Risk factors and their interactive effects on severe acute pancreatitis complicated with acute gastrointestinal injury

BACKGROUND There are many risk factors for severe acute pancreatitis(SAP)complicated with acute gastrointestinal injury(AGI),but few reports on the interaction between these risk factors.AIM To analyze the risk factors for SAP complicated with AGI and their interactive effects.METHODS We selected 168 SAP patients admitted to our hospital between December 2019 and June 2022.They were divided into AGI group and non-AGI group according to whether AGI was present.Demographic data and laboratory test data were compared between the two groups.The risk factors for SAP with concomitant AGI were analyzed using multifactorial logistic regression,and an analysis of the interaction of the risk factors was performed.RESULTS The percentage of patients with multiple organ dysfunction syndrome,acute physiological and chronic health scoring system II(APACHE II)score,white blood cell count and creatinine(CRE)level was higher in the AGI group than in the non-AGI group.There was a statistically significant difference between the two groups(P<0.05).Logistic regression analysis indicated that an APACHE II score>15 and CRE>100μmol/L were risk factors for SAP complicating AGI.The interaction index of APACHE II score and CRE level was 3.123.CONCLUSION An APACHE II score>15 and CRE level>100μmol/L are independent risk factors for SAP complicated with AGI,and there is a positive interaction between them.

Association between acute pancreatitis and peptic ulcer disease

AIM:To evaluate the relationship between peptic ulcer disease(PUD) and acute pancreatitis.METHODS:A cohort of 78 patients with acute pancreatitis were included in this study.The presence of PUD and the Helicobacter pylori(H.pylori) status were assessed by an endoscopic method.The severity of acute pancreatitis was assessed using Ranson's score,the Acute Physiology and Chronic Health Evaluation(APACHE) □ score,computed tomography severity indexand the clinical data during hospitalization,all of which were compared between the patients with and without PUD.The risk factors for PUD were also evaluated.RESULTS:Among 78 patients,41 patients(52.6%) with acute pancreatitis suffered from PUD,but only 13(31.7%) patients with PUD were infected by H.pylori.On univariate analysis,male gender,an etiology of alcohol-induced pancreatitis,a history of smoking or alcohol consumption,elevated triglyceride and C-reactive protein levels,and high APACHE □ score were signif icantly associated with PUD.However,on multivariate logistic regressionanalysis,the APACHE □ score(odds ratio:7.69;95% conf idence interval:1.78-33.33;P < 0.01) was found to be the only independent risk factor for PUD.CONCLUSION:Patients with acute pancreatitis are liable to suffer from PUD.PUD is associated with severeacute pancreatitis according to the APACHE □ score,and treatment for PUD should be considered for patients with severe acute pancreatitis.

脓毒症患者SAA、PCT、ALB水平及SII、APACHEⅡ、SOFA评分与预后的相关性研究

目的分析脓毒症患者淀粉样蛋白A(SAA)、降钙素原(PCT)、白蛋白(ALB)水平、系统免疫炎症指数(SII)评分、急性生理与慢性健康状况评分系统Ⅱ(APACHEⅡ)评分、序贯器官衰竭(SOFA)评分与预后的相关性。方法回顾性分析2019年7月到2022年6月在陕西省人民医院诊治的100例脓毒症患者的临床资料。按照患者是否合并休克分为脓毒症组44例和脓毒症休克组56例,比较两组患者入院24 h的SAA、PCT、ALB水平和SII、APACHEⅡ、SOFA评分。按照28 d存活与否分为死亡组26例和生存组74例,比较两组患者入院24 h的SAA、PCT、ALB水平和SII、APACHEⅡ、SOFA评分。采用Spearman相关性分析法分析SAA、PCT、ALB水平及SII、APACHEⅡ、SOFA评分与预后的相关性。结果脓毒症休克组患者入院24 h的ALB水平为(21.58±4.49)g/L,明显低于脓毒症组的(37.09±6.25)g/L,SAA、PCT水平及SII、APACHEⅡ、SOFA评分分别为(473.81±90.47)mg/L、(68.90±12.21)μg/L、1463.26±105.29、(24.51±5.64)分、(19.56±5.02)分,明显高于脓毒症组的(350.23±95.14)mg/L、(50.38±11.42)μg/L、393.15±37.18、(10.52±3.11)分、(8.08±2.35)分,差异均有统计学意义(P<0.05);死亡组患者入院24 h的ALB水平为(17.46±3.95)g/L,明显低于存活组的(41.20±6.83)g/L,SAA、PCT水平及SII、APACHEⅡ、SOFA评分分别为(547.27±97.58)mg/L、(75.35±14.52)μg/L、2166.26±241.59、(27.84±6.36)分、(22.09±5.12)分,明显高于存活组(316.37±83.47)mg/L、(42.43±9.36)μg/L、273.29±56.27、(14.35±6.82)分、(13.51±4.55)分,差异均有统计学意义(P<0.05);经Spearman相关性分析结果显示,ALB与预后呈正相关(r=0.698,P<0.05),SAA、PCT、SII、APACHEⅡ、SOFA评分与预后呈负相关(r=-0.598、-0.607、-0.737、-0.564、-0.595,P<0.05)。结论脓毒症患者ALB水平明显高于脓毒症休克患者,SAA、PCT水平及SII、APACHEⅡ、SOFA评分明显低于脓毒症休克患者;脓毒症患者的ALB水平与预后呈正相关,SAA、PCT水平及SII、APACHEⅡ、SOFA评分与预后呈负相关。

