血清淀粉样蛋白A,C反应蛋白和降钙素原在脓毒性休克中的应用价值与相关性分析
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摘要
目的:分析血清淀粉样蛋白A(SAA),C反应蛋白(CRP)和降钙素原(PCT)在脓毒性休克中的诊断及预后的评估价值。方法将同济大学附属杨浦医院急诊科收治的89例脓毒症患者根据病情分为脓毒性休克组(n=41)、非脓毒性休克组(n=48);同时根据预后情况分为预后良好组(n=58)和预后不良组(n=31)。比较各组SAA,PCT,CRP水平及序贯器衰竭评估(SOFA)评分的变化,并分析各炎症指标联合检测对脓毒性休克患者预后的预测价值。结果与非脓毒性休克组比较,脓毒性休克组SAA(280.27±14.16mg/L vs 251.87±25.20mg/L),CRP(105.74±23.57mg/L vs 84.25±15.27mg/L),PCT(7.11±2.54μg/L vs 3.34±1.84μg/L),SOFA评分(9.03±2.37vs 5.75±2.05)均明显升高,差异有统计学意义(t=6.61,5.07,7.97,6.96,均P<0.001)。预后不良组SAA(291.32±15.28mg/L vs 242.35±24.88mg/L),PCT(7.28±2.69μg/L vs 2.44±1.24μg/L),SOFA评分(9.16±2.25vs 5.34±1.80)较预后良好组显著升高,差异有统计学意义(t=11.27,10.77,8.81,均P<0.001)。非脓毒性休克患者SOFA评分与SAA(r=0.372,P=0.041),PCT(r=0.354,P=0.047)呈显著正相关,而与CRP无显著相关性(r=0.289,P=0.071);脓毒性休克患者SOFA评分与SAA(r=0.414,P=0.024),CRP(r=0.342,P=0.044),PCT(r=0.395,P=0.031)均呈显著正相关(P<0.05)。联合检测预测脓毒性休克患者预后的AUC(0.96vs 0.84,0.67,0.82)、灵敏度(0.81±0.21vs 0.78±0.20,0.60±0.22,0.75±0.25)、特异度(0.74±0.25vs 0.72±0.24,0.63±0.17,0.71±0.28)均显著高于SAA,PCT,PCR单独检测(P<0.05)。结论 SAA,PCT和CRP是脓毒性休克患者病情严重程度及预后的有效评价指标,在SOFA的基础上,联合SAA,PCT,CRP可进一步提高脓毒性休克预后预测的敏感性。
Objective To explore the evaluation value of serum amylase A(SAA),C-reactive protein(CRP)and procalcitonin(PCT)in the diagnosis and prognosis of septic shock.Methods According to the severity of disease,89 patients with sepsis who were admitted in the department of emergency were divided into two groups,including 41 patients of septic shock group,48 patients of non-septic shock group.All the patients were also divided into good prognosis group(n=58)and poor prognosis group(n=31)according to the prognosis.SAA,PCT,CRP and SOFA scores were detected and compared,and the efficiency of combined detection in the prediction of prognosis was analyzed.Results Compared with non-septic shock group,SAA(280.27±14.16 mg/L vs 251.87±25.20 mg/L),CRP(105.74±23.57 mg/L vs 84.25±15.27 mg/L),PCT(7.11±2.54μg/L vs 3.34±1.84μg/L),SOFA scores(9.03±2.37 vs 5.75±2.05)were significantly increased in septic shock group(t=6.61,5.07,7.97,6.96,all P<0.001).SAA(291.32±15.28 mg/L vs 242.35±24.88 mg/L),PCT(7.28±2.69μg/L vs 2.44±1.24μg/L),SOFA scores(9.16±2.25 vs 5.34±1.80)in poor prognosis group were significantly higher than those in good prognosis group(t=11.27,10.77,8.81,all P<0.001).SOFA score of patients with non-septic shock was positively correlated with SAA(r=0.372,P=0.041)and PCT(r=0.354,P=0.047),but no correlation with CRP(r=0.289,P=0.071).SOFA score was positively correlated with SAA(r=0.414,P=0.024),CRP(r=0.342,P=0.044)and PCT(r=0.395,P=0.031)in patients with septic shock.The AUC(0.96 vs 0.84,0.67,0.82),sensitivity(0.81±0.21 vs 0.78±0.20,0.60±0.22,0.75±0.25)and specificity(0.74±0.25 vs 0.72±0.24,0.63±0.17,0.71±0.28)of combined detection in predicting the prognosis of patients with septic shock were significantly higher than those of SAA,PCT and PCR alone(P<0.05).Conclusion SAA,PCT and CRP are effective indicators for evaluating the severity and prognosis of septic shock.On the basis of SOFA,the combination of SAA,PCT and CRP may further improve the sensitivity of prognosis prediction of septic shock.
