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目的:判别高原地区多脏器功能障碍综合征(mu ltip le organ dysfunction syndrom e at h igh altitude,H-MODS)各项诊断指标参数界值与平原地区的差异;验证新的评分诊断标准的准确性、可操作性。方法:按统一标准将总数为462例MODS患者根据海拔高度分为平原对照组(CG,n=113)、中度高原组(MHG,1 517 m,n=314)、高原组(HG,2 808~3 400 m,n=35)。分别用平原地区MODS评分诊断标准(庐山会议标准和M arshall诊断标准)以及兰州修订的H-MODS评分标准,绘制ROC曲线(rece iver operating characteristic curve),计算约登指数和最佳界值,验证3个标准在不同海拔高度预测MODS结局的准确性。结果:多脏器评分提示兰州标准随海拔梯度升高有进一步提高预测准确性的效果,P=0.034。分层分析还表明,肺、脑、心、肾等单项指标的ROC预测值也以兰州标准的适用度最高(P<0.05)。结论:通用的MODS诊断标准中某些参数界值不适合中度高原以上地区;海拔高度大于1 500 m以上地区可能是区分平原和高原MODS诊断标准的一个有意义的分界线,值得进一步实践观察。
OBJECTIVE: To determine the difference between the threshold values of various diagnostic indicators and the plains in the highland area with multiple organ dysfunction syndrome (H-MODS); to verify the accuracy of the new diagnostic criteria Sexuality, maneuverability. Methods: A total of 462 MODS patients were divided into three groups according to the standard of altitude: plain control group (CG, n = 113), moderate altitude group (MHG, 1517 m, n = 314) 808 ~ 3400 m, n = 35). The ROC curve was calculated by using the diagnostic criteria of MODS score in plain area (Lushan conference standard and M arshall diagnostic criteria) and Lanzhou revised H-MODS score standard, and the Youtube curve was calculated to calculate the Youden index and the best cutoff value. The three criteria predict the accuracy of MODS outcomes at various altitudes. Results: The multiple organ score suggested that the Lanzhou standard could further improve the prediction accuracy with the elevation gradient, P = 0.034. Hierarchical analysis also showed that ROC predictions of individual indicators such as lung, brain, heart and kidney were also the most suitable for Lanzhou standard (P <0.05). CONCLUSION: Some parameters of MODS diagnostic criteria are not suitable for medium plateau above sea level. Above sea level above 1 500 m may be a meaningful demarcation line to distinguish MODS from plain and plateau, which is worth further practice observation .