Predictors of the outcomes of acute-on-chronic hepatitis B liver failure

AIM： To identify the risk factors in predicting the out- come of acute-on-chronic hepatitis B liver failure pa- tients. METHODS： We retrospectively divided 113 patients with acute-on-chronic liver failure-hepatitis B virus （ACLF-HBV） and without concurrent hepatitis C or D virus infection and hepatocellular carcinoma into two groups according to their outcomes after anti-HBV therapy. Their demographic, clinical, and biochemical data on the day of diagnosis and after the first week of treatment were analyzed using the Mann-Whitney U test, Fisher＇s exact test, and a multiple logistic regres- sion analysis. RESULTS： The study included 113 patients （87 men and 26 women） with a mean age of 49.84 years. Fifty- two patients survived, and 61 patients died. Liver failure （85.2%）, sepsis （34.4%）, and multiple organ failure （39.3%） were the main causes of death. Mul- tivariate analyses showed that Acute Physiology and Chronic Health Evaluation （APACHE） Ⅱ scores ≥ 12 [odds ratio （OR） = 7.160, 95% CI： 2.834-18.092, P 〈 0.001] and positive blood culture （OR = 13.520, 95% CI： 2.740-66.721, P = 0.001） on the day of diagnosis and model for end-stage liver disease （MELD） scores 28 （OR = 8.182, 95% CI： 1.884-35.527, P = 0.005） after the first week of treatment were independent predictors of mortality. CONCLUSION： APACHE II scores on the day of diag- nosis and MELD scores after the first week of anti-HBV therapy are feasible predictors of outcome in ACLF- HBV patients.

血清炎性指标联合APACHEII评分对重症肺部感染患者生存预后的预测价值

目的分析研究血清炎性指标联合APACHEII评分对重症肺部感染患者生存预后的预测价值。方法选取2020年1月至2022年12月皖北煤电集团总医院重症医学二科收治的135例重症肺部感染患者作为研究对象,根据患者治疗后的临床结局分为生存组(n=119)与死亡组(n=16);通过单因素分析比较两组的年龄、性别、BMI指数、血清C反应蛋白(CRP)、降钙素原(PCT)、白细胞计数(WBC)、中性粒细胞计数(NEU)、白蛋白(ALB)、淋巴细胞计数(CD3^(+)、CD4^(+)、CD8^(+)、CD4^(+)/CD8^(+))水平与APACHEⅡ评分;以患者在治疗期间出现死亡为预后不良,采用多因素Logistic回归分析重症肺部感染患者预后不良的影响因素,并采用ROC曲线分析血清CRP、PCT、WBC、NEU水平、APACHEⅡ评分对重症肺部感染患者预后不良的单一及联合预测价值。结果单因素分析结果显示,血清CRP、PCT、WBC、NEU、ALB、CD3^(+)、CD4^(+)、CD8^(+)、CD4^(+)/CD8^(+)水平与APACHEⅡ评分均是重症肺部感染患者生存预后的影响因素(P<0.05);多因素Logistic回归分析显示,CRP水平升高(OR=1.889)、PCT水平升高(OR=2.188)、WBC水平升高(OR=2.125)、NEU水平升高(OR=1.790)、ALB水平降低(OR=1.904)、CD3^(+)水平降低(OR=2.115)、CD4^(+)水平降低(OR=1.872)、CD8^(+)水平降低(OR=2.173)、CD4^(+)/CD8^(+)水平降低(OR=1.978)和APACHEⅡ高评分(OR=2.201)均是重症肺部感染患者预后不良的独立危险因素(P<0.05);ROC曲线分析显示血清CRP、PCT、WBC、NEU水平、APACHEⅡ评分及联合检测的曲线下面积(AUC)分别为0.724、0.697、0.790、0.789、0.830、0.972,故联合检测优于单一检测(P<0.05)。结论血清炎性指标及APACHEⅡ评分与重症肺部感染患者生存预后相关,联合检测对重症肺部感染患者生存预后具有较好的预测价值。

