摘要
目的分析腹腔感染相关性脓毒症患者炎症因子的变化情况并进一步评估患者的预后。方法选择2021年11月至2022年12月常熟市第一人民医院重症医学科收治的114例腹腔感染患者为研究对象,根据2021版《脓毒症和脓毒性休克的管理国际指南》中的脓毒症诊断标准将患者是否发展为脓毒症分为脓毒症组和非脓毒症组,比较两组的一般资料及实验室指标。再根据脓毒症患者出重症监护病房时的病情转归情况分为好转组和恶化组,并分析患者的预后。结果114例腹腔感染患者中,脓毒症患者78例、非脓毒症患者36例。脓毒症患者在出重症监护病房时病情好转59例,病情恶化19例。脓毒症组患者的降钙素原(PCT)、肝素结合蛋白(HBP)、白细胞介素(IL)-6均高于非脓毒症组[8.10(2.75,38.80)μg/L比0.30(0.10,1.08)μg/L、28(12,45)μg/L比11(6,24)μg/L、217(81,712)ng/L比66(20,130)ng/L](P<0.05),两组C反应蛋白(CRP)水平比较差异无统计学意义(P>0.05)。受试者工作特征曲线(ROC曲线)显示,PCT预测腹腔感染进展为脓毒症的曲线下面积(AUC)和灵敏度最高,PCT和IL-6的特异度最高。多因素Logistic回归分析显示,PCT和IL-6升高是腹腔感染进展为脓毒症的独立危险因素(OR=1.104,95%CI 1.011~1.206;OR=1.003,95%CI 1.000~1.006)(P<0.05)。恶化组患者的PCT、HBP、CRP、IL-6、序贯器官功能衰竭评分(SOFA评分)及急性生理与慢性健康状况评价系统Ⅱ(APACHEⅡ)评分均明显高于好转组(P<0.05或P<0.01)。ROC曲线显示,SOFA评分预测脓毒症预后的AUC最高(0.834),IL-6的灵敏度最高(0.831),HBP和APACHEⅡ评分的特异度最高(均为0.947)。结论PCT、HBP、IL-6对腹腔感染相关性脓毒症的早期诊断及预后的判断均有一定的预测价值,CRP、SOFA评分及APACHEⅡ评分对脓毒症患者预后有重要的预测价值。
Objective To explore the changes of inflammatory factors and prognosis of patients with intra-abdominal infection-associated sepsis.Methods A total of 114 patients with intra-abdominal infection admitted to the intensive care unit(ICU)of Changshu NO.1 People′s Hospital from Nov.2021 to Dec.2022 were included.According to the diagnostic criteria of sepsis in the International Guidelines for the Management of Sepsis and Septic Shock(2021 edition),the patients were divided into a sepsis group and a non-sepsis group.The general data and laboratory indicators of the two groups were compared.Then,according to the prognosis of the patients out of ICU,they were divided into an improvement group and a deterioration group to analyze the prognosis.Results Of the 114 patients,78 had sepsis,36 without sepsis,59 improved and 19 worsened when leaving the ICU.The procalcitonin(PCT),heparin-binding protein(HBP),and interleukin-6(IL-6)were all higher in the sepsis group than in the non-sepsis group[8.10(2.75,38.80)μg/L vs 0.30(0.10,1.08)μg/L,28(12,45)μg/L vs 11(6,24)μg/L,217(81,712)ng/L vs 66(20,130)ng/L](P<0.05),there was no significant difference in the C-reactive protein(CRP)levels between the two groups(P>0.05).The receiver operating characteristic curve(ROC curve)showed that PCT had the highest area under curve(AUC)and sensitivity for the prediction of abdominal cavity infection progression to sepsis,and PCT and IL-6 had the highest specificity.Multivariate Logistic regression analysis showed that PCT and elevated IL-6 were independent risk factors for progression of abdominal cavity infection to sepsis(OR=1.104,95%CI 1.011-1.206;OR=1.003,95%CI 1.000-1.006)(P<0.05).PCT,HBP,CRP,IL-6,sequential organ failure assessment(SOFA score)and acute physiology and chronic health evaluationⅡ(APACHEⅡ)scores were significantly higher in the deterioration group than the improvement group(P<0.05 or P<0.01).The ROC curve showed that the SOFA score had the highest AUC(0.834),IL-6 had the highest sensitivity(0.831),and HBP and APACHEⅡscores had the highest specificity for the prediction of sepsis prognosis(both 0.947).Conclusion PCT,HBP and IL-6 are of certain value in the early diagnosis and prognosis of intra-abdominal infection-associated sepsis.CRP,SOFA score and APACHEⅡscore are of great value in predicting the prognosis of the patients with sepsis.
作者
汪易岚
曹岚
叶宏伟
周维一
WANG Yilan;CAO Lan;YE Hongwei;ZHOU Weiyi(Department of Intensive Care Unit,Changshu Hospital Affiliated to Soochow University/Changshu NO.1 People′s Hospital,Changshu 215500,China)
出处
《医学综述》
CAS
2024年第7期892-896,共5页
Medical Recapitulate
基金
苏州市科技发展计划项目(SYSD2019197)。
作者简介
通信作者:叶宏伟,Email:yehongwei@foxmail.com。
