血清肌红蛋白和急性生理学与慢性健康状况评分系统Ⅱ评分在危重病评估中的应用价值比较

A comparison between serum myoglobin and acute physiology and chronic health evaluation Ⅱ score in the evaluation of disease severity and prognosis in critically ill patients

目的以急性生理学与慢性健康状况评分系统Ⅱ（APACHEⅡ）评估体系和患者的治疗预后为标准，分别探讨血清肌红蛋白（Mb）与APACHEⅡ评分在危重病评估中的应用价值，以及Mb对患者生存率的预测价值。方法选择2005年412月收住急诊重症加强治疗病房（EICU）的130例患者，用固相层析免疫分析技术及化学发光技术定量检测全套心肌蛋白，同步检测血常规及血生化指标，计算APACHEⅡ评分。所有患者随访至病情稳定出院或死亡。结果APACHEⅡ评分、白细胞计数（WBC）、病死率在根据Mb值划分的两组（〈140μg／L组（76例）和≥140μg／L组（55例）]间差异均有统计学意义，其中APACHEⅡ评分、病死率的统计学差异均为P〈0．01。在根据患者的治疗转归分成的好转出院组（86例）和死亡组（45例）中，APACHEⅡ评分、Mb和中性粒细胞（N）差异均有统计学意义（P均〈0．01）。多元回归分析也显示，Mb和APACHEⅡ评分均为对患者生存率有显著作用的参数，而且Mb最先入选。当Mb〉500pg／L时，病死率为82％（23／28）；当APACHEⅡ评分〉20分时，病死率为85％（23／27）；对同时满足Mb〉500μg／L、APACHEⅡ评分〉20分的20例患者，病死率高达95％（19／20），提示联合应用Mb和APACHEⅡ评分能显著提高生存风险预测的准确性，有利于临床上早期评估患者的生存率。结论Mb能像APACHEⅡ评分一样反映疾病的危重程度，预测患者的生存率和治疗效果，是一种简单、方便、有效的评估手段。

Objective To determine the clinical significance of serum myoglobin （Mb） in the evaluation of severity and prognosis of non-cardiogenic critically ill patients by comparing with acute physiology and chronic health evaluation Ⅱ （APACHE Ⅱ ） score. Methods One hundred and thirty patients admitted consecutively to emergency intensive care unit （EICU） from April to December in 2005 were enrolled for the study. Determination of serum Mb content, routine serum biochemical tests and APACHE Ⅱ scoring were performed simultaneously. The serum Mb was measured with the use of chemoluminescence and solidchromotography. All the patients were followed up till recovery/discharge or death. Results APACHE Ⅱ score, white blood cell count and mortality were significantly different between the two groups classified by the content of serum Mb [Mb〈140 μg/L （76 patients） and Mb≥140 μg/L （55 patients）]. When Mb rose, diseases aggravated, APACHE Ⅱ score and mortality went up （both P〈0.01）. APACHE Ⅱ score, Mb and neutrophil were remarkably higher in the death group （45 patients） than the recovery group （86 patients, all P〈0.01）. Stepwise Cox Regression showed that Mb and APACHE 1I score were the parameters that related to the survival rate, while Mb was the main option. When Mb〉500 μg/L, the mortality rate was 82% （23/ 28）; when APACHE Ⅱ score〉20, the mortality rate was 85% （23/27）. the morality rate went up to 95% （19/20） in the patients with Mb〉500 μg/L and APACHE Ⅱ score 〉20, suggesting that a combination of Mb determination and APACHE Ⅱ score would raise the accuracy of evaluation of the prognosis of critically ill patients. Conclusion Compares with APACHE Ⅱ score for evaluation of critical illness, Mb can also be considered as a significant biomarker to evaluate the seriousness of the ailment in the critically ill and to judge the effect of the treatment. Therefore, it could be used as a prospective and meaningful biomarker for a quick evaluation of the disease severity in the ICU, so it is worth for further study.