血清脂联素、成纤维生长因子-23在心脏瓣膜置换术患者预后中的评估价值

目的探讨血清脂联素、成纤维生长因子-23(FGF23)水平在心脏瓣膜置换术患者预后中的评估价值。方法选取行心脏瓣膜置换术的患者98例为研究组。根据研究组患者的预后情况分为预后良好组(n=67)和预后不良组(n=31)。选取同期健康体检者90例为对照组。采用Spearman法分析血清脂联素、FGF23水平分别与血浆N末端B型利钠肽前体(NT-proBNP)水平和急性生理学与慢性健康状况评分系统Ⅱ(APACHEⅡ)评分的相关性。采用多因素Logistic回归分析法分析心脏瓣膜置换术患者预后的影响因素。绘制受试者工作特征(ROC)曲线分析血清脂联素、FGF23水平对心脏瓣膜置换术患者预后的预测价值。结果研究组血清FGF23、NT-proBNP水平、APACHEⅡ评分高于对照组,血清脂联素水平低于对照组,差异有统计学意义(P<0.05)。预后不良组血清FGF23、NT-proBNP水平和APACHEⅡ评分高于预后良好组,血清脂联素水平低于预后良好组,差异有统计学意义(P<0.05)。患者的血清FGF23水平与NT-proBNP水平、APACHEⅡ评分呈正相关(P<0.05)。血清脂联素水平与NT-proBNP水平、APACHEⅡ评分呈负相关(P<0.05)。血清脂联素、FGF23、NT-proBNP水平和APACHEⅡ评分为心脏瓣膜置换术患者预后的影响因素(P<0.05)。血清脂联素、FGF23单独预测和联合预测心脏瓣膜置换术患者预后的曲线下面积(AUC)分别为0.862、0.807、0.911。脂联素、FGF23联合预测的AUC大于单独预测,差异有统计学意义(P<0.05)。结论血清脂联素、FGF23联合预测心脏瓣膜置换术患者预后的效果较好。血清脂联素、FGF23有望成为评估心脏瓣膜置换术患者预后效果的有效指标。

血清sTWEAK、Netrin-1联合APACHEⅡ评分对重型颅脑损伤患者术后预后不良的预测价值

目的探讨血清可溶性肿瘤坏死因子样凋亡弱诱导因子(sTWEAK)、神经轴突导向因子-1(Netrin-1)联合急性生理学与慢性健康状况评分系统Ⅱ(APACHEⅡ)评分对重型颅脑损伤患者术后预后不良的预测价值。方法选取2020年6月至2022年6月该院收治的120例重型颅脑损伤患者,根据术后30 d预后情况分为预后良好组和预后不良组。对比两组血清sTWEAK、Netrin-1水平及APACHEⅡ评分。采用单因素和多因素Logistic回归分析重型颅脑损伤患者术后预后不良的影响因素,并据以构建血清sTWEAK、Netrin-1及APACHEⅡ评分联合应用的预测模型,受试者工作特征(ROC)曲线分析血清sTWEAK、Netrin-1水平及APACHEⅡ评分对重型颅脑损伤患者术后预后不良的预测价值。结果预后不良组的重症监护室居住时间长于预后良好组,白蛋白水平、入院时格拉斯哥昏迷评分法评分和血清Netrin-1水平低于预后良好组,多发脑挫裂伤占比、机械通气占比、入院时APACHEⅡ评分和血清sTWEAK、血清肌酐、血尿素氮水平均高于预后良好组,差异有统计学意义(P<0.05)。多因素Logistic回归分析结果显示,多发脑挫裂伤、Netrin-1水平降低、入院时APACHEⅡ评分升高、sTWEAK水平升高为重型颅脑损伤患者术后预后不良的危险因素(P<0.05)。ROC曲线分析结果显示,血清sTWEAK、Netrin-1及APACHEⅡ评分3个指标单独及联合应用时曲线下面积及其95%CI分别为0.742(0.552~0.925)、0.731(0.488~0.963)、0.714(0.502~0.911)、0.882(0.795~0.947)。结论血清sTWEAK、Netrin-1联合APACHEⅡ评分对重型颅脑损伤患者术后预后不良具有较好的预测价值,可为临床治疗方案的制订提供参考。

