6小时乳酸清除率及降钙素原对脓毒症患者预后的评估价值

Evaluation of the prognosis of patients with sepsis by 6 hours arterial blood lactate clearance and PCT

目的：探讨动脉血乳酸清除率、降钙素原（PCT）与脓毒症患者预后的评估价值。方法：回顾性分析2011-10-2014-10入住我院重症医学科的120例脓毒症患者临床资料,入院24h内行PCT及初始乳酸（入科时监测）和6h的血乳酸水平监测,计算6h乳酸清除率、APACHEⅡ评分,并比较死亡组患者和存活组患者乳酸清除率、PCT及APACHEⅡ评分的差异,比较不同APACHEⅡ评分分层组间PCT及6h乳酸清除率的差异,对APACHEⅡ评分、PCT、6h乳酸清除率进行相关性分析;绘制受试者工作特征曲线（ROC）;评价PCT、6h乳酸清除率对脓毒症患者预后的评估价值。结果：死亡组患者入院时PCT、APACHEⅡ评分明显高于存活组患者,6h乳酸清除率明显低于存活组,差异有统计学意义（P〈0.01）;乳酸清除率、PCT在不同APACHEⅡ评分分层组间两两比较差异均有统计学意义（P〈0.01）;经过Spearman相关性分析入院患者6h血乳酸清除率与APACHEⅡ评分呈显著负相关（P〈0.01）,且随着APACHEⅡ评分的升高,动脉血6h乳酸清除率明显降低,PCT与APACHEⅡ评分呈显著正相关（P〈0.01）。6h乳酸清除率预测患者28d病死率的ROC曲线下面积（AUC）为0.93±0.03（95%CI：0.87-0.99）,截断值为18.64%,灵敏度82.86%,特异度95.56%,Youden指数0.784;PCT预测患者28d病死率的AUC为0.79±0.05（95%CI：0.68-0.89）,截断值为7.78ng/ml,灵敏度79.41%,特异度70.37%,Youden指数0.498。结论：动脉血血乳酸清除率联合PCT可作为判断脓毒症患者病情和预后的重要监测指标。

Objective：To investigate the relationship between the arterial blood lactate clearance,PCT and the prognosis of patients with sepsis.Method：Retrospectively analyzed the clinical data of the 120 patients with sepsis syndrome admited in Shengli Oilfield central hospital intensive medicine from October 2011 to October 2014.In 24 hours after admission,PCT,initial lactate（Department）and 6hours of blood lactate levels were monitored to calculate 6hour lactic acid clearance rate,APACHEⅡscore.Lactate clearance rate,PCT and APACHEⅡscore were compared between the death group and survival group.The difference of PCT and lactate clearance rate in different APACHEⅡ score groups were compared and correlation analysis was made among PCT and lactate clearance rate in different APACHEⅡ score.Further,value of PCT and lactate clearance rate on the prognosis of sepsis patients was evaluated.Result：The PCT and APACHEⅡscore in death group is significantly higher than that in the survival group,lactate clearance rate was significantly lower than that in the survival group（P〈0.01）;lactate clearance rate,PCT in different APACHEⅡscore groups were statistically different（P〈0.01）;Based on the Spearman rank correlation analysis,the blood lactic acid level,PCT and APACHEⅡscore has a significant negative correlation（P〈0.01）,and with the increase of APACHEⅡscore,6hours of arterial blood lactate clearance rate significantly reduced.An ROC curve analysis determined that the 6hours lactate clearance rate had an area of 0.93±0.03（95%CI：0.87-0.99）,and cut-off point was 18.64%,which predict the prognosis in patients with sepsis,（82.86%sensitivity.95.56% specificity,Youden index 0.784）.The ROC Curve analysis indicated that the PCT level had an area of 0.79±0.05（95%CI：0.68-0.89）,and the cut-off point was7.78ng/ml,which predict the prognosis in patients with sepsis,（sensitivity 79.41%,specificity 70.37%,Youden index 0.498）.Conclusion：arterial blood lactate clearance rate combined with PCT can be used as an important index to de-termine the severity and prognosis of sepsis.