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目的探讨脓毒症患者血清降钙素原(PCT)、超敏C反应蛋白(hs-CRP)与急性生理和慢性健康评分Ⅱ(APACHEⅡ)的相关性,并评价这3种指标对脓毒症患者预后的预测价值。方法回顾性分析2013年7月—2015年12月广东省中医院重症监护室(ICU)收治的脓毒症患者入院24 h内的血清PCT、hs-CRP和APACHEⅡ评分。根据患者的预后分为存活组和死亡组,Mann-Whitney U检验比较两组PCT、hs-CRP和APACHEⅡ评分的差异;采用Spearman相关分析对PCT、hs-CRP和APACHEⅡ评分进行相关性分析;采用ROC曲线评价血清PCT、hs-CRP和APACHEⅡ评分对脓毒症患者出院结局的预测价值。结果死亡组PCT和APACHEⅡ评分均显著高于存活组(P<0.01),而死亡组和存活组hs-CRP差异无统计学意义(P=0.125);PCT与APACHEⅡ评分呈正相关(r=0.366,P<0.01),而hs-CRP与APACHEⅡ评分无相关性(r=0.108,P=0.289);PCT、hs-CRP和APACHEⅡ评分预测脓毒症患者预后的ROC曲线下面积分别为0.855、0.596和0.701,PCT的特异度、阳性预测值、阴性预测值、阳性似然比及准确度均高于hs-CRP和APACHEⅡ评分。结论 PCT与APACHEⅡ评分具相关性,且PCT对脓毒症患者预后的评估优于APACHEⅡ评分和hs-CRP。
Objective To investigate the correlation between serum procalcitonin (PCT), high-sensitivity C-reactive protein (hs-CRP) and acute physiology and chronic health score Ⅱ (APACHEⅡ) in patients with sepsis and to evaluate the effect of these three indexes on sepsis Prognostic value of patient prognosis. Methods The serum PCT, hs-CRP and APACHEⅡ scores of sepsis patients admitted to intensive care unit (ICU) in Guangdong Provincial Hospital of Traditional Chinese Medicine from July 2013 to December 2015 were retrospectively analyzed. The patients were divided into survival group and death group according to their prognosis. Mann-Whitney U test was used to compare the difference of PCT, hs-CRP and APACHEⅡ between the two groups. Spearman correlation analysis was used to analyze the correlation between PCT, hs-CRP and APACHEⅡ scores. ROC curve was used to evaluate the predictive value of serum PCT, hs-CRP and APACHEⅡ scores in patients with sepsis. Results The scores of PCT and APACHEⅡ in the death group were significantly higher than those in the surviving group (P <0.01), while there were no significant differences in the hs-CRP between the death group and the surviving group (P = 0.125) P <0.01), while there was no correlation between hs-CRP and APACHEⅡscore (r = 0.108, P = 0.289). The area under the curve of ROC curve predicted by PCT, hs-CRP and APACHEⅡscore were 0.855,0.596 and 0.701, PCT specificity, positive predictive value, negative predictive value, positive likelihood ratio and accuracy were higher than hs-CRP and APACHE Ⅱ score. Conclusions There is a correlation between PCT and APACHEⅡscore, and PCT is superior to APACHEⅡscore and hs-CRP in prognosis of sepsis patients.