老年患者ICU获得性衰弱危险因素预测效能的临床研究

目的探讨老年危重患者ICU获得性衰弱的危险因素,研究其在临床诊断中的预测价值。方法选取2017年6月—2018年10月首都医科大学附属复兴医院重症医学科收治的患者进行观察性队列研究,在患者清醒之日使用医学研究委员会评分进行肌力评估,根据临床肌力评估结果将患者分为试验组(肌力评分<48分)和对照组(≥48分)。收集和比较两组相关资料,采用多因素logistic回归分析评估老年危重患者ICU获得性衰弱发生的独立危险因素,采用ROC曲线评估各指标在老年患者ICU获得性衰弱发生中的预测价值。结果共收集62例清醒的老年危重患者,其中诊断为ICU获得性衰弱者30例为试验组(疾病发病率48.39%),无ICU获得性衰弱的32例为对照组。两组急性生理学和慢性健康状况评价(APACHE)Ⅱ评分、序贯器官衰竭评估评分、全身炎症反应综合征持续时间、脓毒症持续时间、脓毒症性休克、休克持续时间、多脏器功能障碍及其持续时间、机械通气持续时间、使用神经肌肉阻滞剂及其使用时间、使用去甲肾上腺素及其使用时间、低钙血症及电解质紊乱等指标比较,差异均有统计学意义(P<0.05)。多因素logistic回归分析显示,APACHEⅡ评分及去甲肾上腺素使用时间是老年危重患者ICU获得性衰弱发生的独立危险因素(P<0.05)。ROC曲线提示应用去甲肾上腺素>3 d和APACHEⅡ评分>20分为截断点时预测性能最佳。结论在老年危重患者中,APACHEⅡ评分和去甲肾上腺素使用时间是ICU获得性衰弱发生的独立危险因素和较好的预测指标。

联合检测外周血TIRAP、FOXO3a、HBP预测脓毒症患者近期预后的价值及意义

目的探讨联合检测外周血TOLL/白介素-1受体相关蛋白(TIRAP)、叉头蛋白转录因子3a(FOXO3a)、肝素结合蛋白(HBP)对脓毒症患者近期预后的预测价值。方法回顾性收集2020年1月—2022年12月本院205例脓毒症患者的临床资料,根据28 d生存情况分为生存组157例、死亡组48例。统计两组外周血TIRAP、FOXO3a、HBP及急性生理功能和慢性健康状况评分系统Ⅱ(APACHEⅡ)、序贯器官衰竭评估(SOFA)评分。分析TIRAP、FOXO3a、HBP与APACHEⅡ、SOFA评分的相关性。采用Logistic回归方程分析TIRAP、FOXO3a、HBP交互作用对脓毒症近期预后的影响。评价TIRAP、FOXO3a、HBP联合预测脓毒症近期预后的价值。结果死亡组入院第1、3、7天外周血TIRAP、HBP水平及APACHEⅡ、SOFA评分高于生存组,FOXO3a水平低于生存组(P<0.05);入院第1天,脓毒症死亡患者TIRAP、HBP水平与APACHEⅡ、SOFA评分呈正相关,FOXO3a与APACHEⅡ、SOFA评分呈负相关(P<0.05);TIRAP×FOXO3a×HBP在脓毒症近期预后中存在交互作用(P<0.05);入院第1天外周血TIRAP+FOXO3a+HBP联合预测预后的曲线下面积(AUC)大于TIRAP+FOXO3a、TIRAP+HBP、FOXO3a+HBP,预测效能更佳(P<0.05)。结论脓毒症预后不良患者外周血TIRAP、HBP水平升高,FOXO3a水平降低,其水平变化与病情严重程度、近期预后有关,联合检测其水平可提高近期预后的预测效能。

两种评分系统评估急性脑梗死患者卧床期间压疮发生的研究

目的对比Braden量表、急性生理与慢性健康评分-Ⅱ(APACHE-Ⅱ)评估急性脑梗死患者卧床期间压疮风险的价值。方法选取70例急性脑梗死患者,患者清醒时,采用Braden量表、APACHE-Ⅱ量表评估患者卧床期间压疮发生风险,统计患者的一般资料和压疮发生情况,对比上述两种量表评估急性脑梗死患者压疮发生价值。结果70例急性脑梗死卧床期间发生压疮13例,占比18.57%,未发生压疮57例,占比81.43%;发生组Braden评分低于未发生组,APACHE-Ⅱ评分高于未发生组(P<0.05);绘制ROC曲线图结果显示,Braden量表和APACHE-Ⅱ量表评估急性脑梗死患者卧床期间压疮发生风险的AUC分别为0.814、0.832,评估价值较理想,且APACHE-Ⅱ量表的AUC大于Braden量表。结论相较于Braden量表,在急性脑梗死患者中应用APACHE-Ⅱ评估卧床期间压疮风险的价值更高。

