| 曾庆华,陈家萍,白云朵,等.降钙素原、 D-二聚体联合抗凝血酶 Ⅲ对脓毒症 212例的预后价值[J].安徽医药,2023,27(4):797-800. |
| 降钙素原、 D-二聚体联合抗凝血酶 Ⅲ对脓毒症 212例的预后价值 |
| Prognostic value of procalcitonin and D-dimer combined with antithrombin Ⅲ in 212 patients with sepsis |
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| DOI：10.3969/j.issn.1009-6469.2023.04.037 |
| 中文关键词: 脓毒症 降钙素原(PCT) D-二聚体 抗凝血酶 Ⅲ 预后 危险性评估 |
| 英文关键词: Sepsis Procalcitonin (PCT) D-dimer Antithrombin Ⅲ Prognosis Risk assessment |
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| 中文摘要: |
| 目的观察降钙素原(procalcitonin，PCT)、D-二聚体( D-dimer)、抗凝血酶 Ⅲ(antithrombin Ⅲ)与脓毒血症病人病情的关系，探讨其在评估预后中的价值。方法回顾性分析 2019年 1月至 2020年 12月在青岛市市立医院住院期间诊断为脓毒症 212例病人基本信息、入院 24 h内 PCT、D-二聚体、抗凝血酶 Ⅲ，应用入院 24 h最差指标计算急性生理学与慢性健康状况评分 Ⅱ(APACHEⅡ评分)、序贯器官衰竭评分( SOFA评分)依据病人 28 d转归情况分为死亡组和存活组。分析 PCT、D-二聚体、抗凝血酶 Ⅲ在评估脓毒症病人预后中的预测价值。结果，死亡组 PCT、D-二聚体水平高于存活组，其中死亡组 PCT为( 40.92±32.62)μg/L，高于存活组( 30.67±32.34)μg/L，死亡组 D-二聚体为( 8.54±6.82)mg/L，高于存活组( 6.25±6.06)mg/L(均 P<0.05)，抗凝血酶 Ⅲ水平低于存活组，其中死亡组凝血酶 Ⅲ为( 60.75±19.71)%，低于存活组( 67.97±16.16)%(P<0.05)； logistic回归分析显示，年龄、 APACHEⅡ评分、 SOFA评分是脓毒症病人死亡的独立危险因素，但 PCT、D-二聚体、抗凝血酶 Ⅲ不能作为死亡的独立危险因素［ OR 95%CI分别为:年龄 1.05(1.02，1.88)； APACHEⅡ评分 1.11(1.03，1.19)； SOFA评分 1.14(1.03，1.27)； PCT 1.00(0.99，1.02)； D-二聚体 1.01(0.96，1.07)；抗凝血酶 Ⅲ 0.99(0.97，1.01)］。ROC曲线分析显示， APACHEⅡ评分、 SOFA评分、 PCT、 D-二聚体、抗凝血酶 Ⅲ预测脓毒症病人 28天死亡的 ROC曲线下面积( AUC)分别是 0.79、0.78、0.61、0.62、0.59，联合检测时 AUC为 0.82，显著高于单一指标: SOFA评分、 PCT、D-二聚体、抗凝血酶 Ⅲ(Z1=2.42，Z2=4.32，Z3=4.08，Z4=4.73，均 P<0.05)。结论检测 PCT、D-二聚体、抗凝血酶 Ⅲ水平有助于评估脓毒症病人病情严重程度，联合检测有助于提高预后评估的准确性。 |
| 英文摘要: |
| Objective To observe the relationship of procalcitonin (PCT), D-Dimer, antithrombin Ⅲ with sepsis patients, and to explore its value in evaluating the prognosis.Methods A total of 212 patients diagnosed with sepsis in Qingdao Municipal Hospital fromJanuary 2019 to December 2020 were analyzed retrospectively. The basic information of patients, PCT, D-dimer and antithrombin Ⅲ within 24 hours of admission were collected, and APACHEⅡ score and SOFA score were calculated by the worst index in 24 hours after admission. According to the outcome of 28 days, the patients were divided into death group and survival group. The predictive valueof PCT, D-dimer and antithrombin Ⅲ in prognosis of patients with sepsis was analyzed.Results The levels of PCT and D-dimer in the death group were higher than those in the survival group, PCT in the death group was (40.92±32.62)μg/L, which was higher than that inthe survival group (30.67±32.34)μg/L, D-dimer in the death group was (8.54±6.82) mg/L, which was higher than that in the survival group (6.25±6.06) mg/L, P<0.05; and the level of antithrombin Ⅲ was lower than those in the survival group, the level of antithrombinⅢ in the death group was (60.75±19.71) %, which was lower than that in the survival group (67.97±16.16) %, P<0.05. Logistic regression analysis showed that age, APACHEⅡ score and SOFA score were independent risk factors for death in patients with sepsis, butPCT, D-dimer and antithrombin Ⅲ could not be used as independent risk factors for death [OR 95%CI: age odds ratio1.05 (1.02,1.88); APACHEⅡ score1.11 (1.03,1.19); SOFA score: 1.14 (1.03,1.27); PCT: 1.00 (0.99,1.02); D-dimer 1.01 (0.96,1.07).Antithrombin Ⅲ:0.99 (0.97,1.01)].The ROC curve analysis showed that the area under the ROC curve (AUC) of APACHEⅡ score, SOFA score, PCT, D-dimer and antithrombin Ⅲ to predict the 28 day death of patients with sepsis were 0.79, 0.78, 0.61, 0.62 and 0.59, respectively. TheAUC of combined detection was 0.82, which was significantly higher than that of single index: SOFA score, PCT, D-dimer and anti?thrombin Ⅲ (Z1 = 2.42, Z2 = 4.32, Z3 = 4.08, Z4 = 4.73, all P<0.05).Conclusion Detection of PCT, D-dimer and antithrombin Ⅲ levels is helpful to evaluate the severity of sepsis, and combined detection is helpful to improve the accuracy of prognosis evaluation. |
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