血浆DNA水平对急诊重症监护室休克患者预后价值的探讨

发布时间：2018-07-03 06:10

  本文选题：血浆DNA + 血乳酸值　； 参考：《安徽医科大学》2015年硕士论文

【摘要】：目的:探讨血浆DNA水平对急诊重症监护室(Emergency Intensive Care Unit,EICU)休克患者的病情以及预后的预测价值。方法:采用前瞻性、随机对照方法,选择于2012年6月至2013年12月期间入住安徽医科大学第一附属医院EICU的休克患者共69例,分别于入室0小时(0 hour,0h)、24小时(24 hour,24h)采取外周静脉血,应用实时荧光定量PCR技术定量检测患者血浆DNA水平,同时测定患者血乳酸值,以及24小时内急性生理学和慢性健康状况评分(Acute Physiology and Chronic Health Evaluation II score,APACHE II评分);另选取30例体检者为健康对照组。随访患者28天生存率,比较28天存活组和死亡组之间不同时相点血浆DNA、乳酸水平以及24h APACHE II评分对病情及预后的评估价值。结果:EICU休克患者入室0h血浆DNA水平7.66*10^5 pg/m L(1.61*10^5~2.06*10^6)和24h血浆DNA水平3.91*10^5 pg/m L(3.47*10^4~3.88*10^6)均明显高于健康对照组9.09*10^3 pg/m L(4.77*10^3~8.97*10^4)(P0.05)。入室0h、24h血浆DNA水平存活组与死亡组患者相比分别为2.85*10^5 pg/m L(7.20*10^4~9.35*10^5)vs 1.91*10^6 pg/m L(7.81*10^5~4.60*10^7)、5.74*10^4 pg/m L(1.12*10^4~5.97*10^5)vs 3.82*10^6 pg/m L(1.66*10^6~9.27*10^6),差异均具有统计学意义(P0.05)。入室0h和24h死亡组血乳酸值较存活组亦明显升高2.96(1.14-5.26)mmol/l vs 1.78(0.995-2.705)mmol/l和5.01(1.99-7.74)mmol/l vs 2.15(1.2-3.09)mmol/l,差异具有统计学意义(P0.05)。入室0h血浆DNA曲线下面积为0.822(0.707~0.937),特异度为71.9%,敏感度为75%,最佳截断值为8.11*10^5 pg/ml;入室24h血浆DNA曲线下面积为0.861(0.759~0.963),特异度为87.5%,敏感度为80%,最佳截断值为1.39*10^6 pg/ml。多元logistic回归分析显示,24h血浆DNA水平和24h血乳酸值分别是预测休克患者28天死亡率的独立危险因素。结论:1.休克患者入室0h和24h血浆DNA水平较健康对照组均明显升高,差异具有统计学意义。2.休克患者死亡组和存活组之间住院时间(天)、是否行机械通气治疗、是否使用血管活性药物、24h APACHEII评分、入室0h和24h血乳酸值差异均有统计学意义;而两组间性别、年龄、是否行血液净化治疗、EICU滞留时间(天)、白细胞计数及中性粒细胞比例、前白蛋白、红细胞分布宽度、降钙素原、C-反应蛋白则无明显相关性。3.24h血浆DNA水平的变化对休克患者死亡风险预测价值明显高于24h血乳酸值和APACHE II评分。4.Logistic回归模型显示休克患者死亡组24h血浆DNA水平和24h血乳酸值可作为评价休克患者预后的独立危险因素。
[Abstract]:Objective: to investigate the predictive value of plasma DNA level in patients with shock in emergency intensive care unit (EICU). Methods: a prospective, randomized controlled method was used to select 69 patients with shock admitted to EICU of the first affiliated Hospital of Anhui Medical University from June 2012 to December 2013. Peripheral venous blood was taken at 0 hour (0 hour) and 24 hours (24 hours), respectively. The plasma DNA level and blood lactic acid level were measured by real-time fluorescence quantitative PCR. The Acute Physiology and chronic Health Evaluation II score and the other 30 healthy controls were selected. The 28 day survival rate of the patients was followed up. The plasma DNA, lactate level and 24 h Apache II score were compared between the 28 day survival group and the death group. Results the plasma pg/m levels of 7.66 ~ 10 ^ 5 pg/m / L (1.61g / 10 ~ 52.06 ~ 10 / 6) and 3.91 ~ 10 ^ 5 / 24 pg/m / L (3.47 ~ 10 ^ 4 ~ 3.88 ~ 10 / 6) were significantly higher than 9.0910 ~ (3) pg/m / L (4.77 ~ 10 ~ 38.97 ~ 10 / 4) in the healthy control group (P0.05). The plasma DNA levels in the survival group were 2.85 卤10 ^ 5 pg/m / L (7.20 / 10 10 ^ 49.35 / 10 / 5) vs 1.91 / 10 / 6 pg/m / L (7.81 / 10 / 54.60 / 10 / 7) respectively, and the difference was statistically significant (P0.05). The blood lactic acid levels in the death group at 0 h and 24 h were also significantly higher than those in the survival group (2.96 (1.14-5.26) mmol/l vs 1.78 (0.995-2.705) mmol/l and 5.01 (1.99-7.74) mmol/l vs 2.15 (1.2-3.09) mmol / L, respectively (P0.05). The area under the plasma DNA curve was 0.822 (0.707 卤0.937), the specificity was 71.9, the sensitivity was 75, the best truncation value was 8.11 ~ 10 ^ 5 PG / ml, the area under the plasma DNA curve was 0.861 (0.759 ~ 0.963), the specificity was 87.5, the sensitivity was 80, the best truncation value was 1.3910 ^ 6 PG / ml. Multivariate logistic regression analysis showed that 24 h plasma DNA level and 24 h blood lactic acid level were independent risk factors for predicting 28 day mortality in patients with shock. Conclusion 1. The plasma DNA level in shock patients was significantly higher than that in healthy controls at 0 h and 24 h, and the difference was statistically significant. There were statistically significant differences in hospital stay (days), mechanical ventilation therapy, 24 hours Apache II score, 0 h and 24 h blood lactic acid values between death and survival groups of shock patients, and gender, age, and age between the two groups. Whether blood purification therapy is performed in EICU (days), white blood cell count and neutrophil ratio, prealbumin, erythrocyte distribution width, There was no significant correlation between procalcitonin C-reactive protein. 3.The change of plasma DNA level in 24 h was significantly higher than that in 24 h blood lactic acid value and Apache II score. 4. Logistic regression model showed that the 24 h plasma DNA level in shock patients was significantly higher than that in shock patients. Serum lactate level and 24 h blood lactic acid level may be independent risk factors for the prognosis of patients with shock.
【学位授予单位】：安徽医科大学
【学位级别】：硕士
【学位授予年份】：2015
【分类号】：R459.7

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