APACHE Ⅱ评分、血清降钙素原和白介素-6与重症肺炎预后的关系

Values of APACHE Ⅱ Serum Procalcitonin and Interleukin-6 in Predicting Prognosis of Patients with Severe Pneumonia

目的探讨APACHEⅡ评分、血清降钙素原(PCT)、白介素-6(IL-6)对重症肺炎预后评估的价值。方法选择2013年12月至2014年5月行机械通气的重症肺炎患者126例作为观察组,其中存活组79例,死亡组47例,观察两组患者入院后第1、3、5、7d及转出ICU(或死亡)当天的APACHEⅡ评分及血清PCT、IL-6的动态变化。结果存活组患者确诊重症肺炎时的APACHE Ⅱ评分、血清PCT、IL-6分别为(51.12±5.74)分、(10.36±3.08)ng/mL、(89.36±18.79)ng/mL,而死亡组分别为(59.66±6.73)分、(13.17±3.99)ng/mL、(165.71±24.32)ng/mL,组间比较差异有统计学意义(P<0.05);在观察期期间,存活组APACHE Ⅱ、血清PCT逐渐下降,死亡组逐渐上升;两组血清IL-6水平均逐渐下降。APACHE Ⅱ评分与血清降钙素原呈正相关。结论重症肺炎治疗后的APACHEⅡ评分及血清PCT、IL-6的动态变化情况,可作为患者病情及预后判断的参考之一。

Objective To explore the value of APACHE Ⅱ, serum procalcitonin（PCT）and interleukin-6（IL-6）in pre-dicting prognosis of patients with severe pneumonia. Methods 126 cases of patients with severe pneumonia who were received me-chanical ventilation from December 2013 to May 2014,79 patients were enrolled as the survival group, and 47 patients were en-rolled as the non-survival group. The dynamic change of APACHE II score, serum PCT and IL-6were observed at day 1,3,5,7 and the day of discharge from ICU or death. Blood specimens were collected at the same points. Results APACHE II score,ser-um PCT in survival group were（20. 12 ± 5. 74）scores,（10. 36 ± 3. 08）ng /mL, and were（25. 66 ± 6. 73）scores,（13. 17 ± 3. 99） ng /mL in death group respectively. Significant differences（ P〈0. 05）were found between two groups of data. Within the period, APACHE II score and the serum PCT of the survival group decreased,while the non-survival group increased. The serum IL-6 of the two groups decreased gradually. APACHE II was positively correlated with serum procalcitonin. Conclusion The dynamic change of APACHE II score, serum PCT and IL-6can be one of the references to evaluate the condition and prognosis of patients with severe pneumonia.