【摘要】 目的 :探讨重症监护室(intensive care unit,ICU)超高水平血清降钙素原(procalcitonin,PCT)患者的预后影响因素。方法:采用回顾性研究方法,收集2016年12月至2017年11月南京医科大学第一附属医院收治的ICU住院期间PCT>100μg/L的63例患者的临床资料。按照入住ICU后28 d预后分为存活组和死亡组,比较2组患者的临床资料,分析影响该类患者预后的危险因素。结果:63例患者PCT升高的主要原因为腹腔感染(21例,33.3%)、肺部感染(18例,28.6%)、非感染性炎症反应(14例,22.2%)等。单因素分析发现,死亡组患者多器官功能障碍综合征(multiple organ dysfunction syndrome,MODS)的发生率、血乳酸、急性生理与慢性健康评价(acute physiology and chronic health evaluation,APACHE)Ⅱ评分等指标均明显高于存活组,差异具有统计学意义(均P<0.05);多因素分析发现,APACHEⅡ评分是影响超高水平血清PCT患者预后的危险因素。结论:ICU超高水平血清PCT患者常见的原因是感染,其次为非感染性炎症反应等。此类患者的预后与血乳酸水平、发生MODS和APACHEⅡ评分等密切相关,而APACHEⅡ评分是影响该类患者预后的独立危险因素。更多还原

【Abstract】 Objective To explore the prognostic factors of patients with ultra-high level of serum procalcitonin(PCT in intensive care unit(ICU). Methods The clinical data of ICU patients with PCT>100 μg/L in the First Affiliated Hospital of Nanjing Medical University from December 2016 to November 2017 were analyzed retrospectively. According to the 28-day death after admission to ICU, the patients were divided into survival group and death group. The clinical parameters of the two groups were compared, and the risk factors influencing the prognosis of these patients were analyzed with Logistic regression analysis. Results A total of 63 ICU patients with PCT >100 μg/L were enrolled in the study. The main causes of ultra-high level of serum PCT were abdominal infection(21 cases, 33.3%), pulmonary infection(18 cases, 28.6%), noninfectious inflammation(14 cases, 22.2%). Univariate analysis showed that the occurrence of multiple organ dysfunction syndrome(MODS), blood lactic acid level, and acute physiology and chronic health evaluation( APACHE) Ⅱ score in the death group were significantly higher than those in the survival group, the difference was statistically significant(all P<0.05). Multivariate analysis demonstrated that APACHE Ⅱ score was the independent risk factors for prognosis in patients with ultra-high serum level of PCT. Conclusions Infection is the common cause of ultra-high level of serum PCT in ICU patients, and the sites of infection are abdominal cavity and lung; non-infectious inflammatory reaction is also a commonly seen cause. ICU patients with ultra-high level of serum PCT have a poor prognosis, and is closely correlated with blood lactic acid level, occurrence of MODS and APACHE Ⅱ score. APACHEⅡ score is the independent risk factor influencing the prognosis of these patients.更多还原