Objective To explore the evaluation value of serum amylase A(SAA),C-reactive protein(CRP)and procalcitonin(PCT)in the diagnosis and prognosis of septic shock.Methods According to the severity of disease,89 patients with sepsis who were admitted in the department of emergency were divided into two groups,including 41 patients of septic shock group,48 patients of non-septic shock group.All the patients were also divided into good prognosis group(n=58)and poor prognosis group(n=31)according to the prognosis.SAA,PCT,CRP and SOFA scores were detected and compared,and the efficiency of combined detection in the prediction of prognosis was analyzed.Results Compared with non-septic shock group,SAA(280.27±14.16 mg/L vs 251.87±25.20 mg/L),CRP(105.74±23.57 mg/L vs 84.25±15.27 mg/L),PCT(7.11±2.54μg/L vs 3.34±1.84μg/L),SOFA scores(9.03±2.37 vs 5.75±2.05)were significantly increased in septic shock group(t=6.61,5.07,7.97,6.96,all P<0.001).SAA(291.32±15.28 mg/L vs 242.35±24.88 mg/L),PCT(7.28±2.69μg/L vs 2.44±1.24μg/L),SOFA scores(9.16±2.25 vs 5.34±1.80)in poor prognosis group were significantly higher than those in good prognosis group(t=11.27,10.77,8.81,all P<0.001).SOFA score of patients with non-septic shock was positively correlated with SAA(r=0.372,P=0.041)and PCT(r=0.354,P=0.047),but no correlation with CRP(r=0.289,P=0.071).SOFA score was positively correlated with SAA(r=0.414,P=0.024),CRP(r=0.342,P=0.044)and PCT(r=0.395,P=0.031)in patients with septic shock.The AUC(0.96 vs 0.84,0.67,0.82),sensitivity(0.81±0.21 vs 0.78±0.20,0.60±0.22,0.75±0.25)and specificity(0.74±0.25 vs 0.72±0.24,0.63±0.17,0.71±0.28)of combined detection in predicting the prognosis of patients with septic shock were significantly higher than those of SAA,PCT and PCR alone(P<0.05).Conclusion SAA,PCT and CRP are effective indicators for evaluating the severity and prognosis of septic shock.On the basis of SOFA,the combination of SAA,PCT and CRP may further improve the sensitivity of prognosis prediction of septic shock.
引文
[1]PRAVDA J.Metabolic theory of septic shock[J].World J Crit Care Med,2014,3(2):45-54.
[2]SAWICKA W,OWCZUK R,WUJTEWICZ M A,et al.The effectiveness of the APACHE II,SAPS II and SOFA prognostic scoring systems in patients with haematological malignancies in the intensive care unit[J].Anaesthesiology Intensive Ther,2014,46(3):166-170.
[3]刘振国,王婷,王顺达,等.重症肺炎并发脓毒症患者血清降钙素原、血乳酸及内毒素水平的相关研究[J].现代检验医学杂志,2017,32(2):95-97,164.LIU Zenguo,WANG Ti,WANG Sunda,et al.Crelational research of the level of plasma procalcitonin,blood lactic acid and endotoxin in patients of severe pneumonia complicated with sepsis[J].Journal of Modern Laboratory Medicine,2017,32(2):95-97,164.
