[1]戴晓勇,陈永珍,华玮,等.血清淀粉样蛋白A,C反应蛋白和降钙素原在脓毒性休克中的应用价值与相关性分析[J].现代检验医学杂志,2019,34(01):47-50.[doi:10.3969/j.issn.1671-7414.2019.01.012]
　DAI Xiao-yong,CHEN Yong-zhen,HUA Wei,et al.Application and Correlation Analysis of Serum Amylase A， C-reactive Protein and Procalcitonin in Septic Shock[J].Journal of Modern Laboratory Medicine,2019,34(01):47-50.[doi:10.3969/j.issn.1671-7414.2019.01.012]
点击复制

血清淀粉样蛋白A,C反应蛋白和降钙素原在脓毒性休克中的应用价值与相关性分析()
分享到：

《现代检验医学杂志》[ISSN:/CN:]

卷:
第34卷
期数:
2019年01期
页码:
47-50
栏目:
论著
出版日期:
2019-02-28

文章信息/Info

Title:
Application and Correlation Analysis of Serum Amylase A， C-reactive Protein and Procalcitonin in Septic Shock
文章编号:
167 1-7414(2019)01-047-04
作者:
戴晓勇; 陈永珍; 华玮; 沈健; 叶宥文; 杨晓英; 石斌
同济大学附属杨浦医院(杨浦区中心医院)急诊科，上海200090
Author(s):
DAI Xiao-yong; CHEN Yong-zhen; HUA Wei; SHEN Jian; YE You-wen; YANG Xiao-ying; SHI Bin
(Department of Emergency，Affiliated Yangpu Hospital of Tongji University，Yangpu District Central Hospital，Shanghai 200090，C hina)
关键词:
脓毒性休克; 血清淀粉样蛋白A; 降钙素原; C反应蛋白; 预后
分类号:
R631；R446.112
DOI:
10.3969/j.issn.1671-7414.2019.01.012
文献标志码:
A
摘要:
目的：分析血清淀粉样蛋白A(SAA)，C反应蛋白(CRP)和降钙 素原(PCT)在脓毒性休克中的诊断及预后的评估价值。方法将同济 大学附属杨浦医院急诊科收治的89例脓毒症患者根据病情分为脓毒性休克组( n =41)、非 脓毒性休克组( n =48)；同时根据预后情况分为预后良好组( n =58)和预后不良组( n =31)。比较各组SAA，PCT，CRP水平及序贯器衰竭评估(SOFA)评分的变化，并分析各炎 症指标联合检测对脓毒性休克患者预后的预测价值。结果与非脓毒 性休克组比较，脓毒性休克组SAA(280.27±14.16 mg/L vs 251.87±25.20 mg/L)，CR P(105.74±23.57 mg/L vs 84.25±15.27 mg/L)，PCT(7.11±2.54 μg/L vs 3.34 ±1.84 μg/L)，SOFA评分(9.03±2.37 vs 5.75±2.05)均明显升高，差异有统计学意 义( t=6.61，5.07，7.97，6.96，均P <0.001)。预后不良组SAA(291.32±15.28 mg/L vs 242.35±24.88 mg/L)，PCT(7.28±2.69 μg/L vs 2.44±1.24 μg/L)，SO FA评分(9.16±2.25 vs 5.34±1.80)较预后良好组显著升高，差异有统计学意义( t=1 1.27，10.77，8.81，均P <0.001)。非脓毒性休克患者SOFA评分与SAA( r=0.372，P =0.041)，PCT( r=0.354，P =0.047)呈显著正相关，而与CRP无显著相关性( r=0. 289，P =0.071)；脓毒性休克患者SOFA评分与SAA( r=0.414，P =0.024)，CRP( r=0 .342，P =0.044)，PCT( r=0.395，P =0.031)均呈显著正相关( P <0.05)。联合 检测预测脓毒性休克患者预后的AUC(0.96 vs 0.84，0.67，0.82)、灵敏度(0.81±0. 21 vs 0.78±0.20，0.60±0.22，0.75±0.25)、特异度(0.74±0.25 vs 0.72±0 .24，0.63±0.17，0.71±0.28)均显著高于SAA，PCT，PCR单独检测( P <0.05)。 结论SAA，PCT和CRP是脓毒性休克患者病情严重程度及预后的有效 评价指标，在SOFA的基础上，联合SAA，PCT，CRP可进一步提高脓毒性休克预后预测的敏感 性。
Abstract:
