不同严重程度尿源性脓毒血症患者炎性指标变化及其临床意义

Changes and clinical significance of inflammatory indices in patients with urogenic sepsis with different severity

目的探讨尿源性脓毒血症不同阶段炎性指标变化及其临床意义。方法采用回顾性病例对照研究分析2010年1月—2018年4月解放军勤联保障部队第940医院收治的71例尿源性脓毒血症患者的临床资料,其中男34例,女37例;年龄39~96岁[(63.1±18.3)岁]。根据2014版中国泌尿外科疾病诊断治疗指南的脓毒性休克和脓毒血症的临床诊断标准分为三组:脓毒血症组21例[序贯器官衰竭评分(SOFA)评分为3.0(2.0,3.0)分],严重脓毒血症组21例[SOFA评分为9.0(6.0,11.0)分],脓毒性休克组29例[SOFA评分为15.0(14.0,16.0)分]。采用Spearman相关性分析分析炎性指标(白细胞计数、中性粒细胞百分比、C-反应蛋白、白细胞介素-6、降钙素原、纤维蛋白原、D-二聚体、血小板)与SOFA的相关性;采用多元线性回归分析及逐步回归加权分析分析炎性指标与脓毒血症严重程度的相关性。统计并比较各组炎性指标的水平。结果(1)Spearman相关性分析:中性粒细胞百分比、D-二聚体、白细胞介素-6、降钙素原与SOFA呈显著正相关,其rs值分别为0.738,0.712,0.314,0.795(P<0.01);血小板与SOFA评分呈显著负相关,rs值为-0.661(P<0.01)。(2)多元线性回归分析:中性粒细胞百分比、血小板、D-二聚体、降钙素原与SOFA评分显著相关(P<0.01);逐步回归加权分析提示模型具有较好的线性关系及拟合度。(3)炎性指标比较:中性粒细胞占比在脓毒血症组、严重脓毒血症组、脓毒性休克组的中位数分别为82.30(76.25,88.45),90.50(86.55,93.85),95.10(92.05,97.95);血小板中位数分别为183.01(144.50,246.50)×10^9/L、149.11(81.04,207.00)×10^9/L、81.26(50.01,93.50)×10^9/L;D-二聚体中位数分别为0.98(0.71,1.74)mg/L、3.45(1.79,5.56)mg/L、7.19(4.26,11.63)mg/L;降钙素原中位数分别为0.55(0.21,1.09)ng/ml、5.45(3.74,11.80)ng/ml、17.68(13.97,26.75)ng/ml,各组间差异均有统计学意义(P<0.05)。结论降钙素原、中性粒细胞百分比、D-二聚体、血小板血清水平在一定程度上能反映尿脓毒血症的严重程度;多指标联合检测更能准确预测尿脓毒血症患者病情的严重程度。

Objective To explore the changes and clinical significance of inflammatory indices of urogenic sepsis with different severity.Methods A retrospective case-control study was used to analyze the clinical data of 71 patients with urogenic sepsis admitted to 940th Hospital of PLA Joint Logistics Support Force from January 2010 to April 2018,including 34 males and 37 females,aged 39-96 years[(63.1±18.3)years].The patients were divided into three groups according to the clinical diagnostic criteria for septic shock and sepsis according to the 2014 edition of the Chinese Urology Surgical Guidelines for Diagnosis and Treatment:21 cases in sepsis group[sequential organ failure assessment(SOFA)score of 3.0(2.0,3.0)points],21 cases in severe sepsis group[SOFA score of 9.0(6.0,11.0)points],and 29 cases in septic shock group[SOFA score of 15.0(14.0,16.0)points].Spearman correlation analysis was used to analyze the correlation of inflammatory indicators with SOFA,including white blood cell count,percentage of neutrophils,C-reactive protein,interleukin-6,procalcitonin,fibrinogen,D-dimer,and platelet.Multiple linear regression analysis and stepwise regression weighted analysis were performed to analyze the relation between inflammatory indicators and sepsis severity.Levels of each inflammatory indicator was detected and compared among the groups.Results①Spearman correlation analysis:percentage of neutrophils,D-dimer,interleukin-6,procalcitonin and SOFA scores were significantly positively correlated,with the rs value of 0.738,0.712,0.31,0.795,respectively(P<0.01);platelet and SOFA scores were significantly negatively correlated,with the rs value of-0.661(P<0.01).②Multiple linear regression analysis:percentage of neutrophils,platelet,D-dimer,procalcitonin and SOFA score were significantly correlated(P<0.01);Stepwise regression weighted analysis suggested that the model linear relationship and fit was good.③Inflammatory index comparison:percentage of neutrophils in sepsis group,severe sepsis group and septic shock group was 82.30(76.25,88.45),90.50(86.55,93.85),95.10(92.05,97.95),respectively;level of platelet was 183.01(144.50,246.50)×10^9/L,149.11(81.04,207.00)×10^9/L,81.26(50.01,93.50)×10^9/L,respectively;level of D-dimer was 0.98(0.71,1.74)mg/L,3.45(1.79,5.56)mg/L,7.19(4.26,11.63)mg/L,respectively;level of procalcitonin was 0.55(0.21,1.09)ng/ml,5.45(3.74,11.80)ng/ml,17.68(13.97,26.75)ng/ml,respectively.There were significant differences in above indicators among the groups(P<0.05).Conclusions The serum levels of procalcitonin,percentage of neutrophils,D-dimer and platelet are positively correlated with the severity of urogenic sepsis.While combined detection of those indicators can better predict the severity of the sepsis.