烧伤早期伴发脓毒症患者血清总胆红素水平变化及与预后的关系

Change of Serum Total Bilirubin Level in Early Burn Patients with Sepsis and Its Relationship with Prognosis

目的 研究血清总胆红素在烧伤伴发脓毒症患者血清中的水平变化,分析其与患者预后的关系。方法回顾性选取本院2017年2月-2018年2月收治的烧伤伴发脓毒症患者96例为研究对象,按照是否发生预后死亡分为生存组59例和死亡组37例,同时另取本院收治的烧伤非脓毒症患者50例为对照组。收集患者入院当日及健康志愿者白细胞计数(WBC)、血小板计数(PLT)、中性粒细胞比率(NE)、C-反应蛋白(CRP)、白蛋白(Alb)水平,采用全自动生化分析仪检测患者入院当日及确诊伴发脓毒症第1、3、5、7天时的血清总胆红素(TBIL)水平,采用ROC曲线分析血清TBIL对烧伤伴发脓毒症患者不良预后发生的预测价值,采用logistic回归分析影响烧伤伴发脓毒症患者不良预后发生的危险因素。结果 死亡组患者WBC、PLT、NE、CRP水平显著高于生存组和对照组(P<0.05),且生存组显著高于对照组(P<0.05);Alb水平显著低于生存组和对照组(P<0.05),且生存组显著低于对照组(P<0.05)。确诊为脓毒症1d时,死亡组患者血清TBIL水平显著高于生存组和对照组(P<0.05),且在确诊后一直保持相对较高水平;生存组血清TBIL水平显著高于对照组(P<0.05),且确诊后整体呈逐渐降低趋势(P<0.05)。血清TBIL预测烧伤早期伴发脓毒症患者不良预后的发生的AUC为0.901,最佳节点为32.75μmol/L,灵敏度为84.70%,特异度为82.3%,是影响烧伤伴发脓毒症患者不良预后发生的危险因素(P<0.05)。结论 TBIL在烧伤早期伴发脓毒症患者血清中高表达,是影响患者不良预后发生的危险因素。

Objective To study the change of serum total bilirubin level in burn patients with sepsis,and to analyze its relationship with prognosis.Methods 96 burn patients with sepsis admitted to our hospital from February 2017 to February 2018 were retrospectively selected as the study subjects,according to the prognosis of death,they were divided into 59 cases in survival group and 37 cases in death group,at the same time,another 50 burn patients without sepsis in our hospital were selected as the control group.White blood cell count(WBC),platelet count(PLT),neutrophil ratio(NE),C-reactive protein(CRP),and albumin(Alb)levels of patients on the day of admission and of healthy volunteers,serum total bilirubin(TBIL)levels were measured by automatic biochemical analyzer on the day of admission and on the1 st,3 rd,5 th,and 7 th day of diagnosis of sepsis,the ROC curve was used to analyze the predictive value of serum TBIL for the adverse prognosis of burn patients with sepsis,Logistic regression was used to analyze the risk factors of adverse prognosis in burn patients with sepsis.Results The levels of WBC,PLT,NE,and CRP in the death group were significantly higher than those in the survival group and the control group(P<0.05),and the survival group were significantly higher than the control group(P<0.05);Alb level in survival group was significantly lower than that in control group(P<0.05),and the survival group was significantly lower than the control group(P<0.05).The serum TBIL level in the death group was significantly higher than that in the survival group and the control group(P<0.05)at the 1 st day after diagnosis of sepsis,and remained relatively high after diagnosis;the serum TBIL level in survival group was significantly higher than that in control group(P<0.05),and the overall trend was gradually decreasing after diagnosis(P<0.05).The AUC of serum TBIL for predicting adverse prognosis in early burn patients with sepsis was 0.901,the best cut-off point was 32.75μmol/L,the sensitivity was 84.70%,and the specificity was 82.3%,it was a risk factor for adverse prognosis in burn patients with sepsis(P<0.05).Conclusion TBIL is highly expressed in the serum of early burn patients with sepsis,which is a risk factor for adverse prognosis of patients.