国家早期预警评分联合急性生理学与慢性健康状况评分Ⅱ对急诊科敌草快中毒患者预后的评估价值

目的:探讨国家早期预警评分(NEWS)联合急性生理学与慢性健康状况评分Ⅱ(APACHEⅡ)对急诊科敌草快中毒患者预后的评估价值。方法:回顾性分析2020年1月—2022年6月广州市第十二人民医院急诊科收治的急性敌草快中毒患者93例的临床资料,根据患者入院后30 d内预后情况分为痊愈组(n=68)和死亡组(n=25)。比较两组一般资料、NEWS分级、APACHEⅡ评分。绘制受试者工作特征(ROC)曲线获取NEWS和APACHEⅡ评分的曲线下面积(AUC),分析二者对敌草快中毒患者预后的评估价值。结果:两组性别、年龄、病程比较,差异无统计学意义(P>0.05);痊愈组中毒剂量、NEWS分级和APACHEⅡ评分均低于死亡组,差异有统计学意义(P<0.001)。NEWS、APACHEⅡ评分对急性敌草快中毒患者预后均具有显著的预测价值(AUC>0.7,P<0.001),且二者联合的AUC最大。结论:NEWS和APACHEⅡ评分对敌草快中毒患者预后均具有良好的评估价值,联合两种评分系统有助于提高评估准确度。

Prognostic value of red blood cell distribution width for severe acute pancreatitis

BACKGROUND Severe acute pancreatitis(SAP)is a common condition in the intensive care unit(ICU)and has a high mortality.Early evaluation of the severity and prognosis is very important for SAP therapy.Recently,red blood cell distribution(RDW)was associated with mortality of sepsis patients and could be used as a predictor of prognosis.Similarly,RDW may be associated with the prognosis of SAP patients and be used as a prognostic indicator for SAP patients.AIM To investigate the prognostic value of RDW for SAP patients.METHODS We retrospectively enrolled SAP patients admitted to the ICU of the First Affiliated Hospital of China Medical University from June 2015 to June 2017.According to the prognosis at 90 d,SAP patients were divided into a survival group and a non-survival group.RDW was extracted from a routine blood test.Demographic parameters and RDW were recorded and compared between the two groups.The receiver operator characteristic(ROC)curve was constructed and Cox regression analysis was performed to investigate the prognostic value of RDW for SAP patients.RESULTS In this retrospective cohort study,42 SAP patients were enrolled,of whom 22 survived(survival group)and 20 died(non-survival group).The baseline parameters were comparable between the two groups.The coefficient of variation of RDW(RDW-CV),standard deviation of RDW(RDW-SD),Acute Physiology and Chronic Health Evaluation II(APACHE II)score,and Sequential Organ Failure Assessment(SOFA)score were significantly higher in the non-survival group than in the survival group(P<0.05).The RDW-CV and RDW-SD were significantly correlated with the APACHE II score and SOFA score,respectively.The areas under the ROC curves(AUCs)of RDW-CV and RDW-SD were all greater than those of the APACHE II score and SOFA score,among which,the AUC of RDW-SD was the greatest.The results demonstrated that RDW had better prognostic value for predicting the mortality of SAP patients.When the RDW-SD was greater than 45.5,the sensitivity for predicting prognosis was 77.8%and the specificity was 70.8%.Both RDW-CV and RDW-SD could be used as independent risk factors to predict the mortality of SAP patients in multivariate logistic regression analysis and univariate Cox proportional hazards regression analysis,similar to the APACHE II and SOFA scores.CONCLUSION The RDW is greater in the non-surviving SAP patients than in the surviving patients.RDW is significantly correlated with the APACHE II and SOFA scores.RDW has better prognostic value for SAP patients than the APACHE II and SOFA scores and could easily be used by clinicians for the treatment of SAP patients.

