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目的 探讨前肾上腺髓质素(pro-ADM)在脓毒症预测和危险分层中的价值.方法 采用前瞻性分析方法将51例入住重症加强治疗病房的危重病患者按国际脓毒症标准分为全身炎症反应综合征(SIRS)组(25例)、脓毒症组(12例)、严重脓毒症组(9例)、脓毒性休克组(5例)4组.取静脉血,采用新型夹心免疫荧光测量法检测pro-ADM浓度,并与急性生理学与慢性健康状况评分系统I(APACHE I)评分及降钙素原(PCT)、C-反应蛋白(CRP)和白细胞介素-6(IL-6)水平相比较.结果 ①SIRS组、脓毒症组、严重脓毒症组、脓毒性休克组血浆pro-ADM浓度逐渐升高,分别为0.34、2.23、4.57和8.21 μg/L,其中以脓毒性休克组pro-ADM浓度最高(P均＜0.05);②在所有脓毒症患者中,与其他标志物相比,死亡患者的pro-ADM浓度比存活患者明显升高(2.01 μg/L比9.75 μg/L,P＜0.05),APACHE I评分也明显升高(23.44分比38.21分,P＜0.05);③在脓毒症存活患者的受试者工作特征曲线分析中,pro-ADM、PCT、APACHE I评分的曲线下面积(分别为0.87、0.81和0.81)较CRP和IL-6(分别为0.53和0.71)明显增多.结论 pro-ADM浓度测定在脓毒症的预测和危险分层中是一个新的有用的标志物.“,”Objective To assess the clinical value of pro-adrenomedullin (pro-ADM)in the prognosis and risk stratification in sepsis.Methods Fifty-one critically ill patients admitted to the intensive care unit (ICU)were prospectively stratified into four groups according to internationally recognized criteria:systemic inflammatory response syndrome(SIRS,25 cases),sepsis(12 cases),severe sepsis(9 cases)and septic shock(5 cases).The levels of plasma pro-ADM was determined in every patient using a new sandwich immunoassay,and compared with procalcitonin(PCT),C-reactive protein(CRP)and interleukin-6(IL-6),pro-ADM concentration was 0.34 vg/L for SIRS,2.23 μg/L for sepsis,4.57 μg/L for severe sepsis and 8.21 μg/L for septic shock.The plasma concentration of pro-ADM exhibited a gradual increase,and the biomarkers,in the sepsis,severe sepsis and septic shock groups,the plasma concentration of pro-ADM and APACHE I score in the non-survivors was significantly higher than in the survivors(pro-ADM:2.01 μg/L operating characteristic(ROC)curve plot analysis of pro-ADM in sepsis,the area under the ROC curve for pro-ADM(0.87)in survivors was similar to the area under the ROC curve for PCT(0.81)and APACHE I Score(0.81),and was significantly higher than the area under the ROC curve for CRP(0.53)and IL-6(0.71).Conclusion The measurement of pro-ADM is a new and useful marker in sepsis prognosis and risk strafification.