联合乳酸、降钙素原和D-二聚体评估脓毒症患者预后的临床研究

目的探讨联合运用乳酸、降钙素原和D-二聚体水平变化评价脓毒症患者预后的价值。方法 48例住院脓毒症患者按照预后分为存活组和死亡组,对比两组患者病程早期乳酸、降钙素原、D-二聚体水平、慢性健康状况评分(APACHEⅡ)以及乳酸和降钙素原清除率,同时通过ROC曲线观察不同指标对预后的参考价值,并观察联合三种指标组(联合组)与非联合组间患者病死人数的差异。结果两组患者在三种指标和APACHEⅡ评分均存在统计学差异(P<0.05)。三种指标预测死亡结局的ROC曲线下面积在0.71～0.82。存活组患者6 h和24 h乳酸清除率,24 h和72 h降钙素原清除率均显著高于死亡组患者(P<0.05)。联合组与非联合组间患者死亡人数差异有统计学意义(χ2=4.090,P=0.043)。结论联合乳酸、降钙素原和D-二聚体检测对于预测脓毒症患者结局灵敏性高于非联合组。

Clinical research of lactic acid,pro - calcionin and D - dimer in estimating the sepsis patients＇ prognosis

Objective To investigate the value of lactic acid,pro-calcitonin and D-dimer in estimating the prognosis of sepsis patients.Methods Forty-eight patients diagnosed with sepsis were divided into two groups： survival group and death group based on their outcomes.Levels of lactic acid,pro-calcitonin and D-dimer were detected in the early stage of medical treatment,as well as APACHEⅡ scores and clearances of lactic acid and pro-calcitonin.ROC was draw to observe the predicting value of these three parameters on prognosis.And to observe the death differences of patients between combined three kinds of indexes teams（the united group） and the nonassociation group.Results Significant differences were found in these three biomarker levels and APACH EⅡ scores between two groups（P 0.05）.The region of area of three parameters was from 0.71-0.82.The 6 h and 24 h clearance rate of lactic acid,the 24 h and 72 h clearance rate of pro-calcitonin of the patients from the survival group were significantly higher than those from the death group（P 0.05）.Significant differences were demonstrated in the death between the united group and the nonassociation group（Pearson chi square test： χ2 = 4.090,P = 0.043）.Conclusion Combination of lactic acid,pro-calcitonin and D-dimer is more sensitive than one of these parameters alone in estimating sepsis patients＇ prognosis.