血清PCT CRP和APACHEⅡ评分的动态变化在预测多发伤合并脓毒症患者预后中的价值

Dynamic detection of procalcitonin,C-reactive protein and APACHEⅡ scores for predicting the prognosis of sepsis after multiple trauma

目的 观察多发伤后脓毒症患者血清降钙素原（PCT）、C反应蛋白（CRP）和APACHEⅡ评分值1周内的动态变化,分析各项炎症指标和APACHEⅡ评分值之间的相关性,评估其对脓毒症患者预后的预测价值.方法 对48例脓毒症患者于入ICU第1、3、5天检测血清PCT、CRP水平并进行APACHEⅡ评分.根据预后将患者分为存活组和死亡组,其中存活组32例,死亡组16例,比较两组患者各项炎症指标和APACHEⅡ评分值的差异,并根据ROC曲线分析各项指标对预后评估的能力.结果 死亡组患者入ICU第1、3、5天血清PCT、CRP和APACHEⅡ评分明显高于存活组患者,并且随着住院时间的延长呈下降趋势.第5天血清PCT与CRP、APACHEⅡ评分值的相关系数最大,分别为0.61和0.69.CRP与APACHEⅡ评分值之间没有明确的相关性（P〉0.05）.根据ROC曲线分析,对预后评估能力较好的依次为第1天的APACHEⅡ评分和第3天的PCT水平（P〈0.01）,第5天的CRP浓度虽与预后有一定的相关性（P〈0.05）,但AUC值明显低于PCT和APACHEⅡ评分.结论 与CRP相比,PCT与APACHEⅡ评分的相关性较好,并且第1天的APACHEⅡ评分结合第3天的PCT在脓毒症患者预后中的预测价值较高.

Objective To observe the dynamic change of serum procalcitonin （PCT） , C - reactive protein （CRP） and APACHE Ⅱ scores within a week in septic patients after multiple trauma, and to compare the correlation between the various inflammatory indexes and APACHE Ⅱ scores in order to analyze their vales of predicting the prognosis of patients with severe sepsis. Methods 48 patients of sepsis were divided into two groups ：survival group （32 patients） and dead group （16 patients）. The PCT, CRP and APACHE Ⅱ scores of septic patients were calculated on 1st, 3rd, 5th day after admission to the Intensive Care Unit （ICU）. The inflammatory indexes and APACHE Ⅱ scores were compared between the two groups and the ROC curves for predicting the prognosis were analysed. Results The inflammatory indexes and APACHE Ⅱ scores of dead group were higher than those of survival group and decreased with long hospitalization time. The correlation coefficient maximum of the serum PCT with CRP and APACHE Ⅱ scores were 0.61,0.69 on 5th day, respectively. There was no clear correlation between the CRP and APACHE Ⅱ scores （P 〉 0.05 ）. According to the ROC curves, the 1 st APACHE Ⅱ scores and 3rd PCT had the good evaluation ability （ P 〈 0.01 ）. Though the CRP levels had certain correlation with the prognosis on 5th day（P 〈0.05）, the AUC value of CRP was obviously lower than that of PCT and APACHE Ⅱ scores. Conclusion Compared with CRP levels, the correlation between PCT and APACHE Ⅱ scores are good, and the 1st APACHE Ⅱ scores with the 3rd PCT can effectively evaluate the severity and prognosis of patients.