KDIGO标准APACHEII与SOFA评分对脓毒症急性肾损伤患者的预后评估

目的探讨急性肾损伤国际指南（KDIGO）制定的急性肾损伤（AKI）诊断分期标准、急性生理与慢性健康状况评分Ⅱ（APACHE1I）和序贯器官衰竭评估（SOFA）评分对脓毒症AKI患者的预后评估价值。方法前瞻收集2012—03—01～2013—03—01期间在我院ICU接受治疗的脓毒症患者的临床资料，采用KDIGO标准对脓毒症患者进行AKI诊断和分期；根据患者入ICU第1个24h内的生理指标最差值进行APACHEII和SOFA评分，并用受试者工作特征（ROC）曲线评估3项系统对预后评估的准确性。以Logistic多元回归分析对预后的影响。结果共280例脓毒症患者，占同期ICU住院患者的41．7％（280／670），总体院内死亡率为29．8％。脓毒症肾损伤168例，占脓毒症患者的60％，其中1期76例，死亡率22．4％；2期48例，死亡率37．5％；3期44例，死亡率72．7％。脓毒症肾损伤患者的APACHEⅡ及SOFA评分均高于非AKI患者（P〈0．05）。Logistic多元回归分析显示，APACHEII评分〉22分（OR：4．50），KDIGO分期1、2、3期（OR值分别为2．31、7．44、45．00）是脓毒症并AKI患者院内死亡的独立预测指标。结论KDIGO诊断标准与APACHEII、SOFA评分对脓毒症肾损伤患者整体预后都有较好的预测价值。

Prediction of the severity of acute pancreatitis on admission by urinary trypsinogen activation peptide: A meta-analysis

AIM: To undertake a meta-analysis on the value of urinary trypsinogen activation peptide (uTAP) in predicting severity of acute pancreatitis on admission.METHODS: Major databases including Medline, Embase, Science Citation Index Expanded and the Cochrane Central Register of Controlled Trials in the Cochrane Library were searched to identify all relevant studies from January 1990 to January 2013. Pooled sensitivity, specificity and the diagnostic odds ratios (DORs) with 95%CI were calculated for each study and were compared to other systems/biomarkers if mentioned within the same study. Summary receiver-operating curves were conducted and the area under the curve (AUC) was evaluated.RESULTS: In total, six studies of uTAP with a cut-off value of 35 nmol/L were included in this meta-analysis. Overall, the pooled sensitivity and specificity of uTAP for predicting severity of acute pancreatitis, at time of admission, was 71% and 75%, respectively (AUC = 0.83, DOR = 8.67, 95%CI: 3.70-20.33). When uTAP was compared with plasma C-reactive protein, the pooled sensitivity, specificity, AUC and DOR were 0.64 vs 0.67, 0.77 vs 0.75, 0.82 vs 0.79 and 6.27 vs 6.32, respectively. Similarly, the pooled sensitivity, specificity, AUC and DOR of uTAP vs Acute Physiology and Chronic Health Evaluation II within the first 48 h of admission were found to be 0.64 vs 0.69, 0.77 vs 0.61, 0.82 vs 0.73 and 6.27 vs 4.61, respectively.CONCLUSION: uTAP has the potential to act as a stratification marker on admission for differentiating disease severity of acute pancreatitis.

