脓毒症患者血清C-反应蛋白、皮质醇的动态变化及其与预后的关系

Dynamic changes of C-reactive protein and cortisol in patients with sepsis and their relationship with prognosis

目的:研究脓毒症患者血清C-反应蛋白(CRP)、皮质醇(COR)的动态变化特点及其对脓毒症患者预后评估的临床价值。方法:97例脓毒症患者住ICU期间每天采血进行CRP、COR检测,记录CRP、COR的动态变化。分析患者血清CRP、COR的动态变化特点及其与预后的关系。结果:治疗后病死患者的血清CRP和COR水平显著高于存活患者(P<0.05)。按CRP、COR动态变化趋势的不同分为4种类型:Ⅰ型:持续升高型;Ⅱ型:升高-回落型;Ⅲ型:反复波动型;Ⅳ型:正常或轻度升高型。CRPⅠ型患者的病死率显著高于CRPⅡ型和CRPⅣ型(P<0.001)。CORⅠ型、CORⅢ型患者的病死率分别显著高于CORⅡ型和CORⅣ型(P<0.001)。进一步分析,CRP和COR均明显升高组的病死率显著高于CRP或COR任一明显升高组及CRP和COR均非明显升高组(P<0.001);CRP或COR任一明显升高组的病死率亦显著高于CRP和COR均非明显升高组(P<0.001)。结论 :脓毒症患者CRP、COR的动态变化有一定的特点,监测两者的动态变化能够对脓毒症的预后做出较准确的评估。

Objective To study the dynamic changes of plasma C-reactive protein （CRP） and cortisol （COR） and their chnical value in prognosis of patients with sepsis. Methods Daily CRP and COR detection was conducted to record the dynamic changes of CRP and COR for cases of sepsis patients in ICU then the rela- tionship between dynamic changes of serum CRP and COR and prognosis were analyzed. Results Serum CRP and COR levels of dead patients were significantly higher than those of survival patients after treatment （P 〈 0.05）. According to the difference of the dynamic changes of CRP and COR, the data were divided into type Ⅰ ： sustained elevated type, type Ⅱ ： up-and-down type, type Ⅲ fluctuated type and type Ⅳ ： normal or mild elevation type. The mortality of CRP type Ⅰ patients was significantly higher than that of type Ⅱ and type IV （P 〈 0.001 ）. The mortality of COR type I and COR Ⅲ patients was significantly higher than that in COR I/and COR IV （P 〈 0.001）. Further analysis showed that the mortality of group with significant elevation of CRP and COR were obviously higher than that of group with significant increase of CRP or COR and that of group with no significant elevation of CRP and COR （P 〈 0.001 ） ; the mortality of group with significant increase of CRP or COR was also significantly higher than that of group with no significant elevation of CRP and COR （P 〈 0.001 ）. Conclusions The dynamic changes of COR and CRP in patients with sepsis present certain regularity and monitoring the dynamic changes of the two provides accurate assessment of the prognosis of sepsis.