Value of serum procalcitonin, lactic acid and endotoxindetections in evaluating progress of disease and prognosis in patients with severe pneumonia complicated with sepsis
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摘要:目的 探讨血清降钙素原(PCT)、血乳酸(Lac)、内毒素(LPS)检测在评估重症肺炎合并脓毒症病情进展及预后中的价值。方法 回顾性分析90例重症肺炎合并脓毒症患者的临床资料，入院后均行急性生理与慢性健康评分(APACHE Ⅱ评分)。根据患者脓毒症病情程度分为脓毒症组(n=37)、严重脓毒症组(n=35)和脓毒症休克组(n=18), 根据住院预后生存情况分为生存组(n=74)和死亡组(n=16)。检测患者入住ICU后24 h内的血清PCT、Lac、LPS水平，比较3组上述指标差异。采用Pearson法分析血清PCT、Lac、内毒素水平与APACHE Ⅱ评分的相关性。结果 3组的血清PCT、Lac、LPS水平两两比较，差异均有统计学意义(P < 0.05)。生存组血清PCT、Lac、LPS水平显著低于死亡组(P < 0.05)。重症肺炎合并脓毒症患者血清PCT、Lac、LPS水平与入院APACHE Ⅱ评分均呈显著正相关(P < 0.05)。结论 早期加强血清PCT、Lac、LPS水平检测，对评估重症肺炎合并脓毒症病情进展、指导临床干预措施和改善预后有重要意义。Abstract:Objective To explore the value of serum procalcitonin (PCT), lactic acid (Lac) and endotoxin (LPS) detection in evaluating the progress of disease and prognosis in patients with severe pneumonia complicated with sepsis.Methods The clinical materials of 90 patients with severe pneumonia complicated with sepsis were retrospectively analyzed. After hospital admission, all the patients were evaluated by the Acute Physiology and Chronic Health Score (APACHE Ⅱ). The patients were conducted with evaluation of divided into sepsis group (n=37), severe sepsis group (n=35) and septic shock group (n=18) according to severity of disease, and they were also divided into survival group (n=74) and death group (n=16) according to the prognosis. Serum PCT, Lac and LPS levels were measured within 24 hours after ICU admission, and the differences among the three groups were compared. Pearson method was used to analyze the correlations between serum PCT, Lac, endotoxin level and APACHE Ⅱscore.Results There were significant differences in levels of PCT, Lac and LPS among three groups (P < 0.05). Serum PCT, Lac and LPS levels in survival group were significantly lower than those in death group (P < 0.05). Serum PCT, Lac and LPS levels in severe pneumonia patients with sepsis were positively correlated with APACHE Ⅱscores on hospital admission (P < 0.05).Conclusion Early detections of serum PCT, Lac and LPS levels are of great significance in evaluating the progress of disease in severe pneumonia patients complicated with sepsis, guiding clinical intervention and improving prognosis.
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Keywords:
- severe pneumonia /
- sepsis /
- procalcitonin /
- blood lactic acid /
- endotoxin /
- severity of disease /
- prognosis
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表 1 3组血清PCT、Lac、LPS水平比较(x±s)
指标 脓毒症组(n=37) 严重脓毒症组(n=35) 脓毒症休克组(n=18) PCT/(ng/mL) 1.37±0.72 3.58±1.18* 5.93±1.42*# Lac/(mmol/L) 1.95±0.61 3.74±1.07* 6.25±1.58*# LPS/(pg/mL) 12.51±2.35 17.48±3.72* 25.36±4.45*# PCT:降钙素原; Lac:血乳酸; LPS:内毒素。
与脓毒症组比较, *P < 0.05;与严重脓毒症组比较, #P < 0.05。
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表 2 生存组与死亡组血清PCT、Lac、LPS水平比较(x±s)
组别 n PCT/(ng/mL) Lac/(mmol/L) LPS/(pg/mL) 生存组 74 2.72±0.75 2.85±0.81 14.32±4.03 死亡组 16 5.93±1.62* 6.04±1.94* 26.18±3.96* PCT:降钙素原; Lac:血乳酸; LPS:内毒素。
与生存组比较, *P < 0.05。
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