中性粒细胞与淋巴细胞比值联合红细胞分布宽度在急诊老年脓毒症病人中的应用价值

目的 探讨中性粒细胞与淋巴细胞比值(NLR)结合红细胞分布宽度(RDW)对急诊老年脓毒症病人疾病严重程度和预后的评估意义。方法 收集2019年1月到2022年2月在首都医科大学宣武医院急诊科就诊及住院治疗的老年脓毒症病人169例。病人入急诊后给予生化全项、血气分析、全血细胞计数、降钙素原(PCT)、胸部计算机体层摄影(CT)、病原学检查等。依据以上检查结果进行急性生理与慢性健康状况评估(APACHEⅡ)。根据病人入急诊时合并脓毒性休克情况分为脓毒症组114例和脓毒性休克组55例。随访28 d,依据病人死亡情况分成生存组125例和死亡组44例。分别比较脓毒性休克组和脓毒症组、生存组和死亡组病人NLR、白细胞计数(WBC)、PCT、RDW和APACHEⅡ评分的区别,进行NLR、RDW与PCT及APACHEⅡ评分的相关性分析;分析RDW、NLR及2个指标相互结合评估老年脓毒症病人死亡风险的受试者工作特征曲线下面积(AUC)和PCT曲线下面积的区别。结果 脓毒症休克组病人PCT、NLR、RDW和APACHEⅡ评分分别为(1.86±1.04)μg/L、9.63±3.92、(14.95±3.49)%和(16.75±3.53)分,均明显高于脓毒症组的(1.38±1.06)μg/L、7.87±3.94、(12.74±3.83)%、(14.61±2.87)分(P<0.01);WBC在脓毒症死亡组与生存组比较差异无统计学意义(P=0.361),死亡组APACHEⅡ评分、NLR、PCT和RDW分别为(18.52±2.41)分、(10.64±3.74)、(2.55±1.14)μg/L和(15.98±3.69)%,均大于生存组的(14.17±2.71)分、7.67±3.82、(1.19±0.81)μg/L、(12.57±3.43)%(P<0.01),RDW和NLR均与APACHEⅡ评分和PCT具有相关性(均P<0.01);PCT的AUC 95%CI为0.86(0.80,0.92),APACHEⅡ评分的AUC 95%CI为0.88(0.83,0.93),RDW的AUC 95%CI为0.75(0.66,0.83),NLR的AUC95%CI为0.73(0.64,0.81),RDW和NLR的AUC均小于PCT(P=0.048,0.024),但RDW与NLR联合的AUC为0.80,与PCT比较差异无统计学意义(P=0.363)。结论 NLR及RDW两个指标都能够在急诊老年脓毒症病人的病情和预后评估中有较好的应用价值,二者联合的应用价值与PCT相近。

Predictors of irreversible intestinal resection in patients with acute mesenteric venous thrombosis

BACKGROUND Acute mesenteric venous thrombosis(AMVT)can cause a poor prognosis.Prompt transcatheter thrombolysis(TT)can achieve early mesenteric revascularization.However,irreversible intestinal ischemia still occurs and the mechanism is still unclear.AIM To evaluate the clinical outcomes of and to identify predictive factors for irreversible intestinal ischemia requiring surgical resection in AMVT patients treated by TT.METHODS The records of consecutive patients with AMVT treated by TT from January 2010 to October 2017 were retrospectively analyzed.We compared patients who required resection of irreversible intestinal ischemia to patients who did not require.RESULTS Among 58 patients,prompt TT was carried out 28.5 h after admission.A total of 42(72.4%)patients underwent arteriovenous combined thrombolysis,and 16(27.6%)underwent arterial thrombolysis alone.The overall 30-d mortality rate was 8.6%.Irreversible intestinal ischemia was indicated in 32(55.2%)patients,who had a higher 30-d mortality and a longer in-hospital stay than patients without resection.The significant independent predictors of irreversible intestinal ischemia were Acute Physiology and Chronic Health Evaluation(APACHE)II score(odds ratio=2.368,95% confidence interval:1.047-5.357,P=0.038)and leukocytosis(odds ratio=2.058,95% confidence interval:1.085-3.903,P=0.027).Using the receiver operating characteristic curve,the cutoff values of the APACHE II score and leukocytosis for predicting the onset of irreversible intestinal ischemia were calculated to be 8.5 and 12×10^9/L,respectively.CONCLUSION Prompt TT could achieve a favorable outcome in AMVT patients.High APACHE II score and leukocytosis can significantly predict the occurrence of irreversible intestinal ischemia.Therefore,close monitoring of these factors may help with the early identification of patients with irreversible intestinal ischemia,in whom ultimately surgical resection is required,before the initiation of TT.

急性生理学及慢性健康评估II系统在临床重症监护中的应用

急性生理学及慢性健康评估II(APACHE II)系统是目前临床重症监护病房(ICU)应用广泛且极具权威的危重患者病情评价系统。APACHE II能够正确判断患者疾病严重程度及评估患者预后,分值越高病情越重,且预后越差,病死率越高,已成为世界上应用最为广泛的危重病预后评价系统。追溯APACHE II系统的历史发展以及在重症监护领域的应用现状,对其应用的局限性进行回顾和探讨,提示在临床重症监护中充分利用APACHE II系统的优势,克服其局限性使之更好的为临床服务,使危重病评分系统在重症监护工作中得到更广泛更合理的应用,以提高危重患者的救治水平和重症监护水平。

