本文選題：血漿DNA + 血乳酸值�。� 參考：《安徽醫(yī)科大學(xué)》2015年碩士論文

【摘要】：目的:探討血漿DNA水平對急診重癥監(jiān)護(hù)室(Emergency Intensive Care Unit,EICU)休克患者的病情以及預(yù)后的預(yù)測價(jià)值。方法:采用前瞻性、隨機(jī)對照方法,選擇于2012年6月至2013年12月期間入住安徽醫(yī)科大學(xué)第一附屬醫(yī)院EICU的休克患者共69例,分別于入室0小時(shí)(0 hour,0h)、24小時(shí)(24 hour,24h)采取外周靜脈血,應(yīng)用實(shí)時(shí)熒光定量PCR技術(shù)定量檢測患者血漿DNA水平,同時(shí)測定患者血乳酸值,以及24小時(shí)內(nèi)急性生理學(xué)和慢性健康狀況評分(Acute Physiology and Chronic Health Evaluation II score,APACHE II評分);另選取30例體檢者為健康對照組。隨訪患者28天生存率,比較28天存活組和死亡組之間不同時(shí)相點(diǎn)血漿DNA、乳酸水平以及24h APACHE II評分對病情及預(yù)后的評估價(jià)值。結(jié)果:EICU休克患者入室0h血漿DNA水平7.66*10^5 pg/m L(1.61*10^5~2.06*10^6)和24h血漿DNA水平3.91*10^5 pg/m L(3.47*10^4~3.88*10^6)均明顯高于健康對照組9.09*10^3 pg/m L(4.77*10^3~8.97*10^4)(P0.05)。入室0h、24h血漿DNA水平存活組與死亡組患者相比分別為2.85*10^5 pg/m L(7.20*10^4~9.35*10^5)vs 1.91*10^6 pg/m L(7.81*10^5~4.60*10^7)、5.74*10^4 pg/m L(1.12*10^4~5.97*10^5)vs 3.82*10^6 pg/m L(1.66*10^6~9.27*10^6),差異均具有統(tǒng)計(jì)學(xué)意義(P0.05)。入室0h和24h死亡組血乳酸值較存活組亦明顯升高2.96(1.14-5.26)mmol/l vs 1.78(0.995-2.705)mmol/l和5.01(1.99-7.74)mmol/l vs 2.15(1.2-3.09)mmol/l,差異具有統(tǒng)計(jì)學(xué)意義(P0.05)。入室0h血漿DNA曲線下面積為0.822(0.707~0.937),特異度為71.9%,敏感度為75%,最佳截?cái)嘀禐?.11*10^5 pg/ml;入室24h血漿DNA曲線下面積為0.861(0.759~0.963),特異度為87.5%,敏感度為80%,最佳截?cái)嘀禐?.39*10^6 pg/ml。多元logistic回歸分析顯示,24h血漿DNA水平和24h血乳酸值分別是預(yù)測休克患者28天死亡率的獨(dú)立危險(xiǎn)因素。結(jié)論:1.休克患者入室0h和24h血漿DNA水平較健康對照組均明顯升高,差異具有統(tǒng)計(jì)學(xué)意義。2.休克患者死亡組和存活組之間住院時(shí)間(天)、是否行機(jī)械通氣治療、是否使用血管活性藥物、24h APACHEII評分、入室0h和24h血乳酸值差異均有統(tǒng)計(jì)學(xué)意義;而兩組間性別、年齡、是否行血液凈化治療、EICU滯留時(shí)間(天)、白細(xì)胞計(jì)數(shù)及中性粒細(xì)胞比例、前白蛋白、紅細(xì)胞分布寬度、降鈣素原、C-反應(yīng)蛋白則無明顯相關(guān)性。3.24h血漿DNA水平的變化對休克患者死亡風(fēng)險(xiǎn)預(yù)測價(jià)值明顯高于24h血乳酸值和APACHE II評分。4.Logistic回歸模型顯示休克患者死亡組24h血漿DNA水平和24h血乳酸值可作為評價(jià)休克患者預(yù)后的獨(dú)立危險(xiǎn)因素。
[Abstract]:Objective: to investigate the predictive value of plasma DNA level in patients with shock in emergency intensive care unit (EICU). Methods: a prospective, randomized controlled method was used to select 69 patients with shock admitted to EICU of the first affiliated Hospital of Anhui Medical University from June 2012 to December 2013. Peripheral venous blood was taken at 0 hour (0 hour) and 24 hours (24 hours), respectively. The plasma DNA level and blood lactic acid level were measured by real-time fluorescence quantitative PCR. The Acute Physiology and chronic Health Evaluation II score and the other 30 healthy controls were selected. The 28 day survival rate of the patients was followed up. The plasma DNA, lactate level and 24 h Apache II score were compared between the 28 day survival group and the death group. Results the plasma pg/m levels of 7.66 ~ 10 ^ 5 pg/m / L (1.61g / 10 ~ 52.06 ~ 10 / 6) and 3.91 ~ 10 ^ 5 / 24 pg/m / L (3.47 ~ 10 ^ 4 ~ 3.88 ~ 10 / 6) were significantly higher than 9.0910 ~ (3) pg/m / L (4.77 ~ 10 ~ 38.97 ~ 10 / 4) in the healthy control group (P0.05). The plasma DNA levels in the survival group were 2.85 鹵10 ^ 5 pg/m / L (7.20 / 10 10 ^ 49.35 / 10 / 5) vs 1.91 / 10 / 6 pg/m / L (7.81 / 10 / 54.60 / 10 / 7) respectively, and the difference was statistically significant (P0.05). The blood lactic acid levels in the death group at 0 h and 24 h were also significantly higher than those in the survival group (2.96 (1.14-5.26) mmol/l vs 1.78 (0.995-2.705) mmol/l and 5.01 (1.99-7.74) mmol/l vs 2.15 (1.2-3.09) mmol / L, respectively (P0.05). The area under the plasma DNA curve was 0.822 (0.707 鹵0.937), the specificity was 71.9, the sensitivity was 75, the best truncation value was 8.11 ~ 10 ^ 5 PG / ml, the area under the plasma DNA curve was 0.861 (0.759 ~ 0.963), the specificity was 87.5, the sensitivity was 80, the best truncation value was 1.3910 ^ 6 PG / ml. Multivariate logistic regression analysis showed that 24 h plasma DNA level and 24 h blood lactic acid level were independent risk factors for predicting 28 day mortality in patients with shock. Conclusion 1. The plasma DNA level in shock patients was significantly higher than that in healthy controls at 0 h and 24 h, and the difference was statistically significant. There were statistically significant differences in hospital stay (days), mechanical ventilation therapy, 24 hours Apache II score, 0 h and 24 h blood lactic acid values between death and survival groups of shock patients, and gender, age, and age between the two groups. Whether blood purification therapy is performed in EICU (days), white blood cell count and neutrophil ratio, prealbumin, erythrocyte distribution width, There was no significant correlation between procalcitonin C-reactive protein. 3.The change of plasma DNA level in 24 h was significantly higher than that in 24 h blood lactic acid value and Apache II score. 4. Logistic regression model showed that the 24 h plasma DNA level in shock patients was significantly higher than that in shock patients. Serum lactate level and 24 h blood lactic acid level may be independent risk factors for the prognosis of patients with shock.
【學(xué)位授予單位】：安徽醫(yī)科大學(xué)
【學(xué)位級別】：碩士
【學(xué)位授予年份】：2015
【分類號】：R459.7

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