入院患者血清嗜铬粒蛋白A的浓度——危重症病人严重程度的早期生物.doc

PAGE 3 入院血清CGA浓度：ICU患者严重程度的早期生物学标志物 谢明*，陈晓迎，刘景仑，古妮娜，张丹?通讯作者：张丹，Tel：023Email： ?通讯作者：张丹，Tel：023Email： doctor_zhangdan@126.com；任国胜，Email： doctorrenguosheng@126.com。 基金项目：国家自然科学基金资助项目；重庆市自然科学基金资助项目（CSTC，2009BB5066）。 重庆医科大学附属第一医院，重庆400016 中图分类号：R459.7，R446.62，R449 摘要 目的：探讨重症患者入院时血清嗜铬粒蛋白A（Chromogranin A，CGA）浓度与危重病评分以及预后之间的关系。 方法：105例连续收入ICU的患者被分为非全身炎症反应（SIRS），SIRS和脓毒症组（包括脓毒症、严重脓毒症和脓毒性休克亚组）。比较患者入院时血清CGA、降钙素原（PCT）、急性生理与慢性健康评分(APACHE II)和序贯器官衰竭（SOFA）评分。 结果： SIRS组、脓毒症各亚组患者入院时血清CGA浓度比健康对照组和非SIRS组明显增高（P0.05）。CGA浓度与PCT、WBC、APACHE II、SOFA和血肌酐都成正相关。ROC分析显示CGA、APACHE II与PCT评分可作为28d死亡的预测指标（曲线下面积分别为0.818, 0.789和0.685）。以血清CGA浓度为139μg/L为截分值，Kaplan-Meier分析提示CGA增高组患者死亡率明显高于对照组。 结论：重症患者入院的血清CGA浓度和病情严重程度呈正相关，血清CGA浓度超过139μg/L的患者死亡率明显增高，CGA是预测ICU患者死亡风险的独立指标。 关键词：嗜铬粒蛋白A（CGA）；重症监护患者；危重病评分；预后；生物标志物 Serum CGA at admission: an early indictor for evaluating the severity of ICU patients Xie Ming*, Chen Xiaoying, Liu Jinglun，Gu Nina，Zhang Dan#，Ren Guosheng# The First Affiliated Hospital of Chongqing Medical University，Chongqing，400016 Abstract Objective: To explore the relationship between the serum CGA level at admission and illness severity scores, and prognosis in critically ill patients. Methods: 105 consecutive patients admitted to intensive care unit were recruited and divided into three groups：no SIRS，SIRS and sepsis group (including sepsis，severe sepsis and septic shock subgroups)．The concentrations of serum CGA and PCT at admission were measured. APACHE II was calculated as well as SOFA. Results: Serum CGA concentrations in SIRS patients and all the subgroups of sepsis patients were significantly increased comparing to health controls and no SIRS patients（P0.05）. CGA concentration positively correlated with PCT，WBC，APACHE II，SOFA and creatinine．ROC analysis indicated that CGA，APACHE II and PCT were indicators for 28 day mortality (AUC were respectively 0.818，0.789 and 0.685)．Kaplan-Meier analysis showed that the mortality of CGA increased group (as CGA c