脓毒症合并急性肺损伤患者血清巨噬细胞移动抑制因子的变化及对预后的影响

目的 研究脓毒症合并急性肺损伤(ALI)患者血清巨噬细胞移动抑制因子(MIF)的变化及对预后的影响。方法 选择2021年5月至2023年12月河北北方学院附属第一医院收治的180例脓毒症患者,根据是否发生ALI分为ALI组(n=82)和非ALI组(n=98)。比较两组患者血清MIF及各项临床资料差异,分析脓毒症合并ALI的影响因素以及各影响因素对脓毒症合并ALI的诊断价值,比较不同血清MIF水平的脓毒症合并ALI患者生存预后差异。结果 ALI组的急性生理学与慢性健康状况评价Ⅱ(APACHEⅡ)评分、序贯器官衰竭评估(SOFA)评分、D-二聚体、血尿素氮及血清MIF均高于非ALI组(P<0.05)。多因素Logistic回归分析显示,APACHEⅡ评分和血清MIF是脓毒症合并ALI的影响因素(P<0.05)。受试者工作特征(ROC)曲线分析显示,单独血清MIF及与APACHEⅡ评分联合均对脓毒症合并ALI具有诊断效能,联合诊断的敏感度和特异度分别为90.24%和88.78%;Kaplan-Meier生存曲线分析显示,血清MIF升高与脓毒症合并ALI患者生存率降低相关(P<0.05)。结论 血清MIF水平升高与脓毒症合并ALI的发生及生存预后不良相关,血清MIF联合APACHEⅡ评分对脓毒症合并ALI具有一定诊断价值。

APACHEII/Ⅲ与SAPSII评分系统对艾滋病合并播散性马尔尼菲青霉菌病患者病情预后评估的价值

目的评价APACHEII/III与SAPSII评分系统用于艾滋病合并播散性马尔尼菲青霉菌病患者病情评估及预后的价值。方法对128例艾滋病合并播散性马尔尼菲青霉菌病患者分别进行APA-CHEII/III评分与SAPSII评分,比较死亡组和生存组的差异,并用ROC曲线分析比较这三个评分方法的预测能力。结果 128例患者中死亡33例(25.8%),生存95例(74.2%)。死亡组的APACHEⅡ/Ⅲ评分和SAPSⅡ评分分别是22.18±5.63、82.12±24.33和40.36±8.40,均高于生存组的14.07±5.18、53.27±11.98和34.05±6.88(P<0.01);APACHEⅡ/Ⅲ评分和SAPSⅡ评分的AUC分别为0.878、0.888和0.727,Youden指数分别是0.6434、0.6721和0.3825。APACHEⅡ/Ⅲ评分的分辨度均优于SAPSⅡ评分(P均<0.01),APACHEⅡ/Ⅲ评分的分辨度差异无显著性(P>0.05)。结论 APACHEII/III与SAPSII评分系统均能反映艾滋病合并播散性马尔尼菲青霉菌病患者的病情严重程度,但APA-CHEII/III评分系统预测预后的能力优于SAPSII评分系统。

Different phenotypes of monocytes in patients with newonset mild acute pancreatitis

AIM To evaluate the numbers of different subsets of monocytes and their associations with the values of clinical measures in mild acute pancreatitis(MAP) patients.METHODS The study included one group of 13 healthy controls and another group of 24 patients with new-onset MAP. The numbers of different subsets of monocytes were examined in these two groups of subjects by flow cytometry. The concentrations of plasma interleukin(IL)-10 and IL-12 were determined by cytometric bead array. The acute physiology and chronic health evaluation(APACHE) II scores of individual patients were evaluated, and the levels of plasma C-reactive protein(CRP) as well as the activities of amylase and lipase were measured. RESULTS In comparison with that in the controls, significantly increased numbers of CD14+CD163-, CD14+CD163-MAC387+ M1 monocytes, but significantly reduced numbers of CD14+CD163+IL-10+ M2 monocytes were detected in the MAP patients(P < 0.01 or P < 0.05). Furthermore, significantly higher levels of plasma IL-10 and IL-12 were observed in the MAP patients(P < 0.01 for all). More importantly, the levels of plasma CRP were positively correlated with the numbers of CD14+CD163-(R = 0.5009, P = 0.0127) and CD14+CD163-MAC387+(R = 0.5079, P = 0.0113) M1 monocytes and CD14+CD163+CD115+ M2 monocytes(R = 0.4565, P = 0.0249) in the patients. The APACHE II scores correlated with the numbers of CD14+CD163+CD115+(R = 0.4581, P = 0.0244) monocytes and the levels of plasma IL-10(R = 0.4178, P = 0.0422) in the MAP patients. However, there was no significant association among other measures tested in this population. CONCLUSION Increased numbers of CD14+CD163- and CD14+ CD163-MAC387+ monocytes may contribute to the pathogenesis of MAP, and increased numbers of CD14+CD163+CD115+ monocytes may be a biomarker for evaluating the severity of MAP.