探讨血清PCT浓度、SVRI、SOFA评分在脓毒症患者中的相关性及临床意义

中国临床药理学与治疗学 ›› 2017, Vol. 22 ›› Issue (4): 443-447.

探讨血清PCT浓度、SVRI、SOFA评分在脓毒症患者中的相关性及临床意义

王剑¹, 张文²

¹ 新疆乌鲁木齐市头屯河区中心医院老年病科，乌鲁木齐 830023，新疆；² 新疆医科大学附属中医医院VIP病房，乌鲁木齐 830000，新疆

收稿日期:2016-08-15 修回日期:2017-02-21 出版日期:2017-04-26 发布日期:2017-04-26
通讯作者: 张文，女，硕士，主治医师，研究方向：心血管方向。 E-mail：nduq09@163.com
作者简介:王剑，男，学士，主治医师，研究方向：心血管方向。 Tel：17082980061 E-mail：dyly93@163.com

Correlation and clinical value of PCT, SVRI, SOFA in sepsis patients

WANG Jian¹，ZHANG Wen ²

¹ Department of Geriatrics, Xinjiang Urumqi City Toutun River District Center Hospital, Urumqi 830023, Xinjiang, China; ²Chinese Medicine Hospital Affiliated to Xinjiang Medical University VIP Ward, Urumqi 830000, Xinjiang, China

Received:2016-08-15 Revised:2017-02-21 Online:2017-04-26 Published:2017-04-26

摘要/Abstract

摘要：

目的: 探讨结合血清降钙素原（PCT）浓度、系统血管阻力指数（SVRI）以及序贯器官衰竭估计评分（SOFA评分）三者在ICU病房脓毒症患者的早期诊断中的可行性与临床应用价值。方法: 以78位脓毒症患者为研究对象，分为高SVRI、正常SVRI和低SVRI三组，记录和检测患者的年龄、性别、感染部位、SOFA评分、PCT浓度、心指数（CI）、中心静脉压（CVP）、有创平均动脉压（MAP）、全心舒张末期容积指数（GEDVI）以及血管外肺水指数（EVLWI），并对其中的相关性进行研究。结果: 三组在年龄、性别以及感染部位的差异无统计学意义。低SVRI组的SOFA评分、血清PCT浓度以及CI均明显高于正常SVRI组和高SVRI组，高SVRI组与正常SVRI组脓毒症在血清PCT浓度、SOFA评分以及CI差异无统计学意义。Spearman相关分析表明：SVRI与PCT浓度、SOFA评分呈负相关（r=-6.38、-0.527, P=0.000），而与CI无相关性（r=-0.375, P=0.000）；Pearson相关分析表明：PCT浓度与SOFA评分呈正相关（r=0.69,P=0.000）。结论: 结合PCT浓度、SVRI、SOFA评分三因素对于评估患者的病情并制定合理的治疗方案具有重要的临床意义，值得推广。

关键词: 脓毒症, 降钙素原, 系统血管阻力指数, SOFA评分

Abstract:

AIM: To discuss the value of the combination of serum procalcitonin concentration (PCT), systemic vascular resistance index (SVRI) and sequential organ failure assessment score (SOFA score) in the early diagnosis of patients with sepsis in the intensive care unit (ICU) ward and clinical application. METHODS: 78 patients with sepsis were divided into the high SVRI group, the normal SVRI group and the low SVRI group on the basis of the SVRI index. The records and tests included the age, the sex, the infection, concentration of serum PCT and SOFA score, cardiac index (CI), central venous pressure (CVP), mean arterial pressure (MAP), global end diastolic volume index (GEDVI) and extravascular lung water index (EVLWI) respectively. The correlations between the records were studied. RESULTS: The records of the age, gender and infection site of each group showed no statistical significance. The SOFA score, serum PCT concentration and cardiac index of low SVRI group were significantly higher than those of the normal SVRI group and the high SVRI group, respectively. There were no statistical significant of the serum PCT concentration, SOFA score and heart index difference of the high SVRI group and the normal SVRI group of patients with sepsis. The spearman analysis showed that SVRI was negatively correlated with the concentration of PCT (r=-6.38,P=0.000), and SOFA score (r=-0.527,P=0.000), respectively. It showed no significant correlation with CI (r=-0.375,P=0.000). The pearson analysis showed that PCT concentration was positively correlated with SOFA score (r=0.69,P=0.000). CONCLUSION: PCT concentration, SVRI, SOFA score were important clinical indexes in assessing the patient's condition and make the plan for that. This method is referential for clinical application.

