血浆降钙素原和C反应蛋白对多发伤病人预后评估的价值

doi:10.16139/j.1007-9610.2021.06.015

摘要/Abstract

摘要：

目的：探索血浆降钙素原（procalcitonin, PCT）及C反应蛋白（C?reactive protein, CRP）对多发伤病人预后的价值。方法：选取2016年1月至2019年12月期间在苏州大学附属第三医院医院急诊科331例多发伤病人的临床资料，按照入院28天发生死亡情况分为生存组和死亡组。比较两组病人入院血浆PCT及CRP及其与预后的关系。结果：331例病人中男性多于女性（247比84），生存组306例（92.4%），死亡组25例（7.6%）。死亡组收缩压、舒张压、血红蛋白和白蛋白低于生存组（P<0.05）。死亡组病人心率、凝血酶原时间、D?二聚体以及血丙氨酸转氨酶、天冬氨酸转氨酶、血糖、肌酐、肌酸激酶、乳酸、乳酸脱氢酶、CRP及PCT均高于生存组（P<0.05）。按PCT和CRP分组病人，死亡率差异均有统计学意义（P<0.05）。趋势性检验显示，随PCT和CRP的升高，病人死亡率有上升趋势（P_trend<0.001）。相关分析结果显示PCT与CRP值呈正相关（r=0.176，P=0.001）。受试者工作特征曲线显示PCT联合CRP对多发伤病人发生死亡风险预测能力（AUC=0.874）大于PCT（AUC=0.795）和CRP（AUC=0.733）。结论：PCT和CRP对多发伤病人损伤严重程度及预后有较好的预测价值及临床指导意义。

关键词: 降钙素原, C反应蛋白, 多发伤, 预后

Abstract: Objective To explore prognotic significance of plasma procalcitonin (PCT) and C?reactive protein (CRP) in evaluation of multiple trauma patients. Methods The clinical data of 331 multiple trauma patients were collected in Department of Emergency, the Third Affiliated Hospital of Soochow University from January 2016 to December 2019. Patients were divided into survival group at day 28 survived after admission and death group. Plasma PCT and CRP levels at admission associated with prognosis were compared between two groups. Results Of 331 patients with more males than females (247 vs. 84), 306 (92.4%) were in survival group and 25(7.6%) in death group. Systolic pressure, diastolic pressure, hemoglobin, and albumin levels were lower in death group than those in survival group(P<0.05). Heart rate, prothrombin time, D-dimers, alanine aminotransferase, aspartate aminotransferase, glucose, creatinine, creatine kinase, lactic acid, lactate dehydrogenase, CRP, and PCT in serum were all higher in death group than those in survival group (P<0.05). The difference in mortality was statistically significant among the patients grouping based on PCT or CRP levels (P<0.05). Trend test showed an upward trend of mortality of patients when PCT and CRP levels increased (P_trend<0.001). PCT level correla-ted positive with CRP indicated by correlation analysis(r=0.176, P=0.001). Receiver operating characteristic curve showed that prediction on risk of death in multiple trauma patients was greater when using PCT combined with CRP [area under curve (AUC)=0.874] than PCT (AUC=0.795) and CRP (AUC=0.733). Conclusions PCT and CRP levels would have good predictive power in the evaluation of severity and prognosis of multiple trauma patients and would be important in clinical practice.

Key words: Procalcitonin, C-reactive protein, Multiple trauma, Prognosis

中图分类号:

沐阳, 陈欣. 血浆降钙素原和C反应蛋白对多发伤病人预后评估的价值[J]. 外科理论与实践, 2021, 26(06): 532-536.

MU Yang, CHEN Xin. Prognotic significance of plasma procalcitonin and C⁃reactive protein in evaluation of multiple trauma patients[J]. Journal of Surgery Concepts & Practice, 2021, 26(06): 532-536.

