感染性休克患者APACHE Ⅱ评分与血小板参数及心肌损伤标志物的表达分析

Value of APACHE Ⅱ score,platelet parameters,and expression of myocardial injury markers in patients with septic shock

目的观察感染性休克患者急性生理与慢性健康(APACHEⅡ)评分、血小板参数、心肌损伤标志物的表达特点,分析其与感染性休克预后的关系。方法选取2014年8月-2015年8月医院治疗的49例感染性休克患者为感染休克组,将成功生存的26例患者为生存亚组,将死亡的23例患者为死亡亚组,另选取资料相仿的45例未见感染性休克患者为对照组,对比各组患者在APACHEⅡ评分、血小板参数、心肌损伤感染标志物方面的差异,同时分析APACHEⅡ评分与血小板参数、心肌损伤标志物之间的相关性。结果感染休克组患者APACHEⅡ评分、血小板平均容积(MPV)、血小板分布宽度(PDW)、血清肌钙蛋白I(cTn I)显著高于对照组,血小板(PLT)计数显著低于对照组(P<0.05);死亡亚组病患APACHEⅡ评分、MPV、PDW、cTn I显著高于生存亚组,PLT计数显著低于生存亚组(P<0.05);PLT计数与APACHEⅡ评分呈显著负相关,而MPV、PDW、cTn I与APACHEⅡ评分呈显著正相关性(P<0.01)。结论感染性休克患者APACHEⅡ评分、血小板参数、心肌损伤标志物表达水平异常,APACHEⅡ评分、血小板参数、心肌损伤标志物在一定程度上能够反映感染性休克预后,且心肌损伤程度与APACHEⅡ评分具有正相关性。

OBJECTIVE To observe the value of Acute Physiology and Chronic Health Evaluation（APACHE Ⅱ）score,platelet parameters,and expression of myocardial injury markers in patients with septic shock and analyze their relationship with prognosis of septic shock.METHODS A total of 49 patients with septic chock who were treated in hospitals from Aug 2014 to Aug 2015 were chosen as the septic chock group;26patients who survived were assigned as the survival subgroup,and 23 patients who died were set as the death subgroup;meanwhile,45 patients who had the similar data but did not have septic shock were selected as the control group.The APACHEⅡ score,platelet parameters,and myocardial injury makers were observed and compared among the three groups of patients;the relationship between the APACHE Ⅱ score and the platelet parameters,myocardial injury markers was analyzed.RESULTS The APACHE Ⅱ score,mean platelet volume（MPV）,platelet distribution width（PDW）,and serum troponin I（cTn I）were remarkably higher in the septic shock group than in the control group;the platelet（PLT）counts of the septic shock group were significantly lower those of the control group（P〈0.05）.The APACHE Ⅱscore,MPV,PDW,and cTn I were remarkably higher in the death subgroup than in the survival subgroup,and the PLT counts of the death subgroup were significantly higher than those of the survival subgroup（P〈0.05）.The PLT count was negatively correlated with the APACHE Ⅱ score,however,the APACHE Ⅱ score was positively correlated with MPV,PDW,and cTn（P〈0.01）.CONCLUSIONThe APACHEⅡ score,platelet parameters,and levels of expression of myocardial injury markers of the patients with septic shock are abnormal and may reflect,to some extent,the prognosis of septic shock;the degree of myocardial injury is positively correlated with the APACHE Ⅱ score.