血清ACTH水平、降钙素原变化率对尿源性脓毒症预后的价值

Prognostic value of the combination of serum ACTH level and procalcitonin change rate in urogenic sepsis

目的:探讨血清促肾上腺皮质激素(ACTH)水平、降钙素原(PCT)变化率对尿源性脓毒症的预后价值。方法:选取2021年1月至2022年3月本院收治的因上尿路结石行经皮肾镜或输尿管镜手术治疗后产生尿源性脓毒症的76例患者为研究对象,根据患者确诊后14 d的生存情况分为生存组(67例)和死亡组(9例)。采用酶联免疫吸附(ELISA)法检测患者的血清ACTH水平以及确诊当天和确诊后第2天患者的血清PCT水平,计算PCT变化率。采用Spearman相关性分析患者的血清ACTH水平、PCT变化率与序贯器官衰竭评分(SOFA)的相关性。采用Cox回归分析影响尿源性脓毒症患者预后的危险因素。结果:死亡组的谷丙转氨酶、谷草转氨酶、总血红素、活化部分凝血活酶时间(APTT)、血肌酐、白细胞计数高于生存组,而血红蛋白低于生存组,差异均有统计学意义(均P<0.05)。与死亡组比较,生存组患者的血清ACTH水平和SOFA评分降低,PCT变化率明显升高(均P<0.001)。Spearman相关性分析结果显示ACTH水平与SOFA评分呈正相关(r=0.533,P<0.001),PCT变化率与SOFA评分呈负相关(r=-0.600,P<0.001)。多因素Cox回归分析结果表明,ACTH高表达、低PCT变化率是影响尿源性脓毒症患者不良预后的危险因素(均P<0.05)。结论:尿源性脓毒症患者的ACTH水平明显升高,PCT变化率显著降低,二者与尿源性脓毒症患者预后密切相关。

Objective To investigate the prognostic value of the combination of serum adrenocorticotropic hormone(ACTH)level and the change rate of procalcitonin(PCT)in urosepsis.Methods From January 2021 to March 2022,76 patients with urogenic sepsis after percutaneous nephroscopic or ureteroscopic surgery for upper urinary tract calculi admitted to our hospital were selected as the study objects.They were divided into survival group and death group according to the survival conditions of patients 14 days after diagnosis.Enzyme linked immunosorbent assay(ELISA)was used to detect the serum ACTH level of patients and the serum PCT level of patients on the day of diagnosis and the second day after diagnosis,and calculate the PCT change rate.Spearman correlation analysis was applied to analyze the correlation of serum ACTH level,PCT change rate and Sequential Organ Failure Assessment(SOFA).Cox regression analysis was applied to analyze the risk factors affecting the prognosis of patients with urosepsis.Results The glutamic pyruvate transaminase,glutamic oxalate transaminase,total heme,activated partial thromboplastintime(APTT),serum creatinine and white blood cell count in the death group were higher than those in the survival group,and the hemoglobin in the death group was lower than that in the survival group,and the differences were all statistically significant(all P<0.05).Compared with the death group,serum ACTH levels and SOFA scores were lower and the change rate of PCT was significantly higher in the survival group of patients(all P<0.001).The results of Spearman correlation analysis showed that ACTH level was positively correlated with SOFA score(r=0.533,P<0.001),the change rate of PCT was negatively correlated with SOFA score(r=-0.600,P<0.001).Multivariate Cox regression analysis showed that high ACTH level and the low change rate of PCT were risk factors for poor prognosis in patients with urosepsis(all P<0.05).Conclusions The serum ACTH level in patients with urosepsis is greatly increased,and the change rate of PCT is greatly decreased,and the two are closely related to the prognosis of patients with urosepsis.