摘要目的 探究氧合指数、血小板计数(blood platelet,PLT)和血浆降钙素原(plateletcrit,PCT)水平与脓毒症严重程度的相关性。方法 回顾性分析2018年1月至2020年10月本院收治的脓毒症患者126例,根据病情严重程度分为脓毒症组(n=38)、严重脓毒症组(n=47)和脓毒性休克组(n=41),比较患者的一般临床资料、实验室指标,分析氧合指数、PLT和PCT水平与急性生理与慢性健康状况(acute physiology and chronic health evaluation II,APACHEⅡ)评分和序贯器官衰竭(sequential organ failure assessment,SOFA)评分的相关性,采用ROC曲线分析氧合指数、PLT和PCT对脓毒症患者入院后28 d内死亡的评估价值。结果 脓毒性休克组患者的APACHEⅡ评分、SOFA评分和入院后28d内病死率明显高于严重脓毒症组和脓毒症组(P<0.05);脓毒症组、严重脓毒症组和脓毒性休克组患者的红细胞分布宽度(red cell distribution width,RDW)、白细胞计数(blood cell count,WBC)、PLT、C-反应蛋白(C-reactive protein,CRP)、血肌酐(serum creatinine,Scr)、PCT、血乳酸和氧合指数水平比较,差异有统计学意义(P<0.05),且脓毒性休克组患者RDW、WBC、CRP、Scr、PCT和血乳酸水平最高,PLT和氧合指数水平最低(P<0.05);脓毒症患者氧合指数、PLT与APACHEⅡ评分、SOFA评分均呈显著负相关(P<0.05),PCT水平与APACHEⅡ评分、SOFA评分呈显著正相关(P<0.05);脓毒症患者氧合指数与PLT呈正相关,与PCT呈负相关(P<0.05);PLT与PCT呈负相关(P<0.05)。ROC曲线分析结果显示,氧合指数、PLT和PCT可预测脓毒症患者28d死亡,曲线下面积(area under curve,AUC)分别为0.728、0.799和0.762。结论 氧合指数、PLT和PCT水平与脓毒症患者病情严重程度相关,对患者的预后具有一定的预测价值,且三者在脓毒症患者中的表达水平存在相关性,可作为临床脓毒症诊断、评估的辅助指标。
Abstract：Objective: To explore the correlation between oxygenation index,platelet count (PLT) and plasma procalcitonin (PCT) level and the severity of sepsis. Methods: A retrospective analysis was performed among 126 sepsis patients admitted to the hospital between January 2018 and October 2020,and the subjects were divided into sepsis group (n=38),severe sepsis group (n= 47) and septic shock group (n=41) according to the severity. General clinical data and laboratory indicators of the 3 groups were comparatively analyzed,and the correlations among oxygenation index,PLT,PCT,the acute physiology and chronic health evaluation II (APACHEⅡ) score and the sequential organ failure assessment (SOFA) score were analyzed. Meanwhile,ROC curve was used to analyze the value of oxygenation index,PLT and PCT in evaluating death in patients with sepsis within 28 days after admission. Results: The APACHE Ⅱ score,SOFA score and the mortality rate within 28 days after admission were significantly higher in the septic shock group than in the severe sepsis group and the sepsis group (P<0.05). There were significant differences in red blood cell distribution width (RDW),white blood cell count (WBC),PLT,C-reactive protein (CRP),serum creatinine (Scr),PCT,blood lactate and oxygenation index among the 3 groups (P<0.05). Besides,the septic shock group had the highest RDW,WBC,CRP,Scr,PCT and blood lactate levels,and the lowest PLT and oxygenation index (P<0.05). The oxygenation index,and PLT was significantly negatively correlated with APACHEⅡ score and SOFA score (P<0.05),while PCT was significantly positively correlated with APACHEⅡ score and SOFA score (P<0.05). Oxygenation index and PLT in patients with sepsis were positively correlated with PLT,but negatively with PCT Correlation (P<0.05); PLT and PCT were negatively correlated (P<0.05). ROC curve analysis showed that oxygenation index,PLT and PCT could predict 28 days mortality of patients with sepsis,and the area under curve (AUC) was 0.728,0.799 and 0.762,respectively. Conclusion: Oxygenation index,PLT and PCT are related to the condition of patents with sepsis,indicating prognostic value. Besides,the expression levels of the three indexes are correlated in patients with sepsis. They can be used as auxiliary clinical indicators for diagnosis and evaluation of sepsis.
李川, 方长太, 查君敬, 夏泉. 氧合指数血小板计数和血浆PCT水平与脓毒症严重程度的相关性研究[J]. 河北医学, 2021, 27(3): 390-395.
LI Chuan, FANG Changtai, CHA Junjing, et al. Correlation Study of Oxygenation Index Platelet Count and Plasma PCT Level with the Severity of Sepsis. HeBei Med, 2021, 27(3): 390-395.
[1] Seymour C W,Gesten F,Prescott H C,et al.Time to treatment and mortality during mandated emergency care for sepsis.[J]. New Engl Med,2017,18(2):2235~2238. [2] 周红瑜,陶静,盖磊,等.低分子肝素对ICU脓毒症患者ALI/ARDS氧合指数及炎症反应的影响观察[J].中国药师,2019,22(1):110~112. [3] Levi M.Platelets in critical illness[J]. Semin Thromb Hemost,2016,42(3):252~257. [4] 李贵忠,满立波,王海,等.比较降钙素原、C反应蛋白和血白细胞计数在经皮肾镜取石术后脓毒症诊断中的价值[J].中华泌尿外科杂志,2017,38(1):42~46. [5] Singer M,Deutschman CS,Seymour CW,et al.The third international consensus definitions for sepsis and septi shock(Sepsis-3)[J]. JAMA,2016,315(8):801~810. [6] Claushuis TA,van Vught LA,Scicluna BP,et al. Thrombocytopenia is associated with a dysregulated host response in critically illsepsis patients[J]. Blood,2016,127(24):3062~3072. [7] 姜雅珍,翁金龙.APACHE 11评分及乳酸乳酸清除率联合应用于脓毒症患者预后的评估价值[J].浙江临床医学,2017,19(1):90~91. [8] 杨军英,赵建军,雷罗春,等.降钙素原联合APACHEⅡ评分预测老年脓毒症患者预后的价值[J].中国中西医结合急救杂志,2019,26(1):34~37. [9] Park HK,Kim WY,Kim MC,et al.Quick sequential organ failure assessment compared to systemic inflammatory response syndrome for predicting sepsis in emergency department[J].Crit Care,2017,42(5):12~19. [10] Arora S,Singh P,Singh PM,et al.Procalcitonin levels in survivors and nonsurvivors of sepsis[J]. Shock,2015,43(3):212~221. [11] 徐丽梅,王莉.呼出气一氧化氮检测在小儿脓毒症并发急性呼吸窘迫综合征防治中的应用[J].广东医学,2018,39(7):1055~1058. [12] 袁鼎山,李爱林.PCT、IL-6及CRP对脓毒症的诊断价值[J].中国现代医学杂志,2018,28(32):86~90.
2021, Vol. 27 
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