血清淀粉样蛋白A评估脓毒血症严重程度和预后的临床研究

Clinical study of serum amyloid A for assessing the severity and prognosis of sepsis

目的:探讨血清淀粉样蛋白A(SAA)在评估脓毒血症严重程度和预后中的临床应用价值。方法:选取我院收治的112例脓毒血症患者作为研究对象,比较脓毒症休克(n=38)和非脓毒症休克(n=74)患者、死亡患者(n=29)和生存患者(n=83)的SAA、降钙素原(PCT)水平和APACHEⅡ评分。分析SAA、PCT和APACHE-Ⅱ评分及脓毒症患者预后的关系。结果:第1d、3d和7d脓毒症休克组患者的SAA、PCT和APACHEⅡ评分均显著高于非脓毒症休克组(均P<0.05)。第7d生存组的SAA、PCT和APACHEⅡ评分显著低于死亡组(均P<0.05)。第3d和7d SAA水平与PCT呈显著正相关关系(r=0.586,0.623,均P<0.01),第1d、3d和7d SAA水平与APACHE-Ⅱ评分均呈显著正相关(r=0.513,0.391,0.583,均P<0.01)。高SAA水平组的28d生存率显著低于低SAA水平组(P<0.05)。结论:血清SAA水平与脓毒症患者的严重程度密切相关,有助于预测脓毒症患者的临床预后。

Objective:To evaluate the clinical value of serum amyloid A in evaluating the severity and prognosis of sepsis.Methods:A total of 112 patients with sepsis admitted to our hospital were selected as study subjects.The patients were divided into septic shock group(n=38)and non-septic shock group(n=74).They were then divided into death group(n=29)and survival group(n=83)according to their survival status within 28 days after admission.SAA,PCT levels and APACHE Ⅱ scores were compared between the groups.The correlation between SAA and PCT and APACHE-Ⅱ scores were analyzed.KM survival curve was used to analyze the relationship between SAA and the prognosis of patients with sepsis.Results:SAA,PCT and APACHE Ⅱ scores of patients in septic shock group on the first,third and seventh day were significantly higher than those in non-septic shock group(P<0.05).SAA,PCT and APACHE Ⅱ scores were significantly lower in the survival group on the seventh day than those in the death group.SAA levels has significantly positive correlation with PCT levels on the third and seventh day.SAA levels was significantly positively related to APACHE-Ⅱ score on the first,third and seventh day.The 28 d survival rate of the group with high SAA level was significantly lower than that of the group with low SAA level.Conclusion:The serum SAA levels are closely related to the severity of sepsis patients and may help to predict the clinical prognosis of sepsis patients.