急性感染性休克患者血清PCT和急性时相蛋白动态表达及其临床意义

Dynamic expression of serum PCT and acute phase proteins in patients with acute septic shock and its clinical significance

目的动态观察急性感染性休克患者血清降钙素原(PCT)和急性时相蛋白的水平,并探讨其临床意义。方法回顾性分析海南省农垦总医院急诊科2013年5月至2015年9月收治的117例感染性休克患者的临床资料,其中腹部感染休克组64例,胸部感染休克组53例,治疗28 d死亡19例、存活98例,比较所有患者入科时、治疗24 h、48 h和72 h后的血清PCT及急性时相蛋白的水平。结果腹部感染休克组在入科时、治疗24 h、48 h和72 h后的血清PCT、CRP水平均显著高于胸部感染休克组,前白蛋白水平显著低于胸部感染休克组,差异均有显著统计学意义(P<0.01);死亡组患者在入科时、治疗24 h、48 h和72 h后的血清PCT、CRP水平均显著高于存活组,前白蛋白水平显著低于存活组,差异均有显著统计学意义(P<0.01);腹部感染休克组、胸部感染休克组、存活组患者的血清PCT、CRP水平在治疗48 h时达到高峰,而前白蛋白浓度水平在治疗48 h时达到最低水平,后逐渐恢复;死亡组患者的血清PCT、CRP水平均呈逐渐升高的趋势,前白蛋白呈逐渐降低的趋势。结论动态观察感染性休克患者血清PCT、急性时相蛋白的水平变化可以对患者感染原因、病情严重程度及转归进行评估。

Objective To observe the dynamic expression of serum procalcitonin(PCT) and acute phase proteins in patients with acute septic shock, and to explore its clinical significance. Methods The clinical data of 117 patients with septic shock in Emergency Department of Hainan Provincial Nongken General Hospital from May 2013 to September2015 were retrospectively reviewed, including 64 patients with the abdominal infection shock(abdominal infection shock group), and 53 patients with thoracic infection shock(thoracic infection shock group). The patients were treated for 28 d, and19 patients died(death group) and 98 patients survived(survival group). The levels of serum PCT and acute phase protein(C-reaction protein, CRP) at admission, 24 h, 48 h, and 72 h after treatment were compared. Results The levels of serum PCT and CRP 24 h, 48 h and 72 h after treatment in abdominal infection shock group were significantly higher than those in the thoracic infection shock group, and the level of pre-albumin in abdominal infection shock group was significantly lower than that in thoracic infection shock group(P<0.01). The levels of serum PCT and CRP at admission, 24 h,48 h and 72 h after treatment in the death group were significantly higher than those in the survival group, and the level of pre-albumin in death group was significantly lower than that in the survival group(P<0.01). The levels of serum CRP and PCT of abdominal infection shock group, thoracic infection shock group and the survival group reached the peak 48 h after treatment, and the concentration of albumin reached the lowest level 48 h after treatment and then recovered gradually. The levels of serum PCT and CRP were gradually increasing in the death group, and the pre-albumin was gradually decreased. Conclusion Dynamic observation of levels of serum PCT and acute phase protein in patients with septic shock can contribute to the assessment of the cause of infection, severity and prognosis.