摘要
目的 统计血清降钙素原（PCT）在烧伤脓毒症患者中的变化,探讨其对预后的意义.方法 回顾性分析笔者单位2012年1月-2013年12月收治的符合烧伤脓毒症诊断标准的28例大面积烧伤患者,根据患者预后状况分为脓毒症死亡组12例和脓毒症生存组16例,2组患者一般情况水平接近.比较2组患者烧伤脓毒症确诊时白细胞计数、中性粒细胞、血小板计数、急性生理与慢性健康评估Ⅱ（APACHE Ⅱ）评分及脏器功能指标ALT、AST、总胆汁酸（TBA）、肌酐、血钠水平,于烧伤脓毒症确诊时及确诊后1～4、5～8d记录2组患者血清PCT值.对数据行￡检验、x 2检验、非参数秩和检验（Kruskal-Wallis）,于烧伤脓毒症确诊时绘制28例患者血清PCT值的受试者工作特征（ROC）曲线,分析其对死亡的预测效果. 结果 2组患者烧伤脓毒症确诊时白细胞计数、中性粒细胞、血小板计数、APACHEⅡ评分及脏器功能指标比较,差异均无统计学意义（t值为-0.601 ～1.726,P值均大于0.05）.烧伤脓毒症确诊时及确诊后1～4、5～8d,脓毒症死亡组患者血清PCT值分别为（38.5±41.3）、（26.8±38.5）、（19.3±16.3） ng/mL,均明显高于脓毒症生存组[（6.1±2.3）、（5.4±2.9）、（4.9±3.6） ng/mL,Z值为-4.364～-2.955,P值均小于0.01].对28例烧伤脓毒症患者死亡预测的血清PCT值的ROC曲线下总面积为0.990,10.9 ng/mL为血清PCT的最佳阈值,其对死亡预测的敏感度为91.7％、特异度为100.0％. 结论 血清PCT值可作为烧伤脓毒症患者预后判断指标,指导临床合理应用抗生素,为后期治疗提供依据,降低患者病死率.
Objective To evaluate the clinieal implication of serum procalcitonin （PCT） in patients with burn sepsis by analyzing its change.Methods Twenty-eight extensively burned patients with sepsis hospitalized from January 2012 to December 2013 were recruited in this retrospective study.These patients were divided into death group （n =12） and survival group （n =16） according to the outcome.The baseline characteristics of patients in the two groups were similar.Some conventional indexes of sepsis,including white blood cell count,percentage of neutrophils,platelet count,organ function parameters [ALT,AST,total bile acid （TBA）,creatinine,blood sodium],and acute physiology and chronic health evaluation （APACHE） Ⅱ score were compared between the two groups when sepsis was diagnosed.Serum levels of PCT of patients in the two groups were determined immediately after diagnosis of sepsis,from post sepsis day （PSD） 1 to 4,and from PSD 5 to 8.Data were processed with t test,chi-square test,and nonparametric rank sum test （Keuskal-Wallis）.Receiver operating characteristic （ROC） curve of serum PCT value was used to predict death for 28 burn patients when sepsis was diagnosed.Results There were no statistically significant differences in white blood cell count,percentage of neutrophils,platelet count,APACHE Ⅱ score,and organ function parameters between death group and survival group when sepsis was diagnosed （with t values from-0.601 to 1.726,P values above 0.05）.The serum levels of PCT in death group immediately after diagnosis of sepsis,from PSD 1 to 4,and from PSD 5 to 8 were respectively （38.5 ± 41.3）,（26.8 ± 38.5）,（19.3 ± 16.3） ng/mL,which were significantly higher than those in survival group [（6.1 ± 2.3）,（5.4± 2.9）,（4.9 ±3.6） ng/mL,with Z values from-4.364 to-2.955,Pvalues below 0.01].The total area under ROC curve of serum PCT value for predicting death for 28 patients with burn sepsis was 0.990,and 10.9 ng/mL was chosen as the optimal threshold value,with sensitivity of 91.7% and specificity of 100.0%.Conclusions Serum PCT value can be served as a vital prognostic indicator for patients with burn sepsis,which can be considered as a guide for rational use of antibiotics,also provide as a reference for treatment,in order to reduce mortality.
出处
《中华烧伤杂志》
CAS
CSCD
北大核心
2014年第3期223-226,共4页
Chinese Journal of Burns
基金
卫生部卫生行业科研专项（201202002）
“十二五”全军后勤科研计划重点项目（BWS11J039）
军队临床高新技术重大项目（2010gxj068）
关键词
烧伤
脓毒症
预后
降钙素原
Burns
Sepsis
Prognosis
Procalcitonin
