严重感染患者发生感染性休克的危险因素分析

目的研究严重感染患者发生感染性休克的危险因素。方法选取北京协和医院加强医疗病房中5个月内连续收治的49例严重感染患者，记录其人口统计学资料、临床信息、血单核细胞人白细胞抗原DR（HLA-DR）、血二胺氧化酶（DAO）等指标，主要研究终点为住院病死率，对上述资料先进行单因素分析，在此基础上选择有统计学差异的变量进行多因素非条件Logistic回归分析。结果共有23例（46．9％）严重感染患者发生感染性休克。统计结果显示血培养阳性、HLA—DR降低、血小板计数下降和血DAO升高与感染性休克的发生有关；其中血培养阳性（OR=6．524，95％CI：1．364—31．206，P：0．019）、HLA—DR降低（OR=0．956，95％CI：0．920—0．993，P=0．020）和血DAO活性升高（OR=2．312，95％CI：1．162～4．600，P=0．017）是发生感染性休克的独立危险因素。结论伴有血培养阳性、HLA—DR降低和外周血DAO活性升高的严重感染患者发生感染性休克的风险较高。

Analysis of Risk Factors Associated with Septic Shock in Patients with Severe Sepsis

Objective To study the risk factors associated with septic shock in patients with severe sepsis. Methods Forty-nine consecutive patients with severe sepsis admitted to the intensive care unit （ICU） in Peking Union Medical College Hospital within five months were analyzed. The demographic data, clinical information, blood monocyte human leucocyte antigen-DR （HLA-DR）, and plasma level of diamine oxidase （DAO） were recorded. The primary end point was hospital mortality. Simple logistic regression analysis was performed for all the risk factors, and variables with statistical significance were chosen for multivariate and unconditioned Logistic regression analysis. Results Septic shock occurred in 23 （46.9%） patients with severe sepsis during hospitalization. Positive blood cultures, decreased platelet count, decreased blood HLA-DR level, and increased plasma level of DAO were significantly associated with the occurrence of septic shock. Positive blood cultures （ OR = 6. 524, 95% CI： 1. 364-31. 206, P = 0. 019） , decreased blood HLA-DR level （ OR = 0. 956, 95% CI ： 0. 920-0. 993, P = 0. 020） , and increased plasma level of DAO （ OR = 2.312, 95 % CI ： 1. 162-4. 600, P = 0. 017） were independent risk factors for septic shock in patients with sepsis. Conclusion Severely septic patients with positive blood cultures, decreased blood HLA-DR level, and increased plasma level of DAO are at high risk of septic shock.