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目的:探讨动态监测血清C反应蛋白(CRP)和降钙素原(PCT)水平对脓毒症患者预后判断的临床应用价值。方法:选择我院重症监护病房2015年1月至2016年3月收治的116例脓毒症患者为研究对象,根据其28 d生存情况分为存活组和死亡组,比较两组患者入院第1、2、3、5、7 d的血清CRP、PCT水平的动态变化,入院第1 d白细胞、乳酸、APACHEⅡ评分和SOFA评分的差异,并分析血清CRP、PCT水平与APACHEⅡ评分和SOFA评分的相关性。结果:存活组和死亡组患者第1、2、3和5 d CRP水平无统计学差异,但死亡组患者第7 d CRP水平明显高于存活组,差异具有统计学意义(P<0.05);存活组和死亡组患者第1、2和3 d PCT水平无统计学差异,但死亡组患者第5、7 d PCT水平明显高于存活组,差异具有统计学意义(P<0.05);入院1 d,死亡组SOFA评分、APACHE II评分明显高于存活组,差异有统计学意义(P<0.05);入院第7 d,患者CRP水平与SOFA评分和APACHE II评分呈正相关(R分别为0.387和0.396,P均<0.01);入院第7 d,患者PCT水平与SOFA评分和APACHE II评分呈正相关(R分别为0.472和0.464,P均<0.01);CRP为10.0 mg/L时敏感性为79.2%,特异性为70.8%。PCT为2.0μg/L时敏感性为76.3%,特异性为69.4%。结论:CRP、PCT可以评价脓毒性患者的严重程度,并且动态观察其变化有助于预测脓毒症患者的预后。
Objective: To investigate the clinical value of dynamic monitoring of serum C-reactive protein (CRP) and procalcitonin (PCT) levels in the prognosis of patients with sepsis. Methods: Seventy-six patients with sepsis admitted from January 2015 to March 2016 in our hospital were divided into survival group and death group according to their 28-day survival. , 2, 3, 5, 7 d serum CRP, PCT levels of dynamic changes, admission 1 d white blood cells, lactic acid, APACHE Ⅱ score and SOFA score differences, and analysis of serum CRP, PCT levels and APACHE Ⅱ score and SOFA score correlation Sex. Results: There was no significant difference in the CRP level between the survivors and the death patients on the 1st, 2nd, 3rd and 5th days, but the CRP level on the 7th day in the death group was significantly higher than that of the survivor group (P <0.05). There was no significant difference in the PCT levels between the survivors and the death patients on the 1st, 2nd and 3rd days, but the PCT levels on the 5th and 7th day in the death group were significantly higher than those in the surviving group (P <0.05) d, the scores of SOFA and APACHE II in death group were significantly higher than those in survival group (P <0.05). On the 7th day after admission, there was a positive correlation between CRP level and SOFA score and APACHE II score (R = 0.387 and 0.396, P <0.01). On the 7th day after admission, the PCT level was positively correlated with the SOFA score and the APACHE II score (R = 0.472 and 0.464, P <0.01, respectively); when the CRP was 10.0 mg / L, the sensitivity was 79.2 %, Specificity is 70.8%. When PCT was 2.0μg / L, the sensitivity was 76.3% and the specificity was 69.4%. Conclusion: CRP and PCT can evaluate the severity of septic patients, and dynamic observation of the changes can help predict the prognosis of patients with sepsis.