PCT在预测危重病患者发生MODS或死亡风险的临床价值

The clinical significance of PCT in the prediction for the occurrence of MODS or the risk of death in critically ill patients

目的探讨危重病患者血清降钙素原(PCT)水平与急性生理学与慢性健康状况Ⅱ(APACHEⅡ)评分及预后的相关性。方法选择重症监护病房(ICU)危重病患者120例,采用APACHEⅡ评分评价患者的病情,并据此分组;测定患者入院后第1、3、5、7天的血清PCT、C反应蛋白(CRP)、肿瘤坏死因子-α(TNF-α)、白细胞介素-6(IL-6)浓度。结果APACHEⅡ评分高评组(>25分)患者的血清PCT阳性率、CRP、IL-6水平均显著高于APACHEⅡ评分中评组(15～25分)和APACHEⅡ评分低评组(<15分),差异有统计学意义(P<0.05);PCT水平与APACHEⅡ评分有良好的相关性(r=0.685,P<0.05)。PCT<10μg/L的患者均未发生多器官功能障碍综合征(MODS),发生MODS或死亡者PCT浓度始终维持较高水平(>10μg/L)。结论血清PCT是一个预测患者发生MODS或死亡风险的较为敏感的指标。

Objective To explore the correlation between serum procalcitonin （PCT） level and acute physiology and chronic health evaluation Ⅱ （APACHE Ⅱ ） score and prognosis in critically ill patients. Methods A total of 120 critically ill patients recruited in this study were further divided into 3 groups according to APACHE lI score. The serum levels of PCT, C-reactive protein （ CRP）, tumor necrosis factor-α（TNF-α ） and interleukin-6（IL-6） were measured on 1, 3, 5 and 7 d after the admission. Results The serum levels of PCT, CRP, IL-6 were all significantly higher （P 〈 0.05） in high APACHE Ⅱ score group （ 〉 25 ） than in middle （ 15-25 ） and low （ 〈 15 ） APACHE Ⅱ score groups. There was significant correlation between PCT level and APACHE Ⅱ score （ r = 0. 685, P 〈 0.05 ）. The patients with PCT 〈 10 μg/L all survived and no case of multiple organ dysfunction syndrome（MODS） complication was found. The PCT always maintained a high level （ 〉 10 μg/L） in the patients dying or with MODS complication. Conclusions The serum PCT level can be used in prediction for the occurrence of MODS or the risk of death.