PCT变化值对判断ICU血行感染患者预后的应用价值
发布时间：2018-09-08 20:37
【摘要】：目的： 降钙素原（Procalcitonin, PCT）在脓毒症诊断、指导治疗方面的应用价值已被广泛研究。其中，在判断血行感染方面，诊断价值优于其他炎性介质。在血行感染的脓毒症患者预后判断方面是否有效，研究尚不充分，并未得到统一结论。本研究通过分析PCT绝对值及动态变化在ICU血行感染患者存活组及死亡组中的特点，分析其与预后的相关性，进而评价PCT在判断重症监护病房血行感染患者预后中的价值。 方法： 回顾性分析2012年6月1日至2014年5月31日在吉林大学白求恩第一医院ICU收治的56例血培养阳性且监测PCT的血行感染患者，根据28天死亡率分为存活组（n=37）及死亡组（n=19），比较两组之间PCT绝对值及数值变化率是否有差异以及与预后的关系，评价PCT在判断ICU血行感染患者预后中的应用价值。 结果： 1、两组患者性别、年龄、ICU住院时间、发热持续天数、24小时APACHE II评分、入科时白细胞数(white blood cell, WBC)、中性粒细胞百分比(percentage of neutrophils, PON)、血红蛋白、血小板、乳酸水平的差异无统计学意义(P0.05)。入组时生命体征、基础疾病无统计学差异(P0.05)。对血行感染患者感染类型在两组中所占比例进行比较，死亡组真菌感染比例高于存活组，有统计学意义（P0.05），两组间革兰阳性菌感染比例、革兰阴性菌感染比例无统计学意义（P0.05）。 2、两组中随着ICU入住时间延长及抗生素的使用，PCT绝对值呈下降趋势，死亡组患者入科时PCT值较低，下降缓慢，存活组入科时PCT值高，前3天下降明显。两组PCT第1、4、7、10天测量值无统计学差异(P0.05)；死亡组PCTT7-T1、PCTT10-T1值明显高于存活组，具有统计学差异（P0.05）。而两组其他时间段PCT变化值、变化率无统计学差异(P0.05)。利用两组中各时间点PCT值及各时间段变化值、变化率的受试者工作特征曲线预测死亡，PCTT7-T1取-0.11ng/ml时，AUC值为0.738，预测死亡的灵敏度为70.0%，，特异度为71.4%。PCTT10-T1取-2.71ng/ml时，AUC值为0.833，预测死亡的灵敏度为100%，特异度为71.4%。其余指标不能预测死亡(P0.05)。 3、两组各时间段的WBC、PON比较无统计学差异(P0.05)。 结论： 1. PCTT7-T1、PCTT10-T1值对预测ICU血行感染患者的预后有一定的指导意义。 2.关于PCT不同时间点测量值及其他各时间段PCT变化值、变化率对预后的评估还需大样本量进一步研究。
[Abstract]:Objective: the application value of procalcitonin (Procalcitonin, PCT) in the diagnosis and treatment of sepsis has been widely studied. The diagnostic value of blood infection was superior to that of other inflammatory mediators. Whether the prognosis of sepsis patients infected by blood is effective or not, the study is not enough, and there is no uniform conclusion. This study analyzed the characteristics of PCT absolute value and dynamic changes in the survival and death groups of patients with hematologic infection of ICU, and analyzed its correlation with prognosis, and then evaluated the value of PCT in judging the prognosis of patients with hematologic infection in intensive care unit. Methods: from June 1, 2012 to May 31, 2014, 56 patients with positive blood culture and monitoring PCT were treated in ICU of Bethune first Hospital of Jilin University. According to the death rate of 28 days, the patients were divided into two groups: survival group (n = 37) and death group (n = 19). The difference of absolute value and numerical value of PCT between the two groups and its relationship with prognosis were compared, and the application value of PCT in judging the prognosis of patients with ICU infection was evaluated. Results: 1. Sex, age, length of stay in ICU, duration of fever, APACHE II score of 24 hours, neutrophil percentage of (percentage of neutrophils, PON), hemoglobin, platelet, neutrophil percentage of neutrophils in the two groups. There was no significant difference in lactic acid level (P0.05). There was no significant difference in vital signs and underlying diseases when entering the group (P0.05). The proportion of fungal infection in the death group was higher than that in the survival group (P0.05), and the proportion of Gram-positive bacteria infection between the two groups was higher than that in the dead group (P0.05). There was no significant difference in the rate of Gram-negative bacilli infection (P0.05). In both groups, with the prolongation of ICU stay time and the use of antibiotics, the absolute value of PCT showed a downward trend, and the PCT value of the patients in the death group was lower and decreased slowly when they entered the department. The PCT value of the survival group was high when entering the department, and decreased obviously in the first 3 days. There was no statistical difference between the two groups in the PCT of the 1st day and the 7th day (P0.05); the PCTT7-T1,PCTT10-T1 value of the death group was significantly higher than that of the survival group (P0.05). However, there was no statistical difference between the two groups in the change value of PCT and the rate of change (P0.05). Using the PCT value at each time point and the variation value of each time period in the two groups, The operating characteristic curve of the subjects with rate of change predicted that the AUC value was 0.738 when PCTT7-T1 was taken -0.11ng / ml, the sensitivity for predicting death was 70.0g / ml, the specificity was -2.71ng / ml for 71.4%.PCTT10-T1 = -2.71ng / ml, and the sensitivity for predicting death was 100ng / ml and the specificity was 71.4 / ml. The other indexes could not predict death (P0.05). 3. There was no significant difference in WBC,PON between the two groups (P0.05). Conclusion: 1. PCTT7-T1,PCTT10-T1 value has certain guiding significance in predicting the prognosis of ICU patients with hematologic infection. 2. The evaluation of the prognostic value of PCT at different time points and other PCT changes in different time periods needs to be further studied in large sample size.
