前白蛋白、C-反应蛋白和D-二聚体在肺炎并感染性休克患者中的动态变化

目的 研究前白蛋白(PA)、C-反应蛋白(CRP)和D-二聚体(DD)的动态变化与肺炎并感染性休克患者病情严重度及预后的关系.方法 测定48例肺炎并感染性休克患者入院第1、3、5天以及出院或死亡前最后一次的PA、CRP、DD、APACHEⅡ评分,按预后将患者分为死亡组及存活组进行动态观察,并对APACHEⅡ评分与PA、CRP、DD水平动态变化进行相关性分析.结果死亡组与存活组入院后第1天PA[(164.33±23.32)、(163.51±32.54)mg/L,t=2.315,P＞0.05]、CRP[(93.25±27.67)、(94.37±30.81)mg/L,t=2.013,P＞0.05]和DD[(917.60±17.09)、(918.07±23.78)μg/L,t=2.511,P＞0.05]比较差异均无统计学意义,死亡组第3、5天和最后一次PA水平明显低于存活组[(118.4±34.7)、(91.7±12.5)、(69.8±21.4)mg/L与(165.3±12.8)、(172.6±11.3)、(189.1±32.6)mg/L,t值分别为2.422、2.557、2.906,P均＜0.05],CRP水平明显高于存活组[(109.5±30.1)、(121.2±31.7)、(133.6±35.1)mg/L与(83.0±45.2)、(67.6±21.6)、(13.1±3.3)mg/L,t值分别为2.061、2.843、3.519,P均＜0.01],DD水平也明显高于存活组[(1138.0±22.8)、(1312.6±2 8.5)、(1830.3±36.2)μg/L与(860.7±38.7)、(651.8±25.6)、(490.6±13.4)μg/L,t值分别为2.576、2.823、3.371,P均＜0.01],PA与APACHEⅡ评分呈负相关(r=-0.631,P＜0.01),CRP及DD与APACHEⅡ评分呈正相关(r值分别为0.687、0.651,P＜0.01).结论 PA持续低水平、CRP和DD持续高水平提示病情危重,所以联合动态观察PA、CRP和DD对评估肺炎并感染性休克病情严重程度及预后有重要的临床意义.

Evaluative value of dynamic observation of prealbumin,C-reactive protein and D-dimer in patients with pneumonia septic shock

Objective To study the changes of Prealbumin (PA),C-reactive protein (CRP) and D-dimer (DD) levels in septic shock patients due to pneumonia so as to explore the relation to the severity of disease and prognosis.Methods PA,CRP and DD levels of 48 sepsis patients were measured on 1st 、 3rd、5th day after admission and the last day before discharge or death.Meanwhile APACHE Ⅱ score were documented.According to prognosis,patients were divided into death group and non-death group.Results The levels of PA、CRP and DD on the 1 st day were of no significant difference between the death group and non-death group( t = 2.315 ,P ＞ 0.05;t =2.013,P ＞0.05; t =2.511 ,P ＞0.05).The level of PA in death group on the 3rd day,the 5th day and the last day was much lower than that in non-death group ( t = 2.422,P ＜ 0.05; t = 2.557,P ＜ 0.05; t = 2.906,P ＜ 0.05 ).The level of CRP and DD in death group on the 3rd day,the 5th day and the last day was much higher than those in nondeath group(t =2.061 ,P ＜0.05 ;t =2.843,P ＜0.05 ,t =3.519,P ＜0.01 and t = 2.576,P ＜0.05,t = 2.823,P ＜0.05; t = 3.371 ,P ＜ 0.01 ).There was a negative correlation between PA and APACHE Ⅱ scores ( r = - 0.631,P ＜0.01 ) ,while a positive correlation was found between CRP,DD and APACHE Ⅱ score(r =0.687 ,P ＜0.01 and r =0.651 ,P ＜ 0.01 ).Conclusions Persistent low level of PA and high level of CRP,DD indicated severe disease course and unflavored prognosis.It is of clinical value to evaluate the severity of disease and predict prognosis in sepsis by combined dynamic observation of PA,CRP and DD levels.