标题：危重症感染患者 IPS评分、PCT、CRP及D-D水平的变化及临床意义

      作者：费志永，董宏，钱秦娟，于维，常媛媛    (天津海滨人民医院重症医学科，天津 300280)

      卷次： 2018年29卷8期

      【摘要】 目的 探讨危重症感染患者感染可能性评分(IPS)、降钙素原(PCT)、C反应蛋白(CRP)及D-二聚体(D-D)水平的变化特点及其临床意义。方法 回顾性分析2016年1月至2017年4月在天津海滨人民医院重症监护室(ICU)治疗的115例危重症患者的临床资料，根据感染标准，其中危重症感染67例（感染组)和危重症非感染48例(非感染组)；同时根据感染组患者预后情况分为存活组21例和死亡组46例；检测所有患者的PCT、CRP、D-D水平，并进行 IPS评分、序贯器官衰竭估计评分(SOFA)和急性生理学与慢性健康状况Ⅱ (APACHEⅡ)评分。结果 感染组和非感染组患者性别、年龄及入 ICU时 SOFA评分比较差异均无统计学意义(P>0.05)；感染组患者入 ICU时APACHEⅡ评分、IPS评分、PCT、CRP和 D-D水平分别为 (23.10±8.22)分、(17.60±3.22)分、(6.54±2.03) ng/mL、(54.22±12.10) ng/mL和(6.44±1.61) mg/L，明显高于非感染组的(17.06±9.03)分、(12.10±4.10)分、(0.31±0.12) ng/mL、(9.87±1.80) ng/mL和(1.22±0.30) mg/L，差异均有统计学意义(P<0.05)；死亡组患者入 ICU时 SOFA、APACHEⅡ评分、IPS评分、PCT、CRP和D-D水平分别为(18.13±3.03)分、(30.19±7.26)分、(24.66±3.09)分、(8.01±2.91) ng/mL、(68.30±11.19) ng/mL和 (8.20±1.53) mg/L，明显高于存活组的 (10.22±3.16)分、(24.03±8.11)分、(16.03±3.53)分、(3.10±1.43) ng/mL、(41.22±9.71) ng/mL和(5.40±1.60) mg/L，差异均有统计学意义(P<0.05)；危重症感染患者PCT与SOFA、APACHEⅡ评分呈正相关(r=0.587、0.601，P<0.05)。结论 相比于危重症非感染患者，危重症感染患者 IPS评分、PCT、CRP及D-D水平明显升高，且与患者预后有一定关系。
      【关键词】 危重症；感染；感染可能性评分；降钙素原；C反应蛋白；D-二聚体
      【中图分类号】 R63 【文献标识码】 A 【文章编号】 1003—6350（2018)08—1108—03

Changes of infection possibility score, procalcitonin, C reactive protein and D-dimer in critically ill infectedpatients and their clinical significance.
FEI Zhi-yong, DONG Hong, QIAN Qin-juan, YU Wei, CHANG Yuan-yuan.Department of Critical Care Medicine, Tianjin Seashore People's Hospital, Tianjin 300280, CHINA
【Abstract】 Objective To investigate the levels and significance of infection possibility score (IPS), procalcito-nin (PCT), C reactive protein (CRP) and D-dimer (D-D) in critically ill patients with infectious diseases. Methods Theclinical data of 115 critically ill patients treated in Intensive Care Unit (ICU) of Tianjin Seashore People's Hospital wereretrospectively analyzed. According to the standard of infection, 67 infected critically ill patients were enroll into the in-fection group and 48 non-infected patients were enrolled into the non-infection group. Further, the patients in the infec-tion group were divided the survival group (n=21) and the death group (n=46) according to the prognosis. The levels ofPCT, CRP and D-D were examined, and the IPS score, sequential organ failure assessment score (SOFA) and acutephysiology and chronic health statusⅡ (APACHEⅡ) score were recorded. Results There was no significant differ-ence in the gender, age and SOFA score entering ICU between the infection group and the non-infected group (P>0.05). APACHEⅡscore entering ICU, IPS score, PCT, CRP and D-D levels in the infection group were (23.10±8.22),(17.60±3.22), (6.54±2.03) ng/mL, (54.22±12.10) ng/mL and (6.44±1.61) mg/L, respectively, which were significantly high-er than corresponding (17.06±9.03), (12.10±4.10), (0.31±0.12) ng/mL, (9.87±1.80) ng/mL and (1.22±0.30) mg/L in thenon-infection group (P>0.05). SOFA score, APACHEⅡ score, IPS score, PCT, CRP and D-D levels when entering ICUin the death group were (18.13±3.03), (30.19±7.26), (24.66±3.09), (8.01±2.91) ng/mL, (68.30±11.19) ng/mL and (8.20±1.53) mg/L, respectively, which were significantly higher than corresponding (10.22±3.16), (24.03±8.11), (16.03±3.53),(3.10±1.43) ng/mL, (41.22±9.71) ng/mL and (5.40±1.60) mg/L in the survival group (P<0.05). In critically ill patients,PCT was positively correlated with SOFA and APACHEⅡ scores (r=0.587, 0.601, P<0.05). Conclusion Compared tothe non-infective critical illness patients, the IPS score, PCT, CRP and D-D levels in critically ill patients are obviouslyhigher, which are also related to the prognosis of the patients.
      【Key words】 Critical illness; Infection; Infection possibility score (IPS); Procalcitonin; C reactive protein (CRP);D-dimer (D-D)·论 著·doi:10.3969/j.issn.1003-6350.2018.08.021基金项目：天津市卫生计生委攻关项目(编号：16KG108)