脓毒症患者炎性因子、凝血功能与APACHE Ⅱ评分和预后的关系

Relationship Between Inflammatory Factors, Coagulation Function and APACHE Ⅱ Score and Prognosis in Patients with Sepsis

目的:研究脓毒症患者炎性因子、凝血功能与急性生理学和慢性健康状况Ⅱ(APACHEⅡ)评分和预后的关系。方法:选取2017年1月至2018年1月我院收治的脓毒症患者150例为脓毒症组,所有患者根据预后结果分为死亡组(n=49)和存活组(n=101),选择同期在我院住院的非脓毒症患者98例为非脓毒症组,比较脓毒症组与非脓毒症组患者炎性因子、凝血功能指标水平及APACHEⅡ评分,同时比较死亡组和存活组患者炎性因子、凝血功能指标水平及APACHEⅡ评分,并分析脓毒症患者APACHEⅡ评分与炎性因子、凝血功能指标的相关性。结果:脓毒症组患者降钙素原(PCT)、活化部分凝血酶原时间(APTT)、凝血酶原时间(PT)水平及APACHEⅡ评分均高于非脓毒症组,血小板计数(PLT)低于非脓毒症组(P<0.05),两组C-反应蛋白(CRP)比较差异无统计学意义(P>0.05)。死亡组患者PCT、APTT、PT水平及APACHEⅡ评分均高于存活组,PLT水平低于存活组(P<0.05),两组CRP比较差异无统计学意义(P>0.05)。经Spearman相关性分析结果显示,脓毒症患者APACHEⅡ评分与PCT、APTT、PT均呈正相关关系,与PLT呈负相关关系(P<0.05),与CRP无相关性(P>0.05)。结论:脓毒症患者PCT、APTT、PT水平明显上升,PLT水平明显下降,且均与患者的APACHEⅡ评分密切相关,临床可通过调节炎症因子水平及凝血功能指标从而改善患者的病情和预后。

Objective： To study the relationship between inflammatory factors, coagulation function and acute physiology and chronic health status Ⅱ（APACHE Ⅱ） score and prognosis in patients with sepsis. Methods： A total of 150 patients with sepsis, who were treated in the Fifth Affiliated Hospital of Xinjiang Medical University from January 2017 to January 2018, were selected as sepsis group and were further divided into death group（n=49） and survival group（n=101） according to the outcome of the prognosis. Another 98 patients without sepsis, who were hospitalized in the hospital during the same period, were selected as non sepsis group. The levels of inflammatory factors, coagulation function indexes and APACHE Ⅱ score were compared between sepsis group and non sepsis group; at the same time, the levels of inflammatory factors, coagulation function indexes and the APACHE Ⅱ score were compared between the death group and the survival group, and the correlation of APACHE Ⅱ score with inflammatory factors and coagulation function indexes in the patients with sepsis was analyzed. Results： The levels of procalcitonin（PCT）, activated partial thromboplastin time（APTT）, prothrombin time（PT） and APACHE score of patients in sepsis group were higher than those in non sepsis group, but platelet count（PLT） in sepsis group was lower than that in non sepsis group（P〈0.05）. There was no significant difference in C-reactive protein（CRP） between the two groups（P〉0.05）. The levels of PCT, APTT, PT and APACHE Ⅱ score in the death group were all higher than those in the survival group, and the level of PLT was lower than that in the survival group（P〈0.05）. There was no significant difference in CRP between the two groups（P〉0.05）. The correlation analysis of Spearman showed that there was a positive correlation between APACHE Ⅱ score and PCT, APTT and PT in the patients with sepsis, which was negatively correlated with PLT（P〈0.05）, and there was no correlation with CRP（P〈0.05）. Conclusion： The levels of PCT, APTT and PT are increased significantly in the patients with sepsis, and the level of PLT is decreased significantly, which are closely related to the APACHE Ⅱ score of the patients. It is possible to improve the patient＇s condition and prognosis by controlling the levels of inflammatory factors and coagulation function.