同济大学学报（医学版）2018，Vol.39Issue(1)：89-93,5.DOI:10.16118/j.1008-0392.2018.01.017
老年脓毒症患者血浆降钙素原和乳酸浓度动态变化特征及其预后意义
Plasma procalcitonin and lactate levels in elderly patients with sepsis and their clinical significance
摘要
Abstract
Objective To investigate the relationship between plasma procalcitonin,lactate levels and the prognosis of elderly patients with sepsis and septic shock.Methods Thirty-two elderly patients with sepsis,26 patients with septic shock were enrolled in the study;22 healthy elderly subjects (normal control group) and 29 patients with community acquired pneumonia (CAP control group) were also included.The plasma procalditonin(PCT),lactate and C-reaction protein (CRP) levels were measured at d1,d3 and d7 of admission.Acute physiology and chronic health evaluation Ⅱ(APACHE Ⅱ) score and sequential organ failure assessment score (SOFA) were assessed.Patients with sepsis were followed up for 28 days and the fatality cases were documented.Results The plasma PCT,lactate,CRP levels,and APACHE Ⅱ and SOFA scores in patients with sepsis and septic shock were higher than those in healthy control and pneumonia groups at all time points(P＜0.05 or P＜0.01).Plasma PCT level at dl in fatal patients of sepsis group was higher than that in survival group;while it was lower in fatal patients of septic shock group than that in survival group (P＜0.05).SOFA score at d3 in fatal patients of sepsis group was higher than that in survival patients (P ＜ 0.05);the lactate clearance rate at d3 in survival patients of septic shock group was significantly higher than that in fatal patients (P =0.006 5).The APACHE Ⅱ score,SOFA score and CRP level in the fatal patients were higher than those in the survival patients(P＞0.05).ROC curve analysis showed that the area under curve(AUC) of PCT at dl were 0.741 and 0.817 in predicting the mortality for septic patients and septic shock patients,respectively;the AUC of lactic acid clearance rate at d3 was 0.903 in predicting mortality for septic shock patients.Both indexes had better sensitivity and specificity in prognosis.Conclusion Plasma lactate,PCT,CRP levels,and APACHE and SOFA scores are increased in elderly patients with sepsis;and PCT and the lactate clearance rate may predict the risk of death in patients with sepsis and septic shock.关键词
脓毒症/乳酸/降钙素原/老年人Key words
sepsis/procalcitonin/lactate/elderly分类
医药卫生引用本文复制引用
王春梅,唐伦先,徐慧晖,张晓明,白建文..老年脓毒症患者血浆降钙素原和乳酸浓度动态变化特征及其预后意义[J].同济大学学报（医学版）,2018,39(1):89-93,5.基金项目
国家自然科学基金(31470879、81670067) （31470879、81670067）
上海市科委科研计划(15411962300) （15411962300）
