凝溶胶蛋白在危重症患者病情与预后评估中的价值

目的 研究凝溶胶蛋白在危重症患者病情严重程度和预后评估中的应用价值.方法 研究对象为2008年2月至12月入住急诊监护室的48例危重症患者,其中23例存活,25例死亡.31例检测2次以上凝溶胶蛋白水平,17例只在入院时检测过一次,并均在人院24 h内接受急性生理与慢性健康状况评分Ⅱ（APACHE Ⅱ）评分,将307例健康成年人的凝溶胶蛋白水平作为对照.结果 48例危重症患者的凝溶胶蛋白初值明显低于正常对照组水平[（24±11）mg/L与（192±39）mg/L,P〈0.01],存活组23例凝溶胶蛋白初值为（28±10）mg/L,死亡组25例凝溶胶蛋白初值为（21±12）mg/L,组间差异有统计学意义（P=0.033）;经Spearman相关分析,凝溶胶蛋白终值和牛存结局呈负相关（r=-0.469,P=0.008）,预测准确率为74.19%,终值≤22 mg/L时患者死亡率增加;凝溶胶蛋白总体变化趋势和生存结局也具有相关性（r=0.418,P=0.019）,预测准确率为70.97%.当APACHEⅡ评分≥30分时,预测准确率为67.74%;当将APACHE Ⅱ评分与凝溶胶蛋白含量终值和总体变化趋势两两结合进行预测时,其准确率均可达到93.55%.结论 凝溶胶蛋白水平可以反映出危重症的严重程度,尤其是连续监测,优于APACHE Ⅱ评分.若联合APACHE Ⅱ评分可以更准确的预测患者的预后.

Gelsolin level for evaluating severity and prognosis in patients at critically ill

Objective To investigate clinical value of gelsoin level for evaluating severity and prognosis in patients with critical illness. Methods Forty-eight patients with critical illness admitted to the Emergency Intensive Care Unit of Beijing Hospital during February to December 2008 were enrolled in this study, with 23 survivors and 25 deaths. Serum level of gelsolin was measured for 31 of them at least twice during their hospital stay, and for other 17 only once at their admission. They all were evaluated with acute physiology and chronic health evaluation Ⅱ ( APACHE Ⅱ ) scores within 24 hours after admission. In addition, serum level of gelsolin was measured for another 307 healthy adults as controls. Results Initial level of gelsolin was significantly lower in 48 patients at critically ill than that in controls [(24 ± 11) mg/L vs. (192 ±39) mg/L, P < 0. 01]. There was significant difference in initial level of gelsolin between surviving group (23 cases) and death group (25 cases) [(28 ± 10) mg/L vs. (21 ±12) mg/L, P = 0. 033]. Fatality of patients at critically ill increased as their level of gelsolin at 22 mg/L or less, with a predicting accuracy of 74. 19% , as well as decreasing trend of their gelsolin levels in continuously minitoring, with a predicting accuracy of 70. 97%. Predicting accuracy of APACHE Ⅱ scores of 30 or more was 67.74%. However, predicting accuracy would reach 93.55% as final level of gelsolin and its decreasing trend combined with APACHE Ⅱ scores in prognostic assessment for critically ill patients. Conclusions Severity of patients at critically ill can be predicted by their gelsolin level, especially in continuously monitoring, which is an indicator better than APACHE Ⅱ scores. Combination of gelsolin level with APACHE Ⅱ scores shows a more accurate prognostic assessment for critically ill patients.