摘要
目的 探讨白细胞计数(WBC)、血清C反应蛋白(CRP)、肝素结合蛋白(HBP)和降钙素原在脓毒症患者病情进展和预后评估中的应用价值.方法 将2018年4月至2023年3月内江市第一人民医院收治的205例脓毒症患者纳入本次回顾性研究,根据病情严重程度分为脓毒症组(n=129)和脓毒性休克组(n=76),并根据患者预后情况分成存活组(n=154)和死亡组(n=51).检测脓毒症组与脓毒性休克组、存活组与死亡组患者的WBC、血清CRP、HBP、降钙素原水平,收集患者的急性生理与慢性健康状况评分系统Ⅱ(APACHE Ⅱ)评分和序贯器官衰竭评估(SOFA)评分,分析WBC、血清CRP、HBP、降钙素原与APACHE Ⅱ、SOFA评分的相关性;采用受试者工作特征(ROC)曲线分析上述4个指标单独及联合检测评估脓毒症患者预后.结果 脓毒性休克组的WBC、血清CRP、HBP、降钙素原分别为(19.83± 3.09)× 109/L、(114.10±35.17)mg/L、(78.92±13.14)μg/L 和(11.13±0.91)μg/L,均显著高于脓毒症组[(9.55± 2.87)× 109/L、(59.96±23.45)mg/L、(36.47±12.83)μg/L 和(8.21±0.82)μg/L],差异均有统计学意义(P＜0.05).脓毒性休克组的APACHEⅡ评分、SOFA评分分别为(20.05±2.39)、(10.29±2.51)分,均显著高于脓毒症组[(16.21± 2.30)、(7.90±2.17)分],差异均有统计学意义(P＜0.05).Pearson相关性分析显示,WBC、血清CRP、HBP、降钙素原与 APACHE Ⅱ 评分(r=0.554、0.593、0.713、0.651,P＜0.05)、SOFA 评分均呈显著正相关(r=0.540、0.571、0.687、0.609,P＜0.05).死亡组的WBC、血清CRP、HBP、降钙素原、APACHE Ⅱ评分、SOFA评分也均显著高于存活组,差异均有统计学意义(P＜0.05).ROC曲线分析显示,WBC、血清CRP、HBP、降钙素原及4个指标联合检测预测脓毒症患者不良预后的ROC曲线下面积分别为0.835、0.803、0.881、0.817和0.939.结论 脓毒性休克患者的WBC、血清CRP、HBP、降钙素原显著高于脓毒症患者,可反映脓毒症患者的病情严重程度,4个指标联合检测对脓毒症患者的预后有较好的预测价值.
Abstract
Objective To investigate the value of white blood cell count(WBC),serum C-reactive protein(CRP),heparin binding protein(HBP),and procalcitonin in evaluating the progress and prognosis of sepsis.Methods A total of 205 patients with sepsis admitted to Nei-jiang First People's Hospital from April 2018 to March 23 were included in this retrospective study and were divided into the sepsis group(n=129)and the septic shock group(n=76)according to the severity of the disease,and were divided into the survival group(n=154)and the death group(n=51)according to the prognosis of the patients.WBC,serum CRP,HBP and procalcitonin of the sepsis group and the septic shock group,the survival group and the death group were collected,the acute physiology and chronic health status evaluation 11(APACHE 11)scores and sequential organ failure assessment(SOFA)scores of each group were also collected and compared.The correlation of WBC,serum CRP,HBP,procalcitonin with APACHE Ⅱ,SOFA scores was analyzed.The prognosis of sepsis patients was analyzed using receiver operating characteristic(ROC)curves for the individual and combined detection of the above four indicators.Results The WBC,serum CRP,HBP,and procalcitonin of the septic shock group were(19.83±3.09)×109/L,(114.10±35.17)mg/L,(78.92±13.14)μg/L,and(11.13±0.91)μg/L,which were higher than those in the sepsis group[(9.55±2.87)× 109/L,(59.96±23.45)mg/L,(36.47±12.83)μg/L and(8.21±0.82)μg/L],the differences were statistically significant(P＜0.05).The APACHE Ⅱ score and SOFA score of the death group were(20.05±2.39)and(10.29±2.51)points,respectively,which were higher than those of the survival group[(16.21±2.30)and(7.90± 2.17)points],the differences were statistically significant(P＜0.05).Pearson correlation analysis showed that WBC,serum CRP,HBP and procalcitonin were significantly positively correlated with APACHE 11 scores(r=0.554,0.593,0.713,0.651;P＜0.05)and SOFA scores(r=0.540,0.571,0.687,0.609;P＜0.05).The WBC,serum CRP,HBP,procalcitonin,APACHE Ⅱ score,and SOFA score of the death group were higher than those in the survival group,the differences were statistically significant(P＜0.05).Receiver operating charac-teristic analysis showed that the area under the curve of WBC,serum CRP,HBP,procalcitonin and four indicators for predicting the adverse prog-nosis of sepsis patients were 0.835,0.803,0.881,0.817 and 0.939,respectively.Conclusion WBC,serum CRP,HBP,and procalcitonin in patients with septic shock are significantly higher than those in patients with sepsis,it can reflect the severity of the patient's condition,and the combined detection of these four indicators has good predictive value for the prognosis of sepsis patients.
维普
万方数据