摘要
目的 研究急性生理功能和慢性健康状况评分系统Ⅱ(APACHE Ⅱ)评分、序贯器官功能障碍(SOFA)评分及血清炎症指标[降钙素原、中性粒细胞比例(N％)、C反应蛋白(CRP)]与脓毒症胃肠功能障碍患者临床转归的关系.方法 回顾性分析2021年1月至2022年12月期间梅州市人民医院收治的97例脓毒症胃肠功能障碍患者的临床资料,根据患者治疗3～5 d后APACHE Ⅱ评分为标准,分为不良组(APACHE Ⅱ评分＞10分,n=66)和良好组(APACHE Ⅱ评分≤10分,n=31).比较两组的基线资料(年龄、性别、合并慢性疾病、感染性休克、主要感染部位、入住ICU 24 h内APACHE Ⅱ评分、SOFA评分)和实验室指标[降钙素原、N％、血小板计数(PLT)、白细胞计数(WBC)、CRP],采用Logistic回归模型分析影响脓毒症胃肠功能障碍患者预后的相关因素,采用受试者操作特征(ROC)曲线分析APACHE Ⅱ评分、SOFA评分、血清炎症指标及以上指标联合预测脓毒症胃肠功能障碍临床转归不良的临床价值.结果 两组的年龄段、性别、合并慢性疾病、主要感染部位比较,差异均无统计学意义(P＞0.05);不良组的感染性休克、APACHE Ⅱ 评分、SOFA 评分分别为 28.79％、(21.46±6.12)分、(8.07±3.46)分,均高于良好组[12.90％、(15.74±5.68)分、(6.09±3.16)分],差异均有统计学意义(P＜0.05).不良组感染性休克、APACHE Ⅱ评分、SOFA评分高于良好组(P＜0.05);两组PLT、WBC比较,差异均无统计学意义(P＞0.05);不良组降钙素原、N％、CRP分别为5.02(2.08,28.36)ng/mL、(91.15±7.08)％、160.79(104.52,229.89)mg/L,均高于良好组[1.65(0.38,3.68)ng/mL、(82.77±14.03)％、92.33(36.62,173.40)mg/L],差异均有统计学意义(P＜0.05).多因素 Logistic 回归分析显示,APACHE Ⅱ评分、SOFA评分、降钙素原、CRP是脓毒症胃肠功能障碍临床转归不良的独立影响因素(P＜0.05).通过ROC曲线可知,APACHE Ⅱ评分、SOFA评分、降钙素原、CRP四者联合预测脓毒症胃肠功能障碍临床转归不良的曲线下面积最大(0.804).结论 APACHE Ⅱ评分、SOFA评分联合血清炎症指标降钙素原、CRP监测对脓毒症胃肠功能障碍患者的临床转归不良具有一定预测价值.
Abstract
Objective To study the relationship of acute physiology and chronic health evaluation Ⅱ(APACHE Ⅱ)score,sequential or-gan failure assessment(SOFA)score and serum inflammatory indexes of procalcitonin,neutrophil ratio(N％)and C-reactive protein(CRP)and clinical outcomes in patients with sepsis and gastrointestinal dysfunction.Methods The clinical data of 97 patients with sepsis complicated with gastrointestinal dysfunction in the Meizhou People's Hospital were retrospectively analyzed from January 2021 to December 2022.According to the APACHE Ⅱ score after 3-5 days of treatment,patients were divided into the poor group(APACHE Ⅱ score＞10 points,n=66)and the good group(APACHE Ⅱ score ≤10 points,n=31).Baseline data(age,gender,chronic disease,septic shock,main infection site,APACHE Ⅱ score and SOFA score within 24 hours of ICU admission)and laboratory indicators[procalcitonin,N％,platelet(PLT),white blood cell count(WBC),CRP]were compared between the two groups.The related factors affecting the prognosis of patients with sepsis and gastrointestinal dys-function was analyzed using Logistic regression model.The clinical value of APACHE Ⅱ score,SOFA score,serum inflammation indexes and the combination of the above indexes on predicting the poor clinical outcomes of sepsis with gastrointestinal dysfunction was analyzed adopting receiver operating characteristic(ROC)curve.Results There were no statistically significant differences in age,gender,chronic diseases and main in-fection sites between the two groups(P＞0.05);the septic shock,APACHE Ⅱ score and SOFA score in the poor group were 28.79％,(21.46±6.12)points and(8.07±3.46)points,respectively,which were higher than those in the good group[12.90％,(15.74±5.68)points,(6.09±3.16)points],the differences were statistically significant(P＜0.05).There were no statistically significant differences in PLT and WBC between groups(P＞0.05).The procalcitonin,N％,CRP of the poor group were 5.02(2.08,28.36)ng/mL,(91.15±7.08)％,and 160.79(104.52,229.89)mg/L,respectively,which were higher than those of the good group[1.65(0.38,3.68)ng/mL,(82.77±14.03)％,92.33(36.62,173.40)mg/L],the difference was statistically significant(P＜0.05).Multivariate Logistic regression a-nalysis indicated that APACHE Ⅱ score,SOFA score,procalcitonin and CRP were independent influencing factors for poor clinical outcomes of sepsis with gastrointestinal dysfunction(P＜0.05).According to ROC curve,the area under the curve of the combination of APACHE Ⅱ score,SOFA score,procalcitonin and CRP was the largest(0.804)in predicting poor clinical outcomes.Conclusion APACHE Ⅱ score,SOFA score combined with serum inflammatory indexes procalcitonin and CRP monitoring have certain predictive value on poor clinical outcome in patients with sepsis complicated with gastrointestinal dysfunction.
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