Key words: sepsis, procalcitonin, system vascular resistance index, SOFA score

中图分类号:

R969

王剑, 张文. 探讨血清PCT浓度、SVRI、SOFA评分在脓毒症患者中的相关性及临床意义[J]. 中国临床药理学与治疗学, 2017, 22(4): 443-447.

WANG Jian，ZHANG Wen. Correlation and clinical value of PCT, SVRI, SOFA in sepsis patients[J]. Chinese Journal of Clinical Pharmacology and Therapeutics, 2017, 22(4): 443-447.

参考文献

［1］Calfee CS, Matthay MA. Clinical imunology: culprits with evolutionary ties［J］. Nature, 2010, 464(7285): 41-42.
［2］Du B, An Y, Kang Y, et al. Characteristics of critically ill patients in ICUs in mainland China［J］. Crit Care Med, 2013, 41(1): 84-92.
［3］Ensen JU, Heslet L, Ensen TH, et al. Procalcitonin increase in early identification of critically ill patients with a high risk of mortality［J］. Crit Care Med, 2006, 34(10): 2596-2606.
［4］崔英子，谢雁鸣，杨海淼, 等. 探索性新药临床试验的回顾与展望［J］. 长春中医药大学学报, 2016, 32 (5): 1046-1049.
［5］梁晓华，张峰，诸葛宇征，等. 经颈静脉肝内门体分流术联合脾动脉栓塞对肝硬化患者血流动力学和肝功能的影响［J］. 临床肝胆病杂志，2016,12(1): 2112-2117.
［6］Assicot M, Gendrel D, Carsin H, et al. High serum procalcitonin concentrations in patient with sepsis and infection［J］. Lancet, 1993, 341(8844): 515-518.
［7］降钙素原急诊临床应用专家共识组. 降钙素原(PCT)急诊临床应用的专家共识［J］. 中华急诊医学杂志, 2012, 21(9): 944-951.
［8］彭慧云, 李淼, 周丽芳, 等. 58例严重脓毒血症患儿肝损伤的临床分析［J］. 临床肝胆病杂志, 2016, 32(3): 541-544.
［9］伊敏, 么改琦, 郭向阳. 脉搏指示连续心排血量监测下脓毒性休克患者心功能变化的前瞻性研究［J］. 中华危重病急救医学，2015, 27(1): 22-27.
［10］Maloney PJ. Sepsis and septic shock［J］. Emerg Med Clin North Am, 2013, 31(3): 583-600.
［11］Müller B, Becker KL, Schchinger H, et al. Calcitonin precursors are reliable markers of sepsis in a medical intensive care unit［J］. Crit Care Med, 2000, 28 (4): 977-983.
［12］Reynolds SC, Shorr AF, Muscedere J, et al. Longitudinal changes in procalcitonin in a heterogeneous group of critically ill patients［J］. Crit Care Med, 2012, 40(10): 2781-2787.
［13］Meisner M, Tschaikowsky K, Palmaers T, et al. Comparison of procalcitonin (PCT) and C-reactive protein (CRP) plasma concentrations at different SOFA scores during the course of sepsis and MODS［J］. Crit Care, 1999, 3 (1): 45.
［14］Morgenthaler NG, Struck J, Fischer-Schulz C, et al. Detection of procalcitonin (PCT) in healthy controls and patients with local infection by a sensitive IL-MA［J］. Clin Lab, 2002, 48: 263-270.
［15］Aziz M, Jacob A, Yang WL, et al. Current trends in inflammatory and immunomodulatory mediators in sepsis［J］. J Leukoc Biol, 2013, 93(3): 329-342.
［16］Meisner M, Tschaikowsky K, Schnabel S, et al. Procalcitonin-influence of temperature, storage, anticoagulation and arterial or venous asservation of blood samples on procalcitonin concentrations［J］. Eur J Clin Chem Clin Biochem, 1997, 35(8): 597-601.
［17］郑俊福, 蔡照华, 张鑫, 等. 降钙素原和外周血白细胞/血小板单独或联合检测对肝硬化合并细菌感染患者早期诊断的价值［J］. 临床肝胆病杂志, 2015, 31(2): 209-213.
［18］陈法余，吕钽, 张俭, 等. ICU感染患者降钙素原水平的影响因素及相关性分析［J］. 中华医院感染学杂志，2014，24(12): 2898-2900.
［19］Endo S, Aikawa N, Fujishima S, et al. Uesfulness of procalcitonin serum level for the discrimination of sever sepsis from sepsis: a multicenter prospercative study［J］. J Infect Chem, 2008, 14(3): 244-249.
［20］Nie X, Wu B, He Y, et al. Serum procalcitonin predicts development of acute kidney injury in patients with suspected infection［J］. Clin Chem Lab Med, 2013, 51 (8): 1655-1661.
［21］Mackay GJ, Molloy RG, O'dwyer PJ. C-reactive protein as a predictor of postoperative infective complications following elective colorectal resection ［J］. Colorectal Dis, 2011, 13 (5): 583-587.
［22］Travaglino F, De Berardinis B, Magrini L, et al. Utility of Procalcitonin (PCT) and Mid regional pro-Adrenomedullin (MR-pro ADM) in risk stratification of critically ill febrile patients in Emergency Department (ED). A comparison with APACHE II score［J］. BMC Infect Dis,2012,12 (1):184.

