【摘要】：目的： 降鈣素原（Procalcitonin, PCT）在膿毒癥診斷、指導(dǎo)治療方面的應(yīng)用價(jià)值已被廣泛研究。其中，在判斷血行感染方面，診斷價(jià)值優(yōu)于其他炎性介質(zhì)。在血行感染的膿毒癥患者預(yù)后判斷方面是否有效，研究尚不充分，并未得到統(tǒng)一結(jié)論。本研究通過(guò)分析PCT絕對(duì)值及動(dòng)態(tài)變化在ICU血行感染患者存活組及死亡組中的特點(diǎn)，分析其與預(yù)后的相關(guān)性，進(jìn)而評(píng)價(jià)PCT在判斷重癥監(jiān)護(hù)病房血行感染患者預(yù)后中的價(jià)值。 方法： 回顧性分析2012年6月1日至2014年5月31日在吉林大學(xué)白求恩第一醫(yī)院ICU收治的56例血培養(yǎng)陽(yáng)性且監(jiān)測(cè)PCT的血行感染患者，根據(jù)28天死亡率分為存活組（n=37）及死亡組（n=19），比較兩組之間PCT絕對(duì)值及數(shù)值變化率是否有差異以及與預(yù)后的關(guān)系，評(píng)價(jià)PCT在判斷ICU血行感染患者預(yù)后中的應(yīng)用價(jià)值。 結(jié)果： 1、兩組患者性別、年齡、ICU住院時(shí)間、發(fā)熱持續(xù)天數(shù)、24小時(shí)APACHE II評(píng)分、入科時(shí)白細(xì)胞數(shù)(white blood cell, WBC)、中性粒細(xì)胞百分比(percentage of neutrophils, PON)、血紅蛋白、血小板、乳酸水平的差異無(wú)統(tǒng)計(jì)學(xué)意義(P0.05)。入組時(shí)生命體征、基礎(chǔ)疾病無(wú)統(tǒng)計(jì)學(xué)差異(P0.05)。對(duì)血行感染患者感染類(lèi)型在兩組中所占比例進(jìn)行比較，死亡組真菌感染比例高于存活組，有統(tǒng)計(jì)學(xué)意義（P0.05），兩組間革蘭陽(yáng)性菌感染比例、革蘭陰性菌感染比例無(wú)統(tǒng)計(jì)學(xué)意義（P0.05）。 2、兩組中隨著ICU入住時(shí)間延長(zhǎng)及抗生素的使用，PCT絕對(duì)值呈下降趨勢(shì)，死亡組患者入科時(shí)PCT值較低，下降緩慢，存活組入科時(shí)PCT值高，前3天下降明顯。兩組PCT第1、4、7、10天測(cè)量值無(wú)統(tǒng)計(jì)學(xué)差異(P0.05)；死亡組PCTT7-T1、PCTT10-T1值明顯高于存活組，具有統(tǒng)計(jì)學(xué)差異（P0.05）。而兩組其他時(shí)間段PCT變化值、變化率無(wú)統(tǒng)計(jì)學(xué)差異(P0.05)。利用兩組中各時(shí)間點(diǎn)PCT值及各時(shí)間段變化值、變化率的受試者工作特征曲線預(yù)測(cè)死亡，PCTT7-T1取-0.11ng/ml時(shí)，AUC值為0.738，預(yù)測(cè)死亡的靈敏度為70.0%，，特異度為71.4%。PCTT10-T1取-2.71ng/ml時(shí)，AUC值為0.833，預(yù)測(cè)死亡的靈敏度為100%，特異度為71.4%。其余指標(biāo)不能預(yù)測(cè)死亡(P0.05)。 3、兩組各時(shí)間段的WBC、PON比較無(wú)統(tǒng)計(jì)學(xué)差異(P0.05)。 結(jié)論： 1. PCTT7-T1、PCTT10-T1值對(duì)預(yù)測(cè)ICU血行感染患者的預(yù)后有一定的指導(dǎo)意義。 2.關(guān)于PCT不同時(shí)間點(diǎn)測(cè)量值及其他各時(shí)間段PCT變化值、變化率對(duì)預(yù)后的評(píng)估還需大樣本量進(jìn)一步研究。
[Abstract]:Objective: the application value of procalcitonin (Procalcitonin, PCT) in the diagnosis and treatment of sepsis has been widely studied. The diagnostic value of blood infection was superior to that of other inflammatory mediators. Whether the prognosis of sepsis patients infected by blood is effective or not, the study is not enough, and there is no uniform conclusion. This study analyzed the characteristics of PCT absolute value and dynamic changes in the survival and death groups of patients with hematologic infection of ICU, and analyzed its correlation with prognosis, and then evaluated the value of PCT in judging the prognosis of patients with hematologic infection in intensive care unit. Methods: from June 1, 2012 to May 31, 2014, 56 patients with positive blood culture and monitoring PCT were treated in ICU of Bethune first Hospital of Jilin University. According to the death rate of 28 days, the patients were divided into two groups: survival group (n = 37) and death group (n = 19). The difference of absolute value and numerical value of PCT between the two groups and its relationship with prognosis were compared, and the application value of PCT in judging the prognosis of patients with ICU infection was evaluated. Results: 1. Sex, age, length of stay in ICU, duration of fever, APACHE II score of 24 hours, neutrophil percentage of (percentage of neutrophils, PON), hemoglobin, platelet, neutrophil percentage of neutrophils in the two groups. There was no significant difference in lactic acid level (P0.05). There was no significant difference in vital signs and underlying diseases when entering the group (P0.05). The proportion of fungal infection in the death group was higher than that in the survival group (P0.05), and the proportion of Gram-positive bacteria infection between the two groups was higher than that in the dead group (P0.05). There was no significant difference in the rate of Gram-negative bacilli infection (P0.05). In both groups, with the prolongation of ICU stay time and the use of antibiotics, the absolute value of PCT showed a downward trend, and the PCT value of the patients in the death group was lower and decreased slowly when they entered the department. The PCT value of the survival group was high when entering the department, and decreased obviously in the first 3 days. There was no statistical difference between the two groups in the PCT of the 1st day and the 7th day (P0.05); the PCTT7-T1,PCTT10-T1 value of the death group was significantly higher than that of the survival group (P0.05). However, there was no statistical difference between the two groups in the change value of PCT and the rate of change (P0.05). Using the PCT value at each time point and the variation value of each time period in the two groups, The operating characteristic curve of the subjects with rate of change predicted that the AUC value was 0.738 when PCTT7-T1 was taken -0.11ng / ml, the sensitivity for predicting death was 70.0g / ml, the specificity was -2.71ng / ml for 71.4%.PCTT10-T1 = -2.71ng / ml, and the sensitivity for predicting death was 100ng / ml and the specificity was 71.4 / ml. The other indexes could not predict death (P0.05). 3. There was no significant difference in WBC,PON between the two groups (P0.05). Conclusion: 1. PCTT7-T1,PCTT10-T1 value has certain guiding significance in predicting the prognosis of ICU patients with hematologic infection. 2. The evaluation of the prognostic value of PCT at different time points and other PCT changes in different time periods needs to be further studied in large sample size.
【學(xué)位授予單位】：吉林大學(xué)
【學(xué)位級(jí)別】：碩士
【學(xué)位授予年份】：2015
【分類(lèi)號(hào)】：R459.7

【共引文獻(xiàn)】

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