330降钙素原新蝶呤与乳酸对脓毒血症患者预后评估的临床价值研究.doc

降钙素原、新蝶呤与乳酸对脓毒血症患者预后评估的临床价值研究 温海洋 李少洪 钟坚 王存 龙珍 523110 摘要：目的：分析降钙素原、新喋呤与乳酸对脓毒血症患者预后评估的临床价值。方法：按预后将95例脓毒血症患者随机分成生存组和死亡组，其中生存组65例患者，死亡组30例患者，将发病早期的降钙素原、新喋呤与乳酸水平和APACHEⅡ评分进行对比，通过建立ROC曲线探讨标记物对于预后评估的临床意义。结果：分析得知3种标记物水平和APACHEⅡ评分在2组患者中均具有明显差异，并且3种标记物水平与APACHEⅡ评分具有明显的相关性；标记物阳性结果越多，病死率越高；3项标记物预测死亡的ROC曲线下面积在0.70~0.78之间。结论：降钙素原、新喋呤与乳酸对脓毒血症患者的预后评估具有重要的临床研究价值，对患者的死亡具有较好的预测意义，并且联合检测能够提高预测的敏感程度。 关键词：降钙素原、新喋呤、乳酸、脓毒血症、预后、APACHEⅡ评分 Clinical value of procalcitonin, neopterin and lactic acid on the prognosis of patients with sepsis Wen Haiyang; Li Shaohong; Zhong Jian; Wang Cun; Long Zhen, 523110 Abstract: Objective: Analysis of procalcitonin, neopterin and lactic acid on the prognosis of patients with sepsis clinical value. Methods: The prognosis of 95 cases of sepsis patients were randomly divided into survival group and death group, which the survival of the group of 65 patients, 30 patients were dead group, the incidence of early procalcitonin, neopterin and lactic acid levels and APACHE Ⅱ ratings were compared to investigate the clinical significance of markers for prognostic assessment through the establishment of the ROC curve. Results: The analysis showed that the level and APACHE Ⅱ score of three kinds of markers with a significant difference in the 2 groups of patients, and three kinds of markers and APACHE Ⅱ score has a significant correlation, the markers positive results more, higher mortality, three markers to predict death ROC area were under the curve of 0.70 to 0.78. Conclusion: procalcitonin, neopterin and lactic acid on the prognosis of the patients with sepsis has important clinical research value of death in patients with a better forecast, and joint detection can improve the degree of sensitivity of the forecast. Keywords: procalcitonin, neopterin, lactic acid, sepsis, prognosis, APACHE Ⅱ score 脓毒血症（sepsis）是指由感染引起的全身炎症反应综合征（systemic inflammatory response syndrome, SIRS），临床上证实有细菌存在或有高度可疑感染灶。虽然脓毒症是由感染引起，但是一旦发生后，其发生发展遵循其自身的病理过程和规律，故从本质上讲脓毒症是机体对感染性因素的反应。全球每年有超过1800万