危重烧伤患者降钙素原、血小板的水平变化及其临床意义

Changes and clinical significance of procalcitonin and platelet levels in patients with severe burns

目的:探讨降钙素原(procalcitonin,PCT)、血小板(platelet,PLT)在危重烧伤患者中的水平变化及其临床意义。方法:回顾性分析2018年2月至2020年2月北京积水潭医院92例危重烧伤患者的临床资料,比较患者于入院时、入院后24 h时、入院后48 h时PCT和PLT水平,根据临床预后的不同将其分为存活组(n=60)与死亡组(n=32),比较两组一般资料情况,观察临床预后的相关影响因素并对其进行logistic回归分析,采用受试者工作特征(receiver operative characteristic,ROC)曲线分析PCT、PLT对危重烧伤患者预后的预测价值,曲线下面积(area under the curve,AUC)表示预测的准确度。对PCT、PLT水平与危重烧伤患者烧伤修复评级进行相关性分析。结果:危重烧伤患者于入院时、入院后24 h时、入院后48 h时PCT水平逐渐升高,PLT水平逐渐减低,差异均具有统计学意义(P<0.05);PCT、PLT水平是危重烧伤患者死亡的独立影响因素(P<0.05),ROC曲线分析结果显示,PCT、PLT及PCT联合PLT对危重烧伤患者临床预后均具有预测价值(P<0.05),且PCT联合PLT的AUC大于PCT、PLT,差异均具有统计学意义(P<0.05)。PCT、PLT水平与危重烧伤患者烧伤修复评级呈显著相关性(P<0.05)。结论:危重烧伤患者短期内PCT水平逐渐升高,PLT水平逐渐减低;PCT>29.78μg/L,PLT<71.45×109/L是危重烧伤患者死亡的独立危险因素,PCT、PLT水平与危重烧伤患者临床预后、烧伤修复密切相关,有望成为临床预测危重烧伤患者预后、烧伤修复的新指标。

Objective:To explore the changes and clinical significance of procalcitonin(PCT)and platelet(PLT)levels in patients with severe burns.Methods:The clinical data of 92 patients with severe burns in the hospital from February 2018 to February 2020 were collected for retrospective analysis.The levels of PCT and PLT at admission,at 24 and 48 h after admission were compared.According to different clinical prognosis,they are divided into a survival group(n=60)and a death group(n=32).The general data were compared between the two groups.Besides,the influencing factors of clinical prognosis were observed,and Logistic regression analysis was performed in this study.The predictive value of PCT and PLT for prognosis in patients with severe burns was analyzed by receiver operating characteristic(ROC)curves,and area under the curve(AUC)represented the predicted accuracy.The correlation between PCT,PLT levels and burn repair rating was analyzed.Results:At admission,at 24 and 48 h after admission,the PCT level was gradually increased,while the PLT level was gradually decreased in patients with severe burns,and the difference is statisticly significant(P<0.05).The PCT and PLT levels were independent influencing factors of death in severe burns patients(P<0.05).The results of ROC curve analysis showed that PCT,PLT and PCT combined with PLT were of predictive value for the clinical prognosis of patients with severe burns(P<0.05),and the AUC of PCT combined with PLT was greater than that of PCT and PLT(P<0.05).The PCT and PLT levels were significantly correlated with burn repair rating(P<0.05).Conclusion:The PCT level in patients with severe burns gradually increases while the PLT level decreases in a short time.PCT higher than 29.78μg/L and PLT lower than 71.45×109/L are independent risk factors of death.The PCT and PLT levels are closely related to the patients’clinical prognosis and burn repair,which are expected to be new indexes for clinically predicting prognosis and burn repair of patients with severe burns.