龙邦盛,王振贤,林莉娴,李祖锦,林明豪.PCT和乳酸水平对伴心肌损伤脓毒症患者28天存活率的预测价值.[J].中南医学科学杂志.,2019,(6):601-605.
PCT和乳酸水平对伴心肌损伤脓毒症患者28天存活率的预测价值
Predictive value of PCT and lactic acid levels for 28-day survival in sepsis patients with myocardial injury
投稿时间:2019-08-27  修订日期:2019-10-10
DOI:10.15972/j.cnki.43-1509/r.2019.06.010
中文关键词:  血清降钙素原  乳酸水平  脓毒症  心肌损伤  28天存活率
英文关键词:serum procalcitonin  lactic acid level  sepsis  myocardial injury  28-day survival rate
基金项目:
作者单位
龙邦盛 海口市中医医院重症医学科,海南 海口70000 
王振贤 海口市中医医院重症医学科,海南 海口70000 
林莉娴 海口市中医医院老年病科,海南 海口70000 
李祖锦 海口市中医医院外科,海南 海口70000 
林明豪 海口市中医医院全科医学科,海南 海口70000 
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中文摘要:
      探讨血清降钙素原(PCT)和乳酸水平对伴心肌损伤脓毒症患者28天存活率的预测价值。选取166例伴心肌损伤脓毒症患者作为实验对象,随访28天,根据预后随访结果分为存活组(100例)和死亡阻(66例)。随访结果表明死亡组急性生理功能和慢性健康状况评分系统Ⅱ(APACHEⅡ)评分、序贯器官衰竭估计(SOFA)评分显著高于存活组(P<0.05);死亡组第3、第7天血清PCT、乳酸水平明显高于第1天(P<0.05),第7天血清PCT、乳酸水平明显高于第3天(P<0.05);存活组第7天血清PCT、乳酸水平明显低于第1、3天(P<0.05);根据logistic回归分析发现PCT、乳酸、SOFA评分是伴心肌损伤脓毒症患者死亡因素独立危险因素;PCT最佳诊断截点为9.82 μg/L,ROC曲线下面积(95%Cl)为0.862(0.803~0.918),敏感度82.10%,特异度85.03%较好。乳酸最佳诊断截点为3.73 mmol/L,ROC曲线下的面积(95%Cl)为0.857(0.729~0.988),敏感度为86.11%,特异度为76.24%较好;血清PCT、乳酸与APAHEⅡ评分、SOFA评分均呈正相关(r=0.741,P<0.001;r=0.692,P<0.001)。实验表明,血清降钙素原和乳酸水平与伴心肌损伤脓毒症患者病情严重程度密切相关,血清降钙素原和乳酸水平在评估伴心肌损伤脓毒症患者28天存活率时具有良好的预测价值。
英文摘要:
      To investigate the predictive value of serum procalcitonin (PCT) and lactic acid levels for 28-day survival in sepsis patients with myocardial injury. 166 sepsis patients with myocardial injury were selected as experimental subjects. They were followed up for 28 days. According to the results of follow-up, they were divided into survival group (100 cases) and death resistance group (66 cases). The results of follow-up showed that the APACHE II score and SOFA score of the death group were significantly higher than those of the survival group (P<0.05); the serum PCT and lactic acid levels of the death group were significantly higher than those of the first day (P<0.05), and the serum PCT and lactic acid levels of the 7th day were significantly higher than those of the 3rd day (P<0.05); the serum PCT and lactic acid levels of the survival group were significantly higher than those of the 3rd day(P<0.05). According to logistic regression analysis, PCT, lactic acid and SOFAscores were independent risk factors for death in sepsis patients with myocardial injury. The best diagnostic cut-off point for PCT was 9.82 ug/L, the area under ROC curve (95%Cl) was 0.862 (0.803-0.918), the sensitivity was 82.10%, and the specificity was 85.03%. The best diagnostic cut-off point for lactic acid was 3.73 mmol/L, the area under ROC curve (95%Cl) was 0.857 (0.729-0.988), the sensitivity was 86.11%, and the specificity was 76.24%. Serum PCT and lactic acid were positively correlated with APAHE II score and SOFA score (r=0.741, P<0.001; r=0.692, P<0.001). The results showed that serum procalcitonin and lactic acid levels were closely related to the severity of sepsis patients with myocardial injury. Serum procalcitonin andlactic acid levels had a good predictive value in evaluating the 28-day survivalrate of sepsis patients with myocardial injury.
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