标题：脓毒症合并急性肺损伤患者SOFA评分、APACHEⅡ评分、炎症因子水平变化及临床意义

      作者：杨晓英，庞秀峰，朱玉琴，樊锐，冯忠强    上海市杨浦区中心医院(同济大学附属杨浦医院)急诊科，上海 200090

      卷次： 2023年34卷12期

      【摘要】 目的 探讨脓毒症合并急性肺损伤(ALI)患者序贯性器官衰竭评分(SOFA)、急性生理与慢性健康状况评分Ⅱ (APACHEⅡ)、炎症因子水平的变化及其临床意义。方法 回顾性分析2020年1月至2022年5月期间上海市杨浦区中心医院收治的100例脓毒症合并ALI患者(观察组)临床资料，选择本院同期单纯脓毒症患者80例作为研究组，在我院行体检的80例健康者作为对照组。依据观察组患者病情严重程度分为低危组32例[急性生理与慢性健康状况评分(APACHEⅡ)<10分)]、中危组30例(APACHEⅡ评分10~20分)和高危组38例(APACHEⅡ评分>20分)。依据观察组患者的临床结局分为存活组59例和死亡组41例。比较观察组、研究组和对照组及不同病情不同严重程度、不同预后患者的SOFA评分、APACHEⅡ评分及白细胞介素-22 (IL-22)、肿瘤坏死因子-α (TNF-α)、C反应蛋白(CRP)、降钙素原(PCT)水平，采用Pearson相关性分析法分析炎症因子与SOFA评分、APACHEⅡ评分的相关性。结果 观察组患者的SOFA评分、APACHEⅡ评分、IL-22、TNF-α、CRP、PCT水平明显高于研究组和对照组，而研究组患者的上述指标明显高于对照组，差异均有统计学意义(P<0.05)；随着观察组患者病情严重程度的加重，SOFA评分、APACHEⅡ评分、IL-22、TNF-α、CRP、PCT水平也随之升高，其中高危组明显高于中危组，而中危组明显高于低危组，差异均有统计学意义(P<0.05)；死亡组患者的SOFA评分、APACHEⅡ评分、IL-22、TNF-α、CRP、PCT明显高于存活组，差异均有统计学意义(P<0.05)；经Pearson相关性分析结果显示，PCT、IL-22、TNF-α、CRP水平与SOFA评分、APACHEⅡ评分均呈正相关性(P<0.05)。结论 脓毒症合并ALI患者的SOFA评分、APACHEⅡ评分及炎症因子均呈高表达状态，且与病情具有良好的相关性，密切监测上述指标变化对评估病情严重程度、预后有较高的价值。
      【关键词】 脓毒症；急性肺损伤；序贯性器官衰竭评分；急性生理与慢性健康状况评分；炎症因子；相关性
      【中图分类号】 R631 【文献标识码】 A 【文章编号】 1003—6350（2023）12—1692—04

Changes and clinical significance of sequential organ failure assessment score, acute physiological and chronichealth evalution Ⅱ score, and inflammatory factors level in patients with sepsis complicated with acute lunginjury.
YANG Xiao-ying, PANG Xiu-feng, ZHU Yu-qin, FAN Rui, FENG Zhong-qiang. Department of Emergency,Shanghai Yangpu District Central Hospital (Yangpu Hospital Affiliated to Tongji University), Shanghai 200090, CHINA
【Abstract】 Objective To investigate the changes and clinical significance of sequential organ failure assess-ment (SOFA), acute physiological and chronic health evalution Ⅱ (APACHE Ⅱ), inflammatory factors in patients withsepsis complicated with acute lung injury (ALI). Methods The clinical data of 100 patients with sepsis complicatedwith ALI (observation group) admitted to Shanghai Yangpu District Central Hospital from January 2020 to May 2022were retrospectively analyzed. Eighty patients with simple sepsis in the hospital during the same period were selected asthe study group, and 80 healthy people who underwent physical examination in the hospital were selected as the controlgroup. According to the severity of the disease, the patients in the observation group were divided into low-risk group(32 patients, APACHEⅡ<10), middle-risk group (30 patients, APACHEⅡ score 10 to 20), and the high-risk group(38 patients, APACHE Ⅱscore>20). According to the clinical outcome, the patients of the observation group were divid-ed into survival group (59 cases) and death group (41 cases). The SOFA score, APACHE Ⅱ score, interleukin-22(IL-22), tumor necrosis factor-α (TNF-α), C-reactive protein (CRP), and procalcitonin (PCT) levels were comparedamong the observation group, the study group and the control group, as well as patients with different severity and prog-nosis. Pearson correlation analysis was used to analyze the correlation between inflammatory factors and SOFA scoreand APACHE Ⅱ score. Results The levels of SOFA score, APACHE Ⅱ score, IL-22, TNF-α, CRP, and PCT in the ob-servation group were significantly higher than those in the study group and the control group, while the above indicatorsin the study group were significantly higher than those in the control group, with statistically significant differences (P<0.05). As the severity of the patient's condition in the observation group worsened, the levels of SOFA score, APACHE Ⅱscore, IL-22, TNF-α, CRP, and PCT also increased; the levels were significantly higher in the high-risk group than themiddle-risk group, and also in middle-risk group than low-risk group, with statistically significant differences (P<0.05).The scores of SOFA, APACHE Ⅱ, IL-22, TNF-α, CRP, and PCT in the death group were significantly higher than thosein the survival group, with statistically significant differences (P<0.05). Pearson correlation analysis showed that the lev-els of PCT, IL-22, TNF-α, and CRP were positively correlated with SOFA scores and APACHE Ⅱ scores (P<0.05).Conclusion The SOFA score, APACHE Ⅱ score, and inflammatory factors in patients with sepsis complicated withALI are highly expressed, and have a good correlation with the disease. Close monitoring of the changes of the above in-dicators has a high value in evaluating the severity and prognosis of the disease.
      【Key words】 Sepsis; Acute lung injury; Sequential organ failure assessment score; Acute physiology and chronichealth evalution Ⅱ score; Inflammatory factors; Correlation