本文選題：休克 + 血漿游離DNA濃度��； 參考：《安徽醫(yī)科大學(xué)》2017年碩士論文

【摘要】：目的:探討血漿游離DNA水平及其變化對(duì)急診重癥監(jiān)護(hù)室(Emergency Intensive Care Uint,EICU)休克患者預(yù)后的預(yù)測價(jià)值。方法:本研究為前瞻性觀察性研究。選取從2012年7月至2015年4月入住安徽醫(yī)科大學(xué)第一附屬醫(yī)院EICU并被診斷為休克的患者共173例。分別留取這些休克患者在入室0小時(shí)(0hour,0h)、24小時(shí)(24hour,24h),48小時(shí)(48hour,48h)時(shí)間點(diǎn)的外周靜脈血,以實(shí)時(shí)熒光定量聚合酶鏈?zhǔn)椒磻?yīng)(real-time quantification Polymerase Chain Reaction,RT-PCR)技術(shù)定量測定這些休克患者在不同時(shí)間點(diǎn)的血漿游離DNA水平。同時(shí)記錄休克患者入室24h內(nèi)的血乳酸值水平和急性生理學(xué)和慢性健康狀況評(píng)分(Acute Physiology and Chronic Health Evaluation,APACHE II評(píng)分);同時(shí)選擇安徽醫(yī)科大學(xué)第一附屬醫(yī)院體檢中心與患者基線情況相匹配30例體檢者作為對(duì)照組。隨訪休克患者的28天結(jié)局,根據(jù)結(jié)局不同分為死亡組和存活組,比較兩組之間0h、24h的血漿游離DNA水平,48小時(shí)血漿游離DNA水平的改變情況,24小時(shí)內(nèi)血乳酸水平以及APACHE II評(píng)分,判斷這些指標(biāo)對(duì)休克患者預(yù)后的預(yù)測價(jià)值。結(jié)果:EICU死亡組休克患者0h、24h血漿游離DNA水平均顯著高于存活組的水平,分別為,8.02*10^5pg/ml(2.71*10^5-1.98*10^6)vs1.20*10^5pg/ml(4.59*10^4-3.12*10^5)、5.23*10^5 pg/ml(2.94*10^5-2.05*10^6)vs9.06*10^4 pg/ml(3.38*10^4-3.19*10^5),差異均具有統(tǒng)計(jì)學(xué)意義(P0.001)。且48h血漿游離DNA水平的改變率與存活組相比為+37.93%(-1.07-+137.88%)vs-26.06%(-2.56%--50.96%),差異具有統(tǒng)計(jì)學(xué)意義(P0.001)。此外,與存活組相比,死亡組休克患者的24h內(nèi)血乳酸水平及APACHE II評(píng)分顯著增高,分別為2.38mmol/l(1.56mmol/l-5.62mmol/l)vs1.28mmol/l(0.93mmol/l-2.65mmol/l)和24.9±7.2vs19.3±7.1,差異均具有統(tǒng)計(jì)學(xué)意義(P0.001)。入室0h血漿游離DNA水平的曲線下面積是0.808(0.719-0.896),最佳截?cái)嘀凳?35119.5 pg/ml,敏感度為62.2%,特異度為89.7%;入室24h血漿游離DNA水平的曲線下面積是0.830(0.753-0.907),最佳截?cái)嘀凳?25779.5 pg/ml,敏感度為73.3%,特異度為77.6%;多元Logistic回歸模型顯示48h血漿游離DNA水平的改變率是預(yù)測休克患者28天死亡與否的獨(dú)立預(yù)測因子,其曲線下面積是0.825(0.741-0.909),最佳截?cái)嘀凳?16.12%,敏感度是68.9%,特異度是89.7%。結(jié)論:1.EICU休克患者的循環(huán)血漿游離DNA水平較健康對(duì)照組顯著升高。2.EICU休克患者入室即刻和24h血漿游離DNA的濃度死亡組顯著高于存活組。3.與之前的研究結(jié)果一致,24h血乳酸值和入室即刻APACHE II評(píng)分對(duì)EICU休克患者的28天死亡率具有一定的預(yù)測價(jià)值。4.多元Logistic回歸模型顯示48h血漿游離DNA改變率是預(yù)測休克患者預(yù)后的獨(dú)立預(yù)測因子,其最佳截?cái)嘀涤兄谂R床醫(yī)生決策休克患者進(jìn)一步的治療方案。5.在本次研究中,休克患者的28天死亡率與患者的年齡、性別無明顯相關(guān)性。
[Abstract]:Objective: to investigate the prognostic value of plasma free DNA level and its changes in patients with shock in emergency intensive care unit (EICU). Methods: this study is a prospective observational study. From July 2012 to April 2015, 173 patients were admitted to EICU of the first affiliated Hospital of Anhui Medical University and diagnosed as shock. The peripheral venous blood of these shock patients at the time points of 0 hour (0 hour) and 24 hour (24 hour) of 48 hours (48 hours / 48 h), Real-time quantification polymerase chain reaction (real-time quantification Polymerase chain reaction) was used to quantify the plasma free DNA levels of these shock patients at different time points. At the same time, the blood lactic acid level and the Acute Physiology and chronic Health Evaluation score (Apache II) were recorded in the first affiliated Hospital of Anhui Medical University, and the baseline condition of the patients was also selected in the first affiliated Hospital of Anhui Medical University. 