降钙素原变化率在评估脓毒症患者预后中的价值

Prognostic evaluation of procalcitonin clearance for sepsis

目的：探讨静脉血中降钙素原（Procalcitonin，PCT）及其变化率在评估脓毒症患者预后中的价值。方法对急诊重症监护室收治的72例脓毒症患者，分别于入室即刻（PCT1）、入室后72 h（PCT2）检测静脉血中PCT含量，并计算PCT变化率。患者入室后24 h内利用急性生理学和慢性健康状况评价Ⅱ（APACHEⅡ）进行评分。以患者入室后28 d生存状况，将患者分为存活组（52例）和死亡组（20例），比较两组患者不同时点静脉血中PCT含量、PCT变化率及APACHEⅡ评分对预测患者预后的价值。结果存活组和死亡组患者入室即刻PCT含量分别为14．72μg·L^－1（7．82～20．25μg·L^－1）比18．25μg·L^－1（13．43～21．83μg·L^－1），两组差别有统计学意义（P＝0．047）；存活组和死亡组患者72 h PCT含量分别为4．11μg·L^－1（2．03～8．22μg·L^－1）比12．33μg·L－1（8．21～15．76μg·L^－1），两组差别有统计学意义（P＝0．000）；存活组和死亡组患者PCT变化率依次为0．718（0．589～0．827）比0．365（0．256～0．57），两组差别有统计学意义（P＝0．000）。PCT变化率预测患者预后价值同APACHEⅡ评分一致，但优于不同时点静脉血中PCT含量，其ROC曲线下面积（AUC）为0．814，敏感度82．7％，特异度75％。结论患者静脉血中PCT变化率可作为判断脓毒症患者预后的指标之一，其预测能力优于入室即刻PCT和72 h PCT含量的预测能力。

Objective To investigate the prognostic value of procalcitonin （PCT）and PCT clearance in patients with sepsis in emer-gency intensive care unit （EICU）.Methods 72 cases with sepsis were included in the present study.PCT was measured at admis-sion,72 hours after admission and the PCT clearance was also calculated.Meanwhile,Acute Physiology and Chronic Health Evaluation II （APACHE II）score was recorded within 24 hours.Patients were divided into two groups （survivors and non-survivors）according to 28d mortality.The PCT of two different points,PCT clearance,and APACHE II scores were compared between the survivors and non-survivors Results Significant difference of PCT at admission,72 hours after admission and the PCT clearance were found between the survivors and non-survivors groups with 14.72 μg·L-1 （7.82 ~20.25 μg·L-1 ）vs 18.25 μg·L-1 （13.43 ~21.83 μg·L-1 ） （P =0.047）,4.11 μg·L-1 （2.03 ~8.22 μg·L-1 ）vs 12.33 μg·L-1 （8.21 ~15.76 μg·L-1 ）（P =0.000）,and 0.718 （0.589~0.827）vs 0.365 （0.256~0.57）（P =0.000）,respectively.Prognostic value of the PCT clearance is consistent with A-PACHEⅡ score,but better than the PCT content of the venous blood at different time points.The area under the ROC was 0.849 with sensitivity 78%,specificity 89.2%.Conclusions PCT clearance maybe can be used as a prognostic indicator,which was better than using PCT at admission and 72h after admission.