[4]NI Min,WEI Wei,WANG Yichao,et al.Serum levels of calreticulin in correlation with disease activity in patients with rheumatoid arthritis[J].J Clin Immunol,2013,33(5):947-953.
[5]EKLUND K K,NIEMI K,KOVANEN P T.Immune functions of serum amyloid A[J].Crit Rev Immunol,2012,32(4):335-348.
[6]SINGER M,DEUTSCHMAN C S,SEYMOUR C W,et al.The third international consensus definitions for sepsis and septic shock(Sepsis-3)[J].Jourrnal of the American Medical Association,2016,315(8):801-810.
[7]中国医师协会急诊医师分会,中国研究型医院学会休克与脓毒症专业委员会.中国脓毒症/脓毒性休克急诊治疗指南(2018)[J].中国急救医学,2018,38(9):741-756.Emergency Physicians Branch of Chinese Medical Association,Shock and Sepsis Committee of Chinese Research Hospital Society.Guidelines for emergency treatment of sepsis/septic shock in China(2018)[J].Chinese Journal of Critical Care Medicine,2018,38(9):741-756.
[8]刘大为.实用重症医学[M].北京:人民卫生出版社,2010:1036.LIU Dawei.Practice of critical care medicine[M].Beijing:People’s Health Publishing House,2010:1036.
[9]RIU J A,YANG J H,LEE D,et al.Clinical usefulness of procalcitonin and C-reactive protein as outcome predictors in critically ill patients with severe sepsis and septic shock[J].PLoS One,2015,10(9):e0138150.
[10]GARCIA de GUADIANA-ROMUALDO L M,RE-BOLLO-ACEBES S,ESTEBAN-TORRELLA P,et al.Prognostic value of lipopolysaccharide binding protein and procalcitonin in patients with severe sepsis and septic shock admitted to intensive care[J].Med Intensiva,2015,39(4):207-212.
[11]LIU Shiwen,HOU Yunxiu,CUI Haili.Clinical values of the early detection of serum procalcitonin,C-reactive protein and white blood cells for neonates with infectious diseases[J].Pak J Med Sci,2016,32(6):1326-1329.
[12]ANAND D,DAS S,BHARGAVA S,et al.Procalcitonin as a rapid diagnostic biomarker to differentiate between culture-negative bacterial sepsis and systemic inflammatory response syndrome:aprospective,observational,cohort study[J].J Crit Care,2015,30(1):7-12.
[13]NGUYEN K D,MACAUBAS C,TRUONG P,et al.Serum amyloid A induces mitogenic signals in regulatory T cells via monocyte activation[J].Mol Immunol,2014,59(2):172-179.
[14]韦广莹,卢荣恒,李晶.血清超敏C反应蛋白、血清样淀粉酶A与降钙素原对脓毒症患者的预测价值[J].中华危重症医学杂志(电子版),2015,8(4):235-240.WEI Guangying,LU Rongheng,Li Jing.Predictive value of serum high-sensitivity C-reactive protein,serum amyloid A and procalcitonin in patients with sepsis[J].Chinese Journal of Critical Care Medicine(Electronic Edition),2015,8(4):235-240.
[15]YU MH,CHEN MH,HAN F,et al.Prognostic value of the biomarkers serum amyloid A and nitric oxide in patients with sepsis[J].Int Immunopharmacol,2018,62(4):287-292.
[16]TOWNSEND TR.Can serum amyloid A concentrations aid diagnosis of synovial sepsis[J].Vet Rec,2017,181(16):423-424.
[2]SAWICKA W,OWCZUK R,WUJTEWICZ M A,et al.The effectiveness of the APACHE II,SAPS II and SOFA prognostic scoring systems in patients with haematological malignancies in the intensive care unit[J].Anaesthesiology Intensive Ther,2014,46(3):166-170.
