劳力性热射病患者体内炎症介质表达与临床预后的相关研究

Correlation between the expression of inflammatory mediators and clinical prognosis in the patients with exertional heat stroke

目的探讨劳力性热射病患者发病初期体内炎症介质的表达及其与预后的相关性.方法收集2017年7月至2019年8月就诊于北京潞河医院急诊重症监护室(EICU)的劳力性热射病患者,按照患者的预后分为存活组与死亡组,分析两组患者一般临床资料及体内炎症介质差异,采用多因素Logistic回归分析筛选影响热射病重症患者预后的危险因素,同时对有差异的指标绘制受试者工作特征(ROC)曲线,分析其在预测热射病患者临床预后中的价值.结果共有63例热射病患者入住EICU,排除转院1例,放弃治疗1例,非劳力性热射病2例,59例患者纳入到本研究,存活组41例,死亡组18例,两组入院格拉斯哥昏迷(GCS)评分、血小板(PLT)、谷草转氨酶(A ST)和血乳酸(Lac)差异有统计学意义(P<0.001、P=0.048、P=0.004和P=0.024).与存活组比较,死亡组入院中性粒细胞绝对值(NE#)、降钙素原(PCT)明显升高(P=0.038、P=0.008).两组血白细胞计数(WBC)、肿瘤坏死因子-α(TNF-α)、白细胞介素-6(IL-6)、C-反应蛋白(CRP)比较差异无统计学意义.经Logistic回归分析调整混杂因素后,PCT(P=0.037)与血Lac(P=0.006)是死亡的独立预测因素,OR值分别为1.074与1.358.入院PCT评估劳力性热射病患者死亡的ROC曲线下面积(AUC)为0.719(95%CI0.575~0.862),最佳诊断阈值为2.75 ng/mL,敏感度77.8%,特异度68.3%;Lac预测患者死亡的ROC曲线下面积为0.742(95%CI0.589~0.895),最佳诊断阈值为4.55 mmol/L,敏感度55.6%,特异度92.7%.结论PCT与Lac可能是预测劳力性热射病患者临床预后的敏感指标.

Objective To invetigate and discuss the values of inflammatory mediators in the assessment of elinical prognosis of the patients with exertional heat stroke.Methods A retrospective chart review of exertional heat stroke patients admitted to the Emergent Intensive Care Unit,Beiing Luhe Hospital from July 2017 to August 2019 was conducted.They were divided into the survival group and death group according to clinical prognosis then and the diferences of several common clinical biomarkers and inflammatory mediators for the assessment of clinical prognosis in the patients with exertional heat stroke were compared between two groups by using ROC curve analysis.Results 1 case were transferred,1 case gave up treatment,2 were nonexertional heat stroke,a total of 59 heat stroke patients from the original 63 patients were included in the study.There were 41 patients in survival group,18 patients in death group.There were significant diferences in Glasgow coma scale(GCS)scores(P<0.001),platelet(PLT,P=0.048),aspartate transaminase(AST,P=0.004)and lactate(Lac,P=0.024)between groups.Compared with the survival group,absolute neutrophil(NE#,P=0.038),procalcitonin(PCT,P=0.008)were higher in the death group.After adjusting for confounders,PCT(P=0.037)and Lac(P=0.006)also remained independent determinants of mortality with OR values of 1.074 and 1.358,respectively.PCT predicted the mortality with area under curve of0.719(95%CI 0.575-0.862)when a cut-off value was 2.75 ng/mL,sensitivity was 77.8%,and specificity was 68.3%,Lac predicted the mortality with area under curve of 0.742(95%CI 0.589-0.895)when a cut-off value was 4.55 mmoL/L,sensitivity was 55.6%,and specificity was 92.7%,Concusion PCT value and Lac value may be independent predictors of mortality in the patients with exertional heat stroke.