图/表 6

表1

病人基本情况和血液检查结果

项目	生存组(n=306)	死亡组(n=25)	P值
性别(n/%)			0.686
女	79 (25.8)	5 (20.0)
男	227 (74.2)	20 (80.0)
平均年龄（岁）（$\bar{x}±s$）	48.18±15.60	52.52±17.17	0.185
受伤方式(n/%)			0.233
爆炸	14 (4.6)	0
车祸	188 (61.4)	16 (64.0)
斗殴	12 (3.9)	0
电击	3 (1.0)	0
坠落	62 (20.3)	7 (28.0)
摔伤	11 (3.6)	0
砸伤	11 (3.6)	0
其他	5 (1.6)	2 (8.0)
伤型(n/%)			0.166
闭合伤	229 (74.8)	15 (60.0)
开放伤	77 (25.2)	10 (40.0)
腋下体温（℃）[M (Q₂₅, Q₇₅)]	36.70 (36.50, 36.90)	36.50 (36.20, 36.90)	0.178
心率（次/min）[M (Q₂₅, Q₇₅)]	84.00 (75.00, 98.00)	99.00 (83.00, 121.00)	0.004
呼吸（次/min）[M (Q₂₅, Q₇₅)]	20.00 (19.00, 24.00)	22.00 (18.00, 27.00)	0.360
收缩压（mmHg）[M (Q₂₅, Q₇₅)]	130.00 (116.00, 148.00)	101.00 (92.00, 123.00)	<0.001
舒张压（mmHg）[M (Q₂₅, Q₇₅)]	80.50 (70.00, 91.00)	63.00 (42.00, 72.00)	<0.001
WBC（×10⁹/L）[M (Q₂₅, Q₇₅)]	10.80 (4.83, 15.78)	14.10 (3.79, 20.70)	0.693
Hb（g/L）[M (Q₂₅, Q₇₅)]	135.00 (119.00, 149.00)	119.00 (98.00, 138.00)	0.009
血小板（×10⁹/L）[M (Q₂₅, Q₇₅)]	191.00 (151.50, 233.75)	203.00 (139.00, 254.00)	0.991
PT（s）[M (Q₂₅, Q₇₅)]	12.00 (11.40, 12.90)	13.20 (12.50, 17.40)	<0.001
D（mg/L）[M (Q₂₅, Q₇₅)]	12.54 (4.57, 28.24)	40.00 (13.67, 40.00)	0.001
纤维蛋白原（g/L）[M (Q₂₅, Q₇₅)]	2.12 (1.71, 2.54)	2.17 (1.51, 2.71)	0.972
TBIL（μmol/L）[M (Q₂₅, Q₇₅)]	11.30 (8.03, 15.20)	11.80 (7.80, 17.70)	0.497
ALB（g/L）[M (Q₂₅, Q₇₅)]	38.50 (34.30, 42.40)	29.90 (27.00, 37.90)	<0.001
ALT（U/L）[M (Q₂₅, Q₇₅)]	41.00 (29.00, 62.00)	48.00 (37.00, 62.00)	0.047
AST（U/L）[M (Q₂₅, Q₇₅)]	48.50 (33.25, 78.00)	64.00 (58.00, 118.00)	0.002
Glu（mmol/L）[M (Q₂₅, Q₇₅)]	7.15 (6.20, 8.80)	12.40 (8.10, 14.30)	<0.001
Crea（μmol/L）[M (Q₂₅, Q₇₅)]	65.00 (55.00, 76.00)	73.00 (63.00, 106.00)	0.002
CK（U/L）[M (Q₂₅, Q₇₅)]	309.00 (176.00, 631.00)	724.00 (338.00, 1 399.00)	0.003
血乳酸（mmol/L）[M (Q₂₅, Q₇₅)]	1.80 (1.10, 2.90)	5.00 (2.40, 6.60)	<0.001
LDH（U/L）[M (Q₂₅, Q₇₅)]	837.00 (639.25, 1 186.75)	1 147.00 (842.00, 1 491.00)	0.002
CRP（mg/L）[M (Q₂₅, Q₇₅)]	8.49 (6.47, 12.11)	12.84 (9.34, 23.02)	<0.001
PCT（μg/L）[M (Q₂₅, Q₇₅)]	0.24 (0.06, 0.74)	1.25 (0.47, 8.20)	<0.001

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参考文献 17

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PCT（μg/L）分组	n	生存	死亡	死亡率（%）	CRP（mg/L）[M（Q₂₅, Q₇₅）]
<0.5	207	199	8	3.86	8.12 (6.30，11.52)
0.5~2.0	104	96	8	7.69	9.80 (7.64，15.75)
>2.0	20	11	9	45.00	9.97 (7.87，17.84)
χ²值				44.202	16.40
P值				<0.001， P_trend<0.001	<0.001

CRP（mg/L）分组	病例（n）	生存（n）	死亡（n）	死亡率（%）	PCT（μg/L）[M（Q₂₅, Q₇₅）]
<10.0	200	193	7	3.50	0.22 (0.06，0.66)
10.0~50.0	118	105	13	11.02	0.39 (0.10，1.08)
>50.0	13	8	5	38.46	0.74 (0.44，1.69)
χ²值				24.52	12.69
P值				<0.001， P_trend<0.001	0.002

预测指标	AUC	误差	95%CI
PCT（μg/L）	0.795	0.103	0.692~0.897
CRP（mg/L）	0.733	0.098	0.635~0.831
两者联合	0.874	0.028	0.844~0.901