[3]刘振国,王婷,王顺达,等.重症肺炎并发脓毒症患者血清降钙素原、血乳酸及内毒素水平的相关研究[J].现代检验医学杂志,2017,32(2):95-97,164.LIU Zenguo,WANG Ti,WANG Sunda,et al.Crelational research of the level of plasma procalcitonin,blood lactic acid and endotoxin in patients of severe pneumonia complicated with sepsis[J].Journal of Modern Laboratory Medicine,2017,32(2):95-97,164.
[4]NI Min,WEI Wei,WANG Yichao,et al.Serum levels of calreticulin in correlation with disease activity in patients with rheumatoid arthritis[J].J Clin Immunol,2013,33(5):947-953.
[5]EKLUND K K,NIEMI K,KOVANEN P T.Immune functions of serum amyloid A[J].Crit Rev Immunol,2012,32(4):335-348.
[6]SINGER M,DEUTSCHMAN C S,SEYMOUR C W,et al.The third international consensus definitions for sepsis and septic shock(Sepsis-3)[J].Jourrnal of the American Medical Association,2016,315(8):801-810.
[7]中国医师协会急诊医师分会,中国研究型医院学会休克与脓毒症专业委员会.中国脓毒症/脓毒性休克急诊治疗指南(2018)[J].中国急救医学,2018,38(9):741-756.Emergency Physicians Branch of Chinese Medical Association,Shock and Sepsis Committee of Chinese Research Hospital Society.Guidelines for emergency treatment of sepsis/septic shock in China(2018)[J].Chinese Journal of Critical Care Medicine,2018,38(9):741-756.
[8]刘大为.实用重症医学[M].北京:人民卫生出版社,2010:1036.LIU Dawei.Practice of critical care medicine[M].Beijing:People’s Health Publishing House,2010:1036.
[9]RIU J A,YANG J H,LEE D,et al.Clinical usefulness of procalcitonin and C-reactive protein as outcome predictors in critically ill patients with severe sepsis and septic shock[J].PLoS One,2015,10(9):e0138150.
[10]GARCIA de GUADIANA-ROMUALDO L M,RE-BOLLO-ACEBES S,ESTEBAN-TORRELLA P,et al.Prognostic value of lipopolysaccharide binding protein and procalcitonin in patients with severe sepsis and septic shock admitted to intensive care[J].Med Intensiva,2015,39(4):207-212.
[11]LIU Shiwen,HOU Yunxiu,CUI Haili.Clinical values of the early detection of serum procalcitonin,C-reactive protein and white blood cells for neonates with infectious diseases[J].Pak J Med Sci,2016,32(6):1326-1329.
[12]ANAND D,DAS S,BHARGAVA S,et al.Procalcitonin as a rapid diagnostic biomarker to differentiate between culture-negative bacterial sepsis and systemic inflammatory response syndrome:aprospective,observational,cohort study[J].J Crit Care,2015,30(1):7-12.
[13]NGUYEN K D,MACAUBAS C,TRUONG P,et al.Serum amyloid A induces mitogenic signals in regulatory T cells via monocyte activation[J].Mol Immunol,2014,59(2):172-179.
[14]韦广莹,卢荣恒,李晶.血清超敏C反应蛋白、血清样淀粉酶A与降钙素原对脓毒症患者的预测价值[J].中华危重症医学杂志(电子版),2015,8(4):235-240.WEI Guangying,LU Rongheng,Li Jing.Predictive value of serum high-sensitivity C-reactive protein,serum amyloid A and procalcitonin in patients with sepsis[J].Chinese Journal of Critical Care Medicine(Electronic Edition),2015,8(4):235-240.
[15]YU MH,CHEN MH,HAN F,et al.Prognostic value of the biomarkers serum amyloid A and nitric oxide in patients with sepsis[J].Int Immunopharmacol,2018,62(4):287-292.
[16]TOWNSEND TR.Can serum amyloid A concentrations aid diagnosis of synovial sepsis[J].Vet Rec,2017,181(16):423-424.