性激素水平对脓毒症早期病人预后影响及预测价值

目的 评价雌二醇、睾酮水平对脓毒症早期病人预后的影响及预测价值。方法 2013年3月5日—8月3日，选取我院黄岛院区重症监护病房收治脓毒症病人59例。病人入院72 h内采用放射免疫法测定血清雌二醇及睾酮水平，同时记录年龄、体质量指数（BMI）、急性生理学与慢性健康状况评分系统Ⅱ（APACHEⅡ）评分，序贯器官衰竭（SOFA）评分、多器官功能障碍（MODS）评分、住院时间及住院费用。根据病人28 d生存情况分为生存组（44例）和死亡组（15例），比较两组雌二醇、睾酮水平及以上各临床指标，并评价各指标对脓毒症早期病人预后的预测价值。结果 与死亡组比较，生存组血清雌二醇水平显著升高（Z=2.107，P〈0.05），睾酮水平、APACHEⅡ评分及SOFA评分均明显下降（Z=2.437，t=5.917、2.712,P〈0.05），性别、年龄、BMI、住院时间及住院花费比较差异无统计学意义（P〉0.05）。Logistic回归分析显示，血清睾酮水平、APACHEⅡ评分、SOFA评分是脓毒症早期病人预后的独立危险因素（B=0.952、0.33、0.52，P〈0.05）。受试者工作特征曲线显示，APACHEⅡ评分、SOFA评分及睾酮水平曲线下面积分别为0.890、0.769、0.712，对脓毒症病人预后有较好的预测价值；以血清睾酮水平0.64 pmol/L为临界点预测预后，其敏感性（86%）和特异性（84%）最高。结论 血清雌二醇、睾酮水平对脓毒症早期病人的预后有显著影响，睾酮水平可作为预测脓毒症早期病人预后的临床指标。

THE EFFECT OF THE LEVEL OF SEX HORMONE ON PROGNOSIS AND PREDITION IN PATIENTS WITH EARLY-STAGE SEPSIS

Objective To evaluate the effect of serum estradiol and testosterone levels on the prognosis of patients with early sepsis. Methods From March 5, 2013 to August 3, 2013,59 patients with sepsis hospitalized in Intensive Care Unit （ICU） in our hospital were enrolled. Serum estradiol and testosterone levels were detected by radioimmunoassay within 72 hours after admission. Their age, body mass index （BMI）, acute physiology and chronic health evaluationⅡ（APACHEⅡ） score, sepsis-related organ failure （SOFA） score, multiple organ dysfunction syndrome evaluation （MODS） score, hospital stay and costs were recorded. The patients were divided into survival group （44 cases） and non-survival group （15 cases） based on 28-day survival. The serum levels of estradiol and testosterone, as well as other clinical parameters in the two groups were compared and the value of each parameter in predicting the prognosis was assessed. Results Compared with non-survival group, the level of estradiol in the survival group increased significantly （Z=2.107,P〈0.05）, while the level of testosterone decreased obviously （Z=2.437,P〈0.05）, APACHEⅡ and SOFA score lowed dramatically （t=5.917,2.712;P〈0.05）. There were no statistical differences in mortality rate among the sex, age, BMI, hospital stay and costs. The results of Logistic regression analysis indicated the serum testosterone, APACHEⅡ, and SOFA were independent risk factor for sepsis patients （B=0.952,0.33,0.52;P〈0.05）. The area under the receiver-operating characteristic （ROC） curve of APACHEⅡ, SOFA, the serum testosterone was 0.89, 0.77, and 0.71, respectively, which had a higher value in predicting the prognosis of the patients, taking serum testosterone of 0.64 pmol/L as the critical point, its sensitivity and specificity was 86% and 80%, respectively. Conclusion The serum levels of estradiol and testosterone have a notable effect on prognosis of patients with sepsis in the early stage, and the level of testosterone can be used for predicting their prognosis.