凝溶胶蛋白对严重脓毒症患者的预后评估价值

The value of gelsolin for evaluating the prognosis of patients with severe sepsis

目的探讨凝溶胶蛋白对严重脓毒症患者预后的评估价值。方法2015年1月至2015年7月北京医院急诊监护室的50例严重脓毒症患者，入院时检测白细胞计数（WBC）、C反应蛋白（CRP）、降钙素原（PCT）和凝溶胶蛋白（Gelsolin），并记录24h的急性生理学与慢性健康情况评价Ⅱ（APACHEⅡ）评分。根据28d的转归，将50例严重脓毒症患者分为存活组和死亡组，比较上述指标在两组间差异有无统计学意义。采用二元Logistic回归分析筛选其预测死亡的独立危险因素，应用受试者工作特征曲线（ROC曲线）评价和比较预测能力。结果存活组31例，死亡组19例。两组比较，凝溶胶蛋白[（21．43±10．54）VS．（13．31±8．54），P=0．007]和APACHEⅡ评分[（19．2±6．86）vs24．6±8．9，P=0．021）]有统计学意义。二元logistic回归分析显示凝溶胶蛋白和APACHEⅡ评分是预测死亡的独立危险因素。凝溶胶蛋白ROC曲线下面积（AUC）为0．745（95％C10．599～0．851，P=0．004），APACHEⅡ评分ROC曲线下面积（AUC）为0．699（95％CI 0．537～0．862，P：0．019），两者预测能力相当。将二者联合应用，预测的准确率可达到90％，有较好的互补性。结论凝溶胶蛋白能够判断严重脓毒症患者的病情严重程度，并较为准确的预测预后。

Objective To evaluate the value of gelsofin for the prognosis of patients with severe sepsis. Methods 50 patients in the emergency intensive care unit of Beijing hospital from January 2015 to July 2015, were determined white blood cell count （WBC）, C-reactive protein （CRP）, procalcitonin （PCT）, gelsolin at admission, acute physiology and chronic health evaluation Ⅱ （APACHE Ⅱ ） score were estimated within 24 hours. According to the 28 days of survival outcome, 50 patients were divided into two groups ： survival group and death group. The significant difference of these factors was compared. Binary logistic regression analysis was applied for screening independent risk factors for the prediction of death. The receiver operating characteristic （ROC） curve was applied for the evaluation and comparison about prognosis ability. Results 31 patients were in the survival group, 19 patients in the death group. The gelsolin [ （21.43±10.54） vs. （13.31±8.54）, P=0.007] andAPACHE 1I score [ （19.2±6.86） vs. （24.6 ± 8.9 ） , P = 0. 0211 in two groups had significance difference. Binary logistic regression analysis indicated that the gelsolin and APACHE Ⅱ score were independent risk factors of predicting death. The area under of ROC curve （AUC） of the gelsolin was 0. 745 （95% CI： O. 599-0. 851, P =0. 004） and the APACHE lI score was 0. 699 （ 95% CI： 0. 537-0. 862, P = 0. 019 ） . Both prognosis ability were equivalent. To combine the tow factors , the accuracy of predition was 90% and has better complementarity. Conclusions the gelsolin could assess the severity of patients with severe sepsis and predict the prognosis more accurately.