中华临床医师杂志(电子版) 2017年2月,11卷4期

临床论著

降钙素原清除率用于评估脓毒性休克患者预后的观察研究

周柱江 刘长智 刘海峰 叶志钢 卢剑海 左六二

528300 广东佛山,南方医科大学附属顺德第一人民医院重症医学科
左六二,Email: 13500276597@163.com

摘要:目的 通过动态监测脓毒性休克患者入住ICU第1~3天血清降钙素原(PCT)清除率,探讨早期降钙素原清除率(PCTc)评估预后的价值。方法 采用前瞻性方法进行观察研究,纳入2014年5月至2015年4月入住顺德第一人民医院ICU,符合脓毒性休克诊断标准且感染灶无需外科处理的内科患者。入选84例,男女各42例,生存49例,死亡35例。检测入选患者住ICU第1、2、3天血清PCT质量浓度(PCT-day1、PCT-day2、PCT-day3),并计算第2、3天的PCTc(PCTc-day2、PCTc-day3)。PCTc对患者预后的评估价值,采用绘制受试工作特征曲线(ROC曲线)下面积(AUC)判定。结果 生存组与死亡组比较,PCT-day1、PCT-day2、PCT-day3差异均无统计学意义(P值分别为0.580、0.877、0.160),生存组PCTc-day2、PCTc-day3明显高于死亡组[17.00%(-1.00%,40.50%)vs. 2.00%(-32.00%,22.00%),Z=-2.35,P=0.018;51.00%(22.50%,67.50%)vs. 20.00%(-250.00%,37.00%),Z=-4.01,P<0.001]。PCTc-day2、PCTc-day3预测28 d生存的ROC曲线AUC分别为0.651(95% CI 0.53~0.77,P=0.019)与0.758(95% CI 0.66~0.86,P<0.001)。PCTc-day3预测28 d生存最佳截断值为38%,敏感度为63.26%,特异度为77.14%。结论 入住ICU第1~3天PCT明显下降的脓毒性休克患者生存率较高,早期监测PCTc有助于判断预后。

关键词:降钙素原; 脓毒症; 休克

佛山市医学类科技攻关项目(2014AB001613)

Prognostic value of procalcitonin clearance in septic shock patients: an observational study

Zhou Zhujiang, Liu Changzhi, Liu Haifeng, Ye Zhigang, Lu Jianhai, Zuo Liuer.

Department of Critical Care Medicine, the First People's Hospital of Shunde, Southern Medical University, Foshan 528300, China
Zuo Liuer, Email: 13500276597@163.com

Abstract:Objective Investigating procalcitonin kinetics in the first 3 days to evaluate the prognostic value of procalcitonin clearance in septic shock patients admitted to ICU. Methods This prospective observational study enrolled septic shock patients without surgery intervention admitted to ICU in the First People's Hospital of Shunde from May 2014 and April 2015. Results 84 patients were enrolled (42 male, 42 female) divided into survival group (49 patients) and nonsurvival group (35 patients). Serum concentrations of procalcitonin were determined at 1, 2 and 3 days after admitted to ICU, and procalcitonin clearance were calculated at day 2 and day 3. Receive operating characteristic curve (ROC curve) was drawn to evaluate the ability of procalcitonin clearance in assessing the prognostic value. There were no statistical different on serum concentrations of procalcitonin at day1, day2 and day3 between two groups (P=0.580, 0.877, 0.160 respectively). But procalcitonin clearances in survival group at day 2 and day 3 were significant higher than nonsurvival group [17.00% (-1.00%, 40.50%) vs. 2.00% (-32.00%, 22.00%), Z=-2.35, P=0.018; 51.00% (22.50%, 67.50%) vs. 20.00% (-250.00%, 37.00%), Z=-4.01, P<0.001]. The area under the ROC curve was 0.651 (95% CI, 0.53-0.77, P=0.019) for procalcitonin clearance at day 2, and 0.758 (95% CI, 0.66-0.86, P<0.001) at day 3. A ROC analysis identified a clearance of PCT-day3 more than 38% (sensitivity: 63.26%, specificity: 77.14%) as the most accurate cut-offs in predicting survival. Conclusions Survival was high in patients whose PCT concentration decreased significantly (by 3 days). Monitoring procalcitonin clearance was valuable to evaluate prognosis.

Keywords:Procalcitonin; Sepsis; Shock

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(编辑:吴莹 收稿日期:2016-12-28)