血清前肾上腺素髓质素浓度预测不同程度脓毒症的准确性

Accuracy of serum pro-adrenomedullin concentration in predicting sepsis at different degrees of severity

目的评价血清前肾上腺髓质素（pro．ADbl）浓度预测不同程度脓毒症的准确性。方法2015年3月至2017年4月人住我院ICU的脓毒症患者145例，年龄18-64岁，性别不限，ICU住院时间〉24h，根据入住ICU24h内序贯器官衰竭评估量表（SOFA）评分分为3组：轻度脓毒症组（n=50），2分〈SOFA评分≤6分；中度脓毒症组（n=50），6分〈SOFA评分≤12分；重度脓毒症组（n=45），SOFA评分〉12分。入院即刻采集外周静脉血样，采用ELISA法检测血清pro-ADM浓度。绘制pro-ADM预测不同程度脓毒症的受试者工作特征（ROC）曲线，计算曲线下面积及其95％可信区间、临界值、灵敏度及特异度。结果血清pro．ADM浓度随脓毒症程度的增加而升高，ICU住院时间随脓毒症程度的增加而延长（P〈0．05）。轻度脓毒症组ROC曲线下面积为0．770．95％可信区间为0．591～0．949，灵敏度为0．725，特异度为0．700，临界值为6．45nmol／L；中度脓毒症组ROC曲线下面积为0．776，95％可信区间为0．645-0．907，灵敏度为0．813，特异度为0．760，临界值为8．30nmol／L；重度脓毒症组ROC曲线下面积为0．83，95％可信区间为0．715-0．963，灵敏度为0．73，特异度为0．800，临界值为5．70nmol／L。结论血清pro．ADM浓度可作为预测不同程度脓毒症的可靠指标。

Objective To evaluate the accuracy of serum proadrenomedullin （proADM） concen tration in predicting sepsis at different degrees of severity. Methods A total of 145 patients of both sexes, aged 1864 yr, who were admitted to intensive care unit （ICU） of the First Hospital of Hebei Medical Uni versity from March 2015 to April 2017, with length of ICU stay〉24 h, were enrolled. The patients were di vided into 3 groups according to the Sequential Organ Failure Assessment （SOFA） score within 24 h after admission to ICU ： 2 〈 SOFA score 〈 6 mild sepsis group （ n = 50）, 6 〈 SOFA score 〈 12 moderate sepsis group （n= 50） and SOFA score〉 12 severe sepsis group （n= 45）. Peripheral venous blood samples were collected immediately after admission to hospital for determination of serum proADM concentrations by en zymelinked immunosorbent assay. The receiver operating characteristic （ ROC ） curve of proADM in pre dicting sepsis at different degrees of severity was plotted, and the area under the curve and 95% confidence interval, cutoff value, sensitivity and specificity were calculated. Results The serum proADM concen trations were significantly increased with the severity of sepsis, and the length of ICU stay was prolonged with the severity of sepsis （P〈0.05）. In mild sepsis group, the area under the ROC curve was 0. 770, 95% confidence interval 0. 5910. 949, sensitivity 0. 725, specificity 0. 700 and cutoff value 6. 45 nmol/L.In moderate sepsis group, the area under the ROC curve was 0. 776, 95% confidence interval 0. 645 0. 907, sensitivity 0. 813, specificity 0. 760, cutoff value 8.30 nmol/L. In severe sepsis group, the area under the ROC curve was 0. 83, 95% confidence interval 0. 7150. 963, sensitivity 0. 73, specificity 0. 800, cutoff value 5.70 nmol/L. Conclusion Serum proADM concentration can be used as a reliable index in predicting sepsis at different degrees of severity.