[1]	邢博民, 郭娜, 宁海慧, 丁新耘, 马玉清. Rho激酶抑制剂对脓毒症肝损伤的影响[J]. 中国临床药理学与治疗学, 2022, 27(5): 544-550.
[2]	何锐, 滕文彬, 姚刘旭, 单跃, 祝胜美, 李玉红. 低氧诱导因子-1α对脓毒症肠黏膜屏障的保护作用[J]. 中国临床药理学与治疗学, 2021, 26(3): 264-270.
[3]	李会, 李俊, 黄素琴, 李玉红, 范俊. 右美托咪定上调低氧诱导因子-1ɑ对脓毒症大鼠肠黏膜屏障损伤的保护作用[J]. 中国临床药理学与治疗学, 2021, 26(12): 1386-1392.
[4]	杨慧芳, 罗颖, 赵莉. 右美托咪定对脓毒症大鼠肾功能及血清炎症因子的影响[J]. 中国临床药理学与治疗学, 2020, 25(8): 857-861.
[5]	茹彩旺, 袁天明, 杨兵芬, 吴福根, 林应荣, 莫妙军. 亚胺培南-西司他丁钠联合免疫球蛋白对婴儿脓毒症并发弥散性血管内凝血的疗效[J]. 中国临床药理学与治疗学, 2020, 25(5): 559-565.
[6]	华旭丹，解红艺，余淑芳. C反应蛋白和降钙素原指导高危新生儿预防性应用抗生素的效果、安全性和经济性分析[J]. 中国临床药理学与治疗学, 2019, 24(5): 561-566.
[7]	乔阳, 陈群, 杨光, 曹迎亚, 鲁卫华. 基于iTRAQ技术的脓毒症脑病的蛋白质组学研究[J]. 中国临床药理学与治疗学, 2019, 24(11): 1269-1274.
[8]	李文书，董淮富. 血清降钙素原在细菌性脑膜炎中的价值[J]. 中国临床药理学与治疗学, 2019, 24(11): 1315-1320.
[9]	蔡云，徐锦龙，张茂. 脓毒症患者在接受持续血液透析滤过时哌拉西林他唑巴坦的药代动力学研究[J]. 中国临床药理学与治疗学, 2018, 23(8): 905-911.
[10]	方晶晶，陶静，黄钦，史超路，颜碧清，盖磊，厉旭光. 脓毒症中血小板活化对肾小管上皮影响的机制研究[J]. 中国临床药理学与治疗学, 2018, 23(3): 283-289.
[11]	吴永磊，王丹，张睢扬，王英，孙芹. 比较美罗培南传统延长和优化延长输注在脓毒症大鼠不同组织中的药代动力学/药效动力学[J]. 中国临床药理学与治疗学, 2017, 22(7): 767-774.
[12]	赵志强，席錾，闫鹏飞. 血清脂肪酶、血清淀粉酶与血清降钙素原在儿童急性胰腺炎诊断中的意义[J]. 中国临床药理学与治疗学, 2017, 22(11): 1265-1268.
[13]	何艳鲁卫华秦雪梅金孝岠. 脓毒症大鼠肠道瞬时感受器电位香草酸受体1及降钙素基因相关肽的表达及作用[J]. 中国临床药理学与治疗学, 2016, 21(1): 38-41.
[14]	李攀, 赵祎博, 李小丽, 李斌, 周红. 内毒素耐受状态小鼠对大肠埃希菌敏感性及促炎细胞因子水平变化的研究[J]. 中国临床药理学与治疗学, 2015, 20(3): 261-265.
[15]	杨义, 杨缙. 加兰他敏减轻脓毒症炎症反应作用的研究[J]. 中国临床药理学与治疗学, 2015, 20(11): 1217-1220.