30 cases of physical examination were matched as control group. Patients with shock were followed up for 28 days. According to the outcome, they were divided into death group and survival group. The changes of plasma free DNA level at 0 h to 24 h and plasma free DNA level at 48 h were compared between the two groups. The lactate level and Apache II score were compared within 24 hours. The prognostic value of these indexes in patients with shock. Results the levels of plasma free DNA in the death group were significantly higher than those in the surviving group at 0 h, 10 ^ 5pg/ml (2.71 ~ 10 ^ 10 ^ 5-1.98 ~ 10 ^ 6) vs1.20*10 ^ 5pg/ml (4.59 ~ 10 ^ 4-3.12 ~ 10 ^ 5) 5.2310 ^ 5 pg/ml (2.9410 ^ 5-2.0510 ^ 6) vs9.06*10 4 pg/ml (3.3810 ^ 4-3.1910 ^ 5), respectively. The difference was statistically significant (P0.001). The change rate of plasma free DNA level in 48h group was 37.93% (-1.07-137.88%), vs-26.06% (-2.56- 50.96%), the difference was statistically significant (P0.001). In addition, the serum lactate level and Apache II score of shock patients in the death group were significantly higher than those in the survival group (2.38mmol/l (1.56mmol/l-5.62mmol/l) vs1.28mmol/l (0.93mmol/l-2.65mmol/l) and 24.9 鹵7.2vs19.3 鹵7.1) within 24 hours, respectively. The difference was statistically significant (P0.001). The area under the curve is 0.808 (0.719-0.896), the best truncation value is 635119.5 PG / ml, the sensitivity is 62.2 and the specificity is 89.70.The area under the curve is 0.830 (0.753-0.907), the best truncation value is 325779.5 PG / ml, the sensitivity is 73.3%, the specificity is 89.7%. Multivariate logistic regression model showed that the change rate of plasma free DNA level at 48 hours was an independent predictor of 28 days death in shock patients. The area under the curve is 0.825 (0.741-0.909), the best truncation value is 16.12, the sensitivity is 68.9 and the specificity is 89.7. Conclusion the level of circulating plasma free DNA in EICU shock patients was significantly higher than that in healthy controls. 2. The concentration of plasma free DNA in EICU shock patients was significantly higher than that in survival group. In accordance with the previous study, the 24 h blood lactic acid level and the immediate Apache II score had a certain predictive value for 28 days mortality in EICU shock patients. Multivariate logistic regression model showed that the change rate of plasma free DNA in 48 hours was an independent predictor of the prognosis of shock patients, and its best truncation value was helpful for clinicians to decide the further treatment plan for shock patients. In this study, there was no significant correlation between 28-day mortality and age and gender in patients with shock.
【學(xué)位授予單位】：安徽醫(yī)科大學(xué)
【學(xué)位級(jí)別】：碩士
【學(xué)位授予年份】：2017
【分類號(hào)】：R459.7
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本文編號(hào)：2052641