血清胆碱酯酶浓度联合APACHEⅡ评分对脓毒症病人预后的评估价值

Value of cholinesterase concentration in blood combined with APACHE Ⅱ score in predicting the prognosis of septic patients

目的探讨并比较有脓毒症病人人院24小时内急性生理学及慢性健康状况评估Ⅱ（APACHE11）评分和胆碱酯酶（Cholinesterase，ChE）浓度改变在预测病情及预后中的价值。方法对60例人院24小时内的脓毒症病人进行APACHEⅡ评分；同时测定ChE浓度．病人预后分为存活组和死亡组．分析ChE和APACHEII评分与病情及预后关系。结果存活组APACHEⅡ分明显低于死亡组（P〈O．01），而ChE浓度明显高于死亡组（P〈0．01）。随着APACHEⅡ评分升高而ChE降低，且死亡率上升。2项指标与预后的Logistic回归分析均有显著性意义（P〈0．01），APACHEⅡ评分（OR95％CI=0．7445～0．9147），ChE浓度（0R95％CI=1．0005～1．0018）。APACHEII评分和ChE与预后的ROC曲线下面积（AUC）分别是0．828和0．818，提示两者在预测脓毒症病人预后时均具有一定的价值，但两者没有显著性差异（p〉0．05），而两者联合预测时AUC为0．952，预测的准确性大于其中任何一项单一预测（P〈0．05）。结论APACHEⅡ评分和ChE浓度的改变对急性重症胆管炎病人病情及预后有重要的相关性，两者联合可明显提高对预后判断的准确性，为临床救治提供一定的指导。

Objective To explore the relationship of acute physiology and chronic health evaluation Ⅱ （APACHE Ⅱ）score and the changes of cholinesterase （ChE） concentration with the state of illness and prognosis of septic patients admitted to hospital in 24 hours. Methods The evalua- tion variable of APACHE Ⅱ score was assessed , and the ChE concentrations were determined in 60 patients. All patients were divided into two groups based on their prognosis： survival group and death group. The relationships of ChE concentration and APACHE Ⅱ score with state of illness and prognosis were analyzed. Results The APACHE Ⅱ score in survival group was significantly lower than in death group （P〈0.01）, while con- centration of ChE in survival group significantly higher than in death group（P〈0.01）. Mortality rate increased with APACHE Ⅱ score, while ChE con- centration became lower. In the logistic regression analysis of prognosis, both indexes were obviously significant （P〈0.01）. Our study indicated A- PACHE Ⅱ score（OR95%CI=0.7445-0.9147）, ChE concentration （OR95% CI=1.0005-1.0018）. Area under curve（AUC） of APACHE Ⅱ score and ChE concentration were 0.828 and 0.818, respectively,they both have some value in predicting the prognosis of septic patients, but there were no significant differences （P〉0.05）. AUC of the joint forecasts was 0.952, the predicting accuracy was higher than any of them （P〈0.05）. Conclusion A-PACHE Ⅱ score and ChE concentration both have some value in predicting the prognosis of septic patients, the two combined can significantly im- prove the accuracy of prognosis and provide some clinical guidance for treatment.