C-反应蛋白下降率对判断严重脓毒症患者预后的作用

The evaluation of the impact of the decline rate of C-reactive protein on the prognosis in patients with severe sepsis

目的：探讨治疗后 C-反应蛋白（CRP）下降率对评估严重脓毒症患者预后的作用。方法选择确诊为严重脓毒症的103例患者，根据治疗3 d 后 CRP 下降率分为 A 组（治疗3 d 后 CRP 较治疗前下降＜30％）、B 组（治疗3 d 后 CRP 较治疗前下降30％～50％）、C 组（治疗3 d 后 CRP 较治疗前下降≥50％），比较3组患者机械通气带机时间、ICU 平均住院天数、平均 ICU 住院费用、平均总住院天数及28 d 病死率。结果A 组患者与 B、C 组患者机械通气平均带机时间、ICU 平均住院天数、平均 ICU 住院费用、平均总住院天数及28 d 病死率比较差异均有统计学意义（P ＜0．05）。B 组患者机械通气平均带机时间、ICU 平均住院天数、平均 ICU 住院费用、平均总住院天数及28 d 病死率均高于 C 组，但差异无统计学意义（P ＞0．05）。判断脓毒症患者存活的治疗后3 d CRP 下降率的最佳界点值为31．48％，敏感性为86．54％，特异度为100％。结论严重脓毒症抗感染治疗3 d 后 CRP 下降率是一个敏感性好、特异性强的用于判断患者预后良好的指标。

Objective We mainly discuss the impact of the decline rate of Creactive protein on the prognosis of severe sepsis patients.Methods 103 cases of severe sepsis patients were divided into 3 groups,according to the rate of decline in CRP after 3 days′treatment：group A （3d after compared to 3d before the treatment,decline rate of CRP〈30%）,group B （3 d after compared to 3 d before the treatment,decline rate of CRP 30%～50%）,C group （3 d after compared to 3 d before the treatment,decline rate of CRP≥ 50%）,we made comparison of 3 groups based on the following five factors：average mechanical ventilation time,average hospitalization days,average hospitalization expenses,total average hospitalization days,the mortality rate in 28 d.Results Compared with group B and C,patients in group A has a statistical difference in all those five factors （P 〈0.05）.No significant differences were found in all the five factors of group B and C,but the observation index was lower in group C.The optimal value of CRP decline rate to evaluate the survive rate after 3 days′ treatment is 31.48%,the sensitivity was 86. 54%,specificity was 100%.Conclusion Decline rate of CRP after 3 days′treatment is a both sensitive and specific index to evaluate the prognosis of severe sepsis.