外科脓毒症患者抗凝血酶Ⅲ与疾病严重程度和预后关系的临床研究

The relationship between antithrombin Ⅲ severity as well as prognosis in surgical patients with sepsis

目的通过监测抗凝血酶Ⅲ（AT-Ⅲ）水平，探讨其与外科脓毒症患者疾病严重程度和预后的关系。方法对2013—01—2015—01收住本院重症医学科外科术后脓毒症患者208例进行回顾性分析，并纳入同期非脓毒症患者208例。脓毒症患者依据诊断标准分为一般脓毒症组（S1）、严重脓毒症＋感染性休克组（S2），根据入ICU基础AT-Ⅲ水平分为AT-Ⅲ≥80％组（A1）、40％≤AT—Ⅲ〈80％组（A2）、AT—Ⅲ〈40％组（A3），依据预后分为生存组和死亡组，依据第3天AT—Ⅲ较入院时是否下降分组，了解AT-Ⅲ与疾病严重程度和预后的关系。结果外科脓毒症患者的APACHEⅡ评分、SOFA评分住ICU病死率及28d病死率均明显高于非脓毒症患者，AT-Ⅲ明显低于非脓毒症患者；严重脓毒症组（S2）AT-Ⅲ下降程度要明显高于一般脓毒症组（S1），死亡组AT-Ⅲ下降程度要明显高于生存组（P〈0．05）；脓毒症组AT-Ⅲ呈逐渐回升趋势；Logistic回归分析显示，人ICU基础AT-Ⅲ与患者预后密切相关；A1组、A2组、A3组三组间APACHEⅡ评分、SOFA评分、住ICU及28d病死率差异有统计学意义（P〈0．05）；人ICU基础AT-Ⅲ与SOFA评分具有相关性，与APACHE Ⅱ评分无相关性，但A3组AT-Ⅲ与APACHEⅡ评分呈负相关（r值=-0．683，P值=0．045）；AT-Ⅲ持续下降组住ICU及28d病死率明显高于未下降组（45% vs．10％，54％VS．7％）；入ICU基础AT-Ⅲ的ROC曲线下面积0．739（P〈0．01），对预后有中等预测能力。结论外科脓毒症患者AT-Ⅲ水平降低，且降低程度与疾病危重程度呈正相关。人ICU基础AT—Ⅲ及动态变化可用于预测预后。

Objective Bymonitoring the level of antithrombin Ⅲ （AT - Ⅲ ）, we could discuss the relationship between AT - Ⅲ of surgical patients with sepsis and severity as well as prognosis. Methods Clinical data of 208 postoperative surgical patients with sepsis and the same period of the 208 patients without sepsis admitted to ICU in our hospital during January 2013 to January 2015 were analyzed retrospectively. The main contents of investigation included the level of AT - Ⅲ of surgical sepsis patients, anditsrelationship with disease severity and prognosis. Results APACHE Ⅱ score, SOFA score and ICU and 28 day mortality in surgical patients with sepsis were significantly higher thanthe patients without sepsis, and the level of AT -Ⅲ was significantly lower than the patients without sepsis. The degree of AT -Ⅲ in severe sepsis group （ S2 ） decreased significantly higher than sepsis group （ S1 ）, and the degree of AT - Ⅲ in death group decreased significantly higher than survivalgroup （ P 〈 0.05 ）. The level of AT -Ⅲ in sepsis group was gradually rising. Logistic regression analysis showed： ICU based AT - Ⅲ wasclosely related to the prognosis of patients. All enrolled surgical patients with sepsiswere divided into A1 group （AT-Ⅲ ≥80% ）, A2 group（40% ≤AT - Ⅲ 〈80% ）and group A3 （AT -Ⅲ 〈 40% ）. Among the three groups, APACHE Ⅱ score, SOFA score, in ICU and 28 day mortality were significantly different （ P 〈 0.05 ）. There was a moderate correlation between ICU based AT -Ⅲ and SOFA score. There was no correlation between ICU based AT - Ⅲ and APACHE Ⅱ score. But ICU based AT - Ⅲ and APACHE Ⅱ score in A3 group was negatively correlated. In ICU and 28 day mortality in AT- Ⅲ declining group was significantly higher than AT- Ⅲ not dropped group（45% vs. 10% ,54% vs. 7% ）. ICU Based AT - Ⅲ helped prognostic ability （AUC = 0. 739）. Conclusion Surgical sepsis patients have lower level of AT - Ⅲ. The decreased degree of AT -Ⅲ has an association with the disease severity and prognosis. ICU based AT - Ⅲ and its dynamic changes in surgical sepsis patients could predict the prognosis.