乳酸和血清胱抑素C评估脓毒症患者病情及预后的临床价值

The clinical significance of lactic acid and serum cystatin C in the evaluating of the condition and prognosis in patients with sepsis

目的：探讨乳酸和血清胱抑素C（Cys C）在评估脓毒症患者病情和预后中的临床价值。方法：选择83例脓毒症患者,检测入院时患者乳酸和Cys C水平,进行APACHEⅡ评分,分别比较病死和存活患者,脓毒症、严重脓毒症和脓毒性休克患者,APACHEⅡ评分〈15分、15~24分和〉24分患者乳酸和Cys C水平的差异。采用Pearson相关分析乳酸、Cys C水平与APACHEⅡ评分之间的相关性。采用logistic回归分析乳酸、Cys C对患者病死率的预测价值。结果：病死患者乳酸和Cys C水平明显高于存活患者（P〈0.01）。脓毒性休克患者乳酸和Cys C水平均高于严重脓毒症患者（P〈0.01和P〈0.05）,严重脓毒症患者乳酸和Cys C水平均高于脓毒症患者（P〈0.01）。随着APACHEⅡ评分增高,患者乳酸和Cys C水平均明显升高（P〈0.01）。乳酸、Cys C水平均与APACHEⅡ评分呈正相关关系（P〈0.05）。乳酸和Cys C均是预测脓毒症预后的独立危险因素。结论：乳酸和Cys C可以作为评估脓毒症患者病情严重程度和判断预后的指标。

Objective： To explore the clinical value of lactic acid and cystatin C（ Cys C） in the evaluating of the condition and prognosis in patients with sepsis. Methods： The levels of lactic acid and Cys C and APACHEⅡ score in 83 patients with sepsis were detected on admission,the differences of which between the death group and survival group,between the sepsis group,severe sepsis group and septic shock group and between the APACHEⅡ score with less than 15 group,APACHEⅡ score with from 15 to 24 group and APACHEⅡ score with more than 24 group were compared. The correlations of lactic acid,Cys C and APACHE Ⅱ score were analyzed using Pearson. The predictive value of lactic acid and Cys C in the mortality of patients were evaluated by logistic regression analysis. Results： The levels of lactic acid and Cys C in death group were significantly higher than those in survival group（ P〈0. 01）.The levels of lactic acid and Cys C in septic shock group were higher than that in severe sepsis group（ P〈0. 01 and P〈0. 05）,the levels of lactic acid and Cys C in severe sepsis group were higher than that in sepsis group（ P〈0. 01）. With the rise of APACHEⅡ score,the levels of lactic acid and Cys C in patients significantly increased（ P〈0. 01）. The levels of lactic acid and Cys C were a positive correlation to APACHE Ⅱ score（ P〈0. 05）. The lactic acid and Cys C were the risk factors in predicting the prognosis of patients with sepsis. Conclusions： Conclusions： Lactic acid and Cys C can be used as the predictive parameters in the condition and prognosis in patients with sepsis.