脓毒症患者血清急性时相蛋白的变化及其与APACHEⅡ评分和预后的关系

Relationship between the change of acute phase protein and APACHEⅡ scores in the patient with sepsis

目的探讨脓毒症患者血清急性时相蛋白含量的变化及其与APACHEⅡ评分和预后的关系。方法应用免疫散射比浊法测定入住ICU病房的81例危重病患者第1天血清急性时相蛋白的含量,包括CRP、CER、HPT、AAG、PAB、TRF及ALB。依据SIRS发生与否分为SIRS组和无SIRS组进行分析。另对70例SIRS患者依据感染发生与否分为SIRS感染组(即脓毒症组)和SIRS无感染组进行分析。结果SIRS组患者CRP、AAG的含量明显高于无SIRS组(P<0.01);PAB、TRF的含量明显低于无SIRS组(P<0.01或P<0.05)。脓毒症组患者CRP水平明显高于SIRS无感染组(P<0.01)。危重病患者7项急性时相蛋白中只有CRP水平与APACHEⅡ评分存在相关性(r=0.253,P<0.05)。经Logistic回归分析结果显示,只有CRP水平与预后明显相关。结论CRP的检测在脓毒症的诊断及疾病严重程度与预后的评估中具有可靠的应用价值。

Objective To investigate the variety of acute phase protein in the patients with sepsis ,especially evaluate whether both parameters could predict the severity and outcome of critical illness. Methods Eighty-one critically ill patients were divided into two groups: SIRS group , no SIRS group .In addition, 70 patients with SIRS were divided into two groups according to infection or not :sepsis group (patients with SIRS and a positive culture, or negative cultures but suspected infection),SIRS without infection group. Blood samples were collected immediately after admission on day 1, and the concentrations of C-reactive protein(CRP), ceruloplasmin(CER), haptoglobin(HPT), α1-acid glycoprotein(AAG), pre-albumin(PAB),transferrin(TRF) and albumin(ALB) were measured by rate nephelometry in the patients with critical illness. Results The concentrations of CRP, AAG were markedly increased in SIRS group;whereas the concentrations of ALB,PAB and TRF were significantly lower than no SIRS group (PCRP levels in sepsis group were significantly higher than SIRS without infection group (P<0.01). The CRP levels significantly correlated with APACHEⅡ scores(r=0.253, P<0.05). Logistic regression analysis showed that the CRP levels related with outcome. Conclusion CRP levels have a reliable value in diagnosis of sepsis and prediction of the severity and outcome in critical illness.