification and Prognosis Judgement of Patients with Sepsis/ZHAO Jun-quan.// Medical Innovation of China，2012，9(11):005-007
【Abstract】Objective:To explore the prognostic significance of serum procalcitonin (PCT) and lactate in patients with the sepsis.Methods:A total of 57 patients with sepsis were divided into 3 groups according to clinical severity:early sepsis group，sever sepsis group and sepsis shock group.In retrospective studies，all the patients were divided into survival group and non-survival group according to mortality.To study the difference of serum PCT，lactate and APACHEⅡ scores in all groups and explore the prognostic significance of the biological markers.Results:The concentration of PCT and lactate varied significantly in different clinical severity groups.Meanwhile，the significant difference of the concentration of PCT，lactate and APACHEⅡ scores was observed in survival group and non-survival group.Conclusion:Serum PCT and lactate are biomarkers in predicating the sepsis prognosis and can reveal the risk stratification.
【Key words】Sepsis；Procalcitonin；Lactate；APACHEⅡ scores
First-author’s address:The People’s Hospital of Laiwu， Laiwu 271100，China
doi：10.3969/j.issn.1674-4985.2012.11.003
对脓毒症患者早期诊断并正确进行风险分层，以便早期实施干预，并对不同严重程度的患者进行区别治疗，对改善患者的预后有重要意义。降钙素原和乳酸在脓毒症时均可出现升高，对脓毒症的诊断有明确的意义，但对脓毒症严重程度及预后判断的研究相对较少。本文就血PCT及乳酸水平对脓毒症的风险分层及预后判断的临床价值作进一步探讨。
1资料与方法
1.1一般资料2008年2月-2011年2月入住重症监护病房(ICU)的脓毒症患者，采用2003年国际脓毒症讨论公报定义的脓毒症诊断标准[1]。排除既往有肝肾功能不全及恶性肿瘤的患者。共57例患者纳入范围，男40例(占70%)，女17例(占30%)；平均年龄(57.1±12.37)岁；肺部感染34例，泌尿系感染9例，腹腔感染5例，胸腔感染5例，导管相关型感染2例，皮肤软组织感染2例。早期脓毒症25例(44%)，严重脓毒症20例(35%) ......
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