【学位授予单位】：吉林大学
【学位级别】：硕士
【学位授予年份】：2015
【分类号】：R459.7
本文编号：2231631
[Abstract]:Objective: the application value of procalcitonin (Procalcitonin, PCT) in the diagnosis and treatment of sepsis has been widely studied. The diagnostic value of blood infection was superior to that of other inflammatory mediators. Whether the prognosis of sepsis patients infected by blood is effective or not, the study is not enough, and there is no uniform conclusion. This study analyzed the characteristics of PCT absolute value and dynamic changes in the survival and death groups of patients with hematologic infection of ICU, and analyzed its correlation with prognosis, and then evaluated the value of PCT in judging the prognosis of patients with hematologic infection in intensive care unit. Methods: from June 1, 2012 to May 31, 2014, 56 patients with positive blood culture and monitoring PCT were treated in ICU of Bethune first Hospital of Jilin University. According to the death rate of 28 days, the patients were divided into two groups: survival group (n = 37) and death group (n = 19). The difference of absolute value and numerical value of PCT between the two groups and its relationship with prognosis were compared, and the application value of PCT in judging the prognosis of patients with ICU infection was evaluated. Results: 1. Sex, age, length of stay in ICU, duration of fever, APACHE II score of 24 hours, neutrophil percentage of (percentage of neutrophils, PON), hemoglobin, platelet, neutrophil percentage of neutrophils in the two groups. There was no significant difference in lactic acid level (P0.05). There was no significant difference in vital signs and underlying diseases when entering the group (P0.05). The proportion of fungal infection in the death group was higher than that in the survival group (P0.05), and the proportion of Gram-positive bacteria infection between the two groups was higher than that in the dead group (P0.05). There was no significant difference in the rate of Gram-negative bacilli infection (P0.05). In both groups, with the prolongation of ICU stay time and the use of antibiotics, the absolute value of PCT showed a downward trend, and the PCT value of the patients in the death group was lower and decreased slowly when they entered the department. The PCT value of the survival group was high when entering the department, and decreased obviously in the first 3 days. There was no statistical difference between the two groups in the PCT of the 1st day and the 7th day (P0.05); the PCTT7-T1,PCTT10-T1 value of the death group was significantly higher than that of the survival group (P0.05). However, there was no statistical difference between the two groups in the change value of PCT and the rate of change (P0.05). Using the PCT value at each time point and the variation value of each time period in the two groups, The operating characteristic curve of the subjects with rate of change predicted that the AUC value was 0.738 when PCTT7-T1 was taken -0.11ng / ml, the sensitivity for predicting death was 70.0g / ml, the specificity was -2.71ng / ml for 71.4%.PCTT10-T1 = -2.71ng / ml, and the sensitivity for predicting death was 100ng / ml and the specificity was 71.4 / ml. The other indexes could not predict death (P0.05). 3. There was no significant difference in WBC,PON between the two groups (P0.05). Conclusion: 1. PCTT7-T1,PCTT10-T1 value has certain guiding significance in predicting the prognosis of ICU patients with hematologic infection. 2. The evaluation of the prognostic value of PCT at different time points and other PCT changes in different time periods needs to be further studied in large sample size.
【学位授予单位】：吉林大学
【学位级别】：硕士
【学位授予年份】：2015
【分类号】：R459.7
【共引文献】
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