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目的分析严重脓毒症合并急性肺损伤患者渗漏指数(C反应蛋白/白蛋白,CRP/ALB)与预后的关系。方法选择2012年6月-2015年1月诊断严重脓毒症合并急性肺损伤患者70例,入院后给予行脉搏指示连续心排出量监测(Pi CCO)检测患者血管外肺水指数(EVLWI)、肺血管通透指数(PVPI)。采用罗氏AU800X全自动生化分析仪检测血浆白蛋白(ALB)、血浆前白蛋白(PA),免疫透射比浊法检测血清C反应蛋白(CRP)水平。依据患者住院预后结局分为存活组57例与病死组13例。比较2组患者EVLWI、PVPI、ALB、PA、CRP水平差异,以CRP/ALB为指标,绘制CRP/ALB受试者工作ROC曲线,判断其对于患者预后的预测价值。结果病死组患者EVLWI、PVPI、ALB、PA、CRP水平高于存活组,差异有统计学意义(P<0.05)。CRP/ALB预测病死率的受试者工作特征曲线(ROC曲线)下面积为0.874[95%CI=(0.591,0.953),P<0.001],最佳节点为2.674,灵敏度71%,特异度83%。结论严重脓毒症合并急性肺损伤患者随着病情加重,CRP/ALB明显升高,CRP/ALB对于患者预后具有较好预测价值。
Objective To analyze the relationship between the prognosis and the leakage index (C-reactive protein / albumin, CRP / ALB) in patients with severe sepsis and acute lung injury. Methods Seventy patients with severe sepsis and acute lung injury diagnosed from June 2012 to January 2015 were enrolled. After admission, patients were given extracorporeal pulmonary perfusion index (EVLWI) Pulmonary vascular permeability index (PVPI). Roche AU800X automatic biochemical analyzer was used to detect serum albumin (ALB), plasma prealbumin (PA), and immunoturbidimetric assay for serum C-reactive protein (CRP) levels. According to the prognosis of patients hospitalized into 57 cases of survival and 13 cases of death. The differences of EVLWI, PVPI, ALB, PA and CRP between the two groups were compared. The CRP / ALB index was used to draw the ROC curve of CRP / ALB, and the predictive value of CRP / ALB was evaluated. Results The levels of EVLWI, PVPI, ALB, PA and CRP in the deceased group were significantly higher than those in the survivor group (P <0.05). The area under the receiver operating characteristic curve (ROC curve) of CRP / ALB predictive mortality was 0.874 [95% CI = (0.591,0.953), P <0.001] with the optimal node of 2.674, sensitivity of 71% and specificity of 83 %. Conclusions Patients with severe sepsis and acute lung injury have a significantly higher CRP / ALB as the disease progresses. CRP / ALB has a better predictive value for the prognosis of patients.