血浆游离DNA浓度及其48小时变化率对急诊重监护室休克患者预后价值的探讨

发布时间：2018-06-22 11:11

  本文选题：休克 + 血浆游离DNA浓度　； 参考：《安徽医科大学》2017年硕士论文

【摘要】：目的:探讨血浆游离DNA水平及其变化对急诊重症监护室(Emergency Intensive Care Uint,EICU)休克患者预后的预测价值。方法:本研究为前瞻性观察性研究。选取从2012年7月至2015年4月入住安徽医科大学第一附属医院EICU并被诊断为休克的患者共173例。分别留取这些休克患者在入室0小时(0hour,0h)、24小时(24hour,24h),48小时(48hour,48h)时间点的外周静脉血,以实时荧光定量聚合酶链式反应(real-time quantification Polymerase Chain Reaction,RT-PCR)技术定量测定这些休克患者在不同时间点的血浆游离DNA水平。同时记录休克患者入室24h内的血乳酸值水平和急性生理学和慢性健康状况评分(Acute Physiology and Chronic Health Evaluation,APACHE II评分);同时选择安徽医科大学第一附属医院体检中心与患者基线情况相匹配30例体检者作为对照组。随访休克患者的28天结局,根据结局不同分为死亡组和存活组,比较两组之间0h、24h的血浆游离DNA水平,48小时血浆游离DNA水平的改变情况,24小时内血乳酸水平以及APACHE II评分,判断这些指标对休克患者预后的预测价值。结果:EICU死亡组休克患者0h、24h血浆游离DNA水平均显著高于存活组的水平,分别为,8.02*10^5pg/ml(2.71*10^5-1.98*10^6)vs1.20*10^5pg/ml(4.59*10^4-3.12*10^5)、5.23*10^5 pg/ml(2.94*10^5-2.05*10^6)vs9.06*10^4 pg/ml(3.38*10^4-3.19*10^5),差异均具有统计学意义(P0.001)。且48h血浆游离DNA水平的改变率与存活组相比为+37.93%(-1.07-+137.88%)vs-26.06%(-2.56%--50.96%),差异具有统计学意义(P0.001)。此外,与存活组相比,死亡组休克患者的24h内血乳酸水平及APACHE II评分显著增高,分别为2.38mmol/l(1.56mmol/l-5.62mmol/l)vs1.28mmol/l(0.93mmol/l-2.65mmol/l)和24.9±7.2vs19.3±7.1,差异均具有统计学意义(P0.001)。入室0h血浆游离DNA水平的曲线下面积是0.808(0.719-0.896),最佳截断值是635119.5 pg/ml,敏感度为62.2%,特异度为89.7%;入室24h血浆游离DNA水平的曲线下面积是0.830(0.753-0.907),最佳截断值是325779.5 pg/ml,敏感度为73.3%,特异度为77.6%;多元Logistic回归模型显示48h血浆游离DNA水平的改变率是预测休克患者28天死亡与否的独立预测因子,其曲线下面积是0.825(0.741-0.909),最佳截断值是+16.12%,敏感度是68.9%,特异度是89.7%。结论:1.EICU休克患者的循环血浆游离DNA水平较健康对照组显著升高。2.EICU休克患者入室即刻和24h血浆游离DNA的浓度死亡组显著高于存活组。3.与之前的研究结果一致,24h血乳酸值和入室即刻APACHE II评分对EICU休克患者的28天死亡率具有一定的预测价值。4.多元Logistic回归模型显示48h血浆游离DNA改变率是预测休克患者预后的独立预测因子,其最佳截断值有助于临床医生决策休克患者进一步的治疗方案。5.在本次研究中,休克患者的28天死亡率与患者的年龄、性别无明显相关性。
[Abstract]:Objective: to investigate the prognostic value of plasma free DNA level and its changes in patients with shock in emergency intensive care unit (EICU). Methods: this study is a prospective observational study. From July 2012 to April 2015, 173 patients were admitted to EICU of the first affiliated Hospital of Anhui Medical University and diagnosed as shock. The peripheral venous blood of these shock patients at the time points of 0 hour (0 hour) and 24 hour (24 hour) of 48 hours (48 hours / 48 h), Real-time quantification polymerase chain reaction (real-time quantification Polymerase chain reaction) was used to quantify the plasma free DNA levels of these shock patients at different time points. At the same time, the blood lactic acid level and the Acute Physiology and chronic Health Evaluation score (Apache II) were recorded in the first affiliated Hospital of Anhui Medical University, and the baseline condition of the patients was also selected in the first affiliated Hospital of Anhui Medical University. 30 cases of physical examination were matched as control group. Patients with shock were followed up for 28 days. According to the outcome, they were divided into death group and survival group. The changes of plasma free DNA level at 0 h to 24 h and plasma free DNA level at 48 h were compared between the two groups. The lactate level and Apache II score were compared within 24 hours. The prognostic value of these indexes in patients with shock. Results the levels of plasma free DNA in the death group were significantly higher than those in the surviving group at 0 h, 10 ^ 5pg/ml (2.71 ~ 10 ^ 10 ^ 5-1.98 ~ 10 ^ 6) vs1.20*10 ^ 5pg/ml (4.59 ~ 10 ^ 4-3.12 ~ 10 ^ 5) 5.2310 ^ 5 pg/ml (2.9410 ^ 5-2.0510 ^ 6) vs9.06*10 4 pg/ml (3.3810 ^ 4-3.1910 ^ 5), respectively. The difference was statistically significant (P0.001). The change rate of plasma free DNA level in 48h group was 37.93% (-1.07-137.88%), vs-26.06% (-2.56- 50.96%), the difference was statistically significant (P0.001). In addition, the serum lactate level and Apache II score of shock patients in the death group were significantly higher than those in the survival group (2.38mmol/l (1.56mmol/l-5.62mmol/l) vs1.28mmol/l (0.93mmol/l-2.65mmol/l) and 24.9 卤7.2vs19.3 卤7.1) within 24 hours, respectively. The difference was statistically significant (P0.001). The area under the curve is 0.808 (0.719-0.896), the best truncation value is 635119.5 PG / ml, the sensitivity is 62.2 and the specificity is 89.70.The area under the curve is 0.830 (0.753-0.907), the best truncation value is 325779.5 PG / ml, the sensitivity is 73.3%, the specificity is 89.7%. Multivariate logistic regression model showed that the change rate of plasma free DNA level at 48 hours was an independent predictor of 28 days death in shock patients. The area under the curve is 0.825 (0.741-0.909), the best truncation value is 16.12, the sensitivity is 68.9 and the specificity is 89.7. Conclusion the level of circulating plasma free DNA in EICU shock patients was significantly higher than that in healthy controls. 2. The concentration of plasma free DNA in EICU shock patients was significantly higher than that in survival group. In accordance with the previous study, the 24 h blood lactic acid level and the immediate Apache II score had a certain predictive value for 28 days mortality in EICU shock patients. Multivariate logistic regression model showed that the change rate of plasma free DNA in 48 hours was an independent predictor of the prognosis of shock patients, and its best truncation value was helpful for clinicians to decide the further treatment plan for shock patients. In this study, there was no significant correlation between 28-day mortality and age and gender in 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】：2017
【分类号】：R459.7
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本文编号：2052641