胆碱酯酶、乳酸对脓毒症患者病情严重程度及预后的评估价值

目的探讨胆碱酯酶、乳酸对脓毒症患者病情严重程度及预后的评估作用。 方法选择2018年1月至2018年12月入住中南大学湘雅二医院急诊ICU的86例脓毒症患者，根据患者病情的严重程度将86例患者分为脓毒症组（62例）和脓毒性休克组（24例）；再根据患者28 d生存情况将86例患者分为存活组（57例）和死亡组（29例）。记录所有患者的年龄、性别、生命体征、呼吸机使用情况、血管活性药物使用情况、胆碱酯酶、乳酸、急性病生理学和长期健康评价（APACHE）Ⅱ评分、序贯器官衰竭估计（SOFA）评分及28 d预后情况。采用多因素Logistic回归分析影响脓毒症患者病情严重程度及预后的危险因素；绘制受试者工作特征（ROC）曲线，分析胆碱酯酶、乳酸评估脓毒症患者病情严重程度及预后的价值。 结果脓毒症组患者胆碱酯酶水平3 897.30（2 970.70，4 760.15）U/L vs. 2 718.05（2 080.25，3 182.05）U/L]显著高于脓毒性休克组患者，而乳酸水平2.09（1.15，2.99）mmol/L vs. 3.00（2.10，7.00）mmol/L]、APACHEⅡ评分9.00（6.00，15.00）分vs. 15.50（9.00，19.75）分]及SOFA评分4.00（2.00，7.50）分vs. 9.50（6.25，13.75）分]均显著低于脓毒性休克组患者（P均< 0.05）。存活组患者胆碱酯酶水平（3 933 ± 1 484）U/L vs.（2 678 ± 756）U/L]显著高于死亡组患者，而乳酸水平2.14（1.24，2.98）mmol/L vs. 4.55（1.72，12.13）mmol/L]、APACHEⅡ评分9.00（6.00，14.50）分vs. 17.50（15.00，19.75）分]及SOFA评分5.00（2.50，8.50）分vs. 10.50（7.50，13.75）分]均显著低于死亡组患者（P均< 0.05）。将胆碱酯酶、乳酸、APACHEⅡ评分及SOFA评分纳入多因素Logistic回归分析，结果显示，胆碱酯酶是脓毒症患者病情严重程度及预后的保护因素，而乳酸、APACHEⅡ评分及SOFA评分则是脓毒症患者严重程度及预后的独立危险因素（P均< 0.05）。ROC曲线结果显示，胆碱酯酶、乳酸、胆碱酯酶联合乳酸、APACHEⅡ评分及SOFA评分均对脓毒症病情的严重程度及预后具有预测价值（P均< 0.05）。 结论胆碱酯酶和乳酸对脓毒症患者病情的严重程度及预后均具有预测价值，可协助临床医生做出准确、快速的判断。

Effect of cholinesterase and lactic acid on severity and prognosis of sepsis

ObjectiveTo investigate the value of cholinesterase and lactic acid on the severity and prognosis of sepsis patients. MethodsFrom January 2018 to December 2018, 86 patients with sepsis were admitted to the Department of Emergency ICU of the Second Xiangya Hospital of Central South University. According to their disease severity, 86 patients were divided into a sepsis group (n = 62) and a septic shock group (n = 24); then according to their 28-d survival status, 86 patients were divided into a survival group (n = 57) and a death group (n = 29). The age, sex, vital signs, ventilator use, vasoactive drug use, cholinesterase, lactic acid examination, acute physiology and chronic health evaluation (APACHE) Ⅱ score, sequential organ failure estimation (SOFA) score and 28-d prognosis of all patients were recorded. A multivariate Logistic regression was used to analyze risk factors affecting the severity and prognosis of sepsis patients. A receiver operating characteristic (ROC) curve was drawn to analyze the value of cholinesterase and lactic acid in evaluating their severity and prognosis. ResultsThe level of cholinesterase 3 897.30 (2 970.70, 4 760.15) U/L vs. 2 718.05 (2 080.25, 3 182.05) U/L] in the sepsis group was significantly higher than that in the septic shock group, while the lactic acid level 2.09 (1.15, 2.99) mmol/L vs. 3.00 (2.10, 7.00) mmol/L], APACHEⅡ score 9.00 (6.00, 15.00) scores vs. 15.50 (9.00, 19.75) scores] and SOFA score 4.00 (2.00, 7.50) scores vs. 9.50 (6.25, 13.75) scores] in the sepsis group were significantly lower (all P < 0.05). The level of cholinesterase (3 933 ± 1 484) U/L vs. (2 678 ± 756) U/L] in the survival group was significantly higher than that in the death group, while the lactic acid level 2.14 (1.24, 2.98) mmol/L vs. 4.55 (1.72, 12.13) mmol/L], APACHEⅡ score 9.00 (6.00, 14.50) scores vs. 17.50 (15.00, 19.75) scores] and SOFA score 5.00 (2.50, 8.50) scores vs. 10.50 (7.50, 13.75) scores] in the survival group were significantly lower (all P < 0.05). The cholinesterase, lactic acid, APACHEⅡ score and SOFA score were included in the multivariate Logistic regression analysis. The results showed that the cholinesterase was a protective factor for the severity and prognosis of sepsis patients, while the lactic acid, APACHE Ⅱ score and SOFA score were their independent risk factors (all P < 0.05). The ROC curve showed that the cholinesterase, lactic acid, cholinesterase combined with lactic acid, APACHEⅡ score and SOFA score all had predictive value for the severity and prognosis of sepsis patients (all P < 0.05). ConclusionCholinesterase and lactic acid can predict the severity and prognosis of sepsis patients and help clinicians to make accurate and rapid judgment.