高浓度降钙素原动态变化与严重脓毒症患者预后的关系

目的探讨高水平血清降钙素原(PCT)水平与序贯器官衰竭评估(SOFA)评分及它们的动态变化与严重脓毒症患者预后的关系。方法将2006年10月至2009年9月在上海长征医院ICU住院而且PCT浓度≥10μg/L的严重脓毒症患者纳入研究,共37例,男性22例,女性15例,年龄(57.3±21.4)岁,根据患者出院时的结局将患者分为存活组(n=25)和死亡组(n=12),回顾分析原始病例,用ANOVA法对比分析下列数据:年龄、性别、入组时及治疗5d后患者的PCT值和记录反映脓毒症患者严重程度的SOFA评分,以治疗5d前后PCT值和SOFA评分的差值表示其动态变化。我们还用Pearson相关分析法分析了治疗前后PCT值与SOFA评分的相关关系。结果存活组和死亡组在年龄、性别、入组时的PCT值和SOFA评分上没有统计学显著差异。经过5d治疗后,存活组PCT值从(19.63±11.14)μg/L降为(6.13±3.70)μg/L,SOFA评分从(12.72±3.88)降为(6.16±4.15),而死亡组PCT从(19.57±23.33)μg/L升为(76.38±141.76)μg/L,SOFA评分从(11.08±2.4)升到(18.42±1.62)。存活组和死亡组在PCT和SOFA评分的动态变化上有非常显著差异,P<0.01。PCT值和SOFA评分在入组时和治疗后5d后无显著相关关系,但PCT值的动态变化却与SOFA值的动态变化有非常显著的相关关系,P=0.04。结论在PCT浓度≥10μg/L后,PCT水平与重症脓毒症患者的预后无关,但PCT值及SOFA评分的变化仍与重症脓毒症患者的预后有密切关系。

The Changes of High Procalcinin(PCT) has a Significant Relationship with the Prognosis of Patients with Severe Sepsis

Objective To investigate the changes of procalcinin（PCT） and sequential organ failure assessment（SOFA） score on the prognosis of patients with severe sepsis. Methods 37 patients （22 male, 15female） who were hospitalized in ICU of Shanghai Changzheng Hospital from October 2006 to September 2009 with PCI concentration≥10μg/L caused by severe sepsis were analyzed retrospectively. They were divided into alive group （n=25） and dead group （n=12）. PCT concentrations and SOFA scores were recorded on first day and the fifth day in the treatment and their own differences between the two different days were discribed as the variation of PCT concentration and SOFA scores. Pearson correlation analysis was used to suggest the relationship between PCT and SOFA scores before and after the treatment. Results Two groups had no statistical difference in ages, genders, PCT concentrations and SOFA scores when the treatment began （P0.05）. 5 days later, the PCT concentration descended from （19.63±11.14）μg/L to （6.13±3.70）μg/L and the SOFA scores descended from （12.72±3.88） to （6.16±4.15） in the alive group. Meanwhile, the PCT concentration ascended from （19.57±23.33）μg/L to （76.38±141.76）μg/L and the SOFA scores ascended from （11.08±2.4） to （18.42±1.62） in the dead group. There as significant difference in the PCT concentration and SOFA scores between the two groups （P0.01）. The PCT concentration and the SOFA scores had no correlation during the treatment, but their variation had significant correlation （P=0.04）. Conclusion There is no correlation between PCT and prognosis of patients with severe sepsis if the PCT concentration is more than 10μg/L. However, the variation of PCT and SOFA scores during the treatment has a significant relationship with the prognosis of patients with severe sepsis.