摘要
目的 探讨高血浆降钙素原（PCT〉100μg/L）患者的临床特征以及预后情况,以提高临床医师对这类患者的认识和诊治水平.方法 采用回顾性研究方法,收集2013年2月至2016年12月浙江大学医学院附属第二医院收治的入院48 h内血浆PCT〉100μg/L的患者资料,分析其临床特征;按照入院28 d预后分为存活组和死亡组.收集患者一般资料及PCT〉100μg/L当日生命体征、24 h尿量、血常规、生化全套、凝血谱、心肌酶谱、动脉血气分析等;采用logistic回归分析筛选影响预后的危险因素.结果 研究期间共收治入院48 h内血浆PCT〉100μg/L的患者188例,所有患者均纳入最终分析;其中男性128例（占68.1%）,平均年龄62（49,75）岁;主要分布于重症加强治疗病房（ICU）,占70.7%（133/188）;患者主诊断多为脓毒症（91.0%）、多器官功能障碍综合征（MODS,57.4%）、胸腹腔大手术后（20.7%）、创伤/烧伤（13.8%）及心肺复苏后（CPR,6.4%）;28 d存活115例,死亡73例,总病死率为38.8%.与存活组相比,死亡组主诊断为MODS（84.9%比40.0%）、创伤/烧伤（26.0%比6.1%）、CPR后的比例（13.7%比1.7%）及主诊断叠加数〔个：2.0（2.0,3.0）比2.0（1.0,2.0）〕,呼吸机支持（82.2%比40.9%）和休克的比例（100.0%比60.0%）,以及急性生理学与慢性健康状况评分系统Ⅱ评分〔APACHEⅡ（分）：24（19,28）比14（10,16）〕、序贯器官衰竭评分〔SOFA（分）：16.0（12.5,18.0）比9.0（6.0,12.0）〕均显著升高,肝功能指标、凝血谱、心肌酶谱以及血乳酸（Lac）等指标均明显升高,但血小板计数（PLT）显著下降〔×109/L：62.00（21.50,111.00）比93.00（53.00,136.00）〕,差异均有统计学意义（均P〈0.05）.将单因素分析中有统计学意义的指标纳入多因素logistic回归分析,结果显示,高APACHEⅡ评分〔优势比（OR）=1.290,95%可信区间（95%CI）=1.121~1.484,P=0.000〕以及发生MODS（OR=7.264,95%CI=1.762~29.941,P=0.006）是预测高血浆PCT患者死亡的独立危险因素.结论 高血浆PCT（〉100μg/L）主要见于脓毒症、MODS、创伤及CPR后患者,多有呼吸及循环功能不全.高血浆PCT患者的预后与原发疾病（创伤/烧伤、MODS、心搏骤停）、PLT、肝功能、凝血功能、心肌酶谱以及Lac水平相关,而高APACHEⅡ评分以及发生MODS为高血浆PCT患者预后不良的独立危险因素.
Objective To investigate the clinical characteristics and prognosis of patients with high level of plasma procalcitonin （PCT 〉 100 μg/L）, and to improve the clinician＇s understanding, diagnosis and treatment of this kind of patients. Methods A retrospective study was conducted. The clinical data of patients with plasma PCT over 100 μg/L within 48 hours of admission admitted to Second Affiliated Hospital of Zhejiang University School of Medicine from February 2013 to December 2016 were collected, and the clinical characteristics were analyzed. The patients were divided into survival and death groups according to 28-day prognosis. The general data and laboratory parameters including vital signs, 24-hour urine output, routine blood test, blood biochemical tests, coagulation parameters, myocardial enzymes and arterial blood gas analysis were collected. The risk factors of mortality were analyzed using multi-logistic regression analysis. Results 188 patients with high level of plasma PCT were enrolled. There were 128 male patients （68.1%） with the average age of 62 （49, 75） years. Most patients were admitted in intensive care unit （ICU, 70.7%, 133/188）. Major diagnosis was sepsis （91.0%）, followed by multiple organ dysfunction syndrome （MODS, 57.4%）, post large operation of thorax and abdomen （20.7%）, trauma/burns （13.8%） and post-cardiopulmonary resuscitation （CPR, 6.4%）. Of all the 188 patients, 115 patients survived and 73 died with a mortality of 38.8%. The parameters in the death group, including the percentages of MODS （84.9% vs. 40.0%）, trauma/burns （26.0% vs. 6.1%）, post-CPR （13.7% vs. 1.7%）, ventilator support （82.2% vs. 40.9%） and shock （100.0% vs. 60.0%）, the numbers of principal diagnosis [2.0 （2.0, 3.0） vs. 2.0 （1.0, 2.0）], acute physiology and chronic health evaluation Ⅱ score [APACHE Ⅱscore： 24 （19, 28） vs. 14 （10, 16）] and sequential organ failure assessment （SOFA） score [16.0 （12.5, 18.0） vs. 9.0 （6.0, 12.0）], as well as liver function, coagulation parameters, myocardial enzymes and lactic acid （Lac） levels were significantly higher than those in the survival group, but the platelet （PLT） count in the death group was significantly lower than that in the survival group [×109/L： 62.00 （21.50, 111.00） vs. 93.00 （53.00, 136.00）, all P 〈 0.05]. The parameters with statistical significance in the univariate analysis were enrolled in the multiple factor logistic regression analysis, which showed that patient with a high score of APACHE Ⅱ [odds ratio （OR） = 1.290, 95% confidence interval （95%CI） = 1.121-1.484, P = 0.000] or the occurrence of MODS （OR = 7.264, 95%CI = 1.762-29.941, P = 0.006） at admission had a poor prognosis. Conclusions The primary patients with high levels of plasma PCT （〉 100 μg/L） were diagnosed with sepsis, MODS, trauma and post-CPR, complicated with respiratory and circulatory insufficiency. These factors of trauma, MODS and cardiac arrest, and some laboratory parameters including PLT, Lac, liver function, coagulation spectrum, and cardiac enzymes were correlated with the prognosis of the patients with high levels of plasma PCT. High APACHE Ⅱ score and the incidence of MODS might be independent predictors of poor prognosis in the patients with high levels of plasma PCT.
作者
潘楚丽
崔巍
周妃妃
涂军伟
林秀慧
李立斌
张根生
Pan Chuli Cui Wei Zhou Feifei Tu Junwei Lin Xiuhui Li Libin Zhang Gensheng(Department of Respiratory Medicine, Jinhua Municipal Central Hospital, Jinhua 321000, Zhejiang, China Department of Critical Care Medicine, Second Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou 310009, Zhejiang, China Department of Critical Care Medicine, Ningbo City Medical Treatment Center IJhuili Hospital, Ningbo 315040, Zhejiang, China)
出处
《中华危重病急救医学》
CAS
CSCD
北大核心
2017年第7期613-618,共6页
Chinese Critical Care Medicine
基金
国家自然科学基金青年科学基金（81570017）
关键词
降钙素原
临床特征
预后因素
Procalcitonin
Clinical characteristic
Prognostic factor