Objective To explore the evaluation value of s erum amylase A(SAA)，C-reactive protein (CRP) and procalcitonin (PCT) in the di agnosis and prognosis of septic shock．Methods According to the severity of disease，89 patients with sepsis who were admitted in the dep artment of emergency were divided into two groups，including 41 patients of sept ic shock group，48 patients of non-septic shock group．All the patients were al so divided into good prognosis group ( n =58) and poor prognosis group　( n =31) according to the prognosis．SAA，PCT，CRP and SOFA scores were detected and compared， and the efficiency of combined detection in the prediction of progno sis was analyzed．Results Compared with non-septic shock group，SAA(280.27±14.16 mg/L vs 251.87±25.20 mg/L)，CRP(105.74±23.5 7 mg/L vs 84.25±15.27 mg/L)，PCT(7.11±2.54 μg/L vs 3.34±1.84 μg/L) ，SOFA scores (9.03±2.37 vs 5.75±2.05) were significantly increased in septic shock group ( t =6.61，5.07，7.97，6.96，all P <0.001)．SAA (291.32±15.28　mg/L vs 242.35±24.88 mg/L)，PCT(7.28±2.69　μg/L vs 2.4 4±1.24 μg/L)，SOFA scores(9.16±2.25　vs 5.34±1.80) in poor prognosis group were significantly higher than those in good prognosis group ( t =11.27，10.77，8.81，all P <0.001)．SOFA score of patients with non-s eptic shock was positively correlated with SAA ( r=0.372，P =0.041) and PCT 　( r=0.354，P =0.047)， but no correlation with CRP　( r=0.289，P =0.07 1)．SOFA score　was positively correlated with SAA　( r=0.414，P =0.024)，CR P　( r=0.342，P =0.044) and PCT　( r=0.395，P =0.031) in patients with s eptic shock．The AUC　(0.96 vs　0.84，0.67，0.82)，sensitivity　(0.81±0.2 1 vs 0.78±0.20，0.60±0.22，0.75±0.25) and specificity (0.74±0.25 vs 0.72±0.24，0.63±0.17，0.71±0.28) of combined detection in predicting t he prognosis of patients with septic shock were significantly higher than those of SAA，PCT and PCR alone ( P <0.05)．Conclusion SAA， PCT and CRP are effective indicators for evaluating the severity and prognosis of septic shock．On the basis of SOFA，the combination of SAA，PCT and CRP may further improve the sensitivity of prognosis prediction of septic shock．

参考文献/References:


[1］PRAVDA J．Metabolic theory of septic shock［J］．Wo-rld J Cri t Care Med，2014，3(2)：45-54．
[2］SAWICKA W，OWCZUK R，WUJTEWICZ M A，et al．The effectiveness of th e APACHE II，SAPS II and SOFA prognostic scoring systems in patients with haematologica l malignancies in the intensive care unit［J］．Anaesthesiology Intensive Ther， 2014，46(3)：166-170．
[3］刘振国，王婷，王顺达，等．重症肺炎并发脓毒症患者血清降钙素原、血乳酸及 内毒素水平的相关研究［J］．现代检验医学杂志，2017，32(2)：95-97，164． LIU Zenguo，WANG Ti，WANG Sunda，et al．Crelational research of the level of plasma procalcitonin，blood lactic acid and endotoxin in patients o f severe pneumonia complicated with sepsis［J］．Journal of Modern Laboratory Me dicine，2017，32(2)：95-97，164．
[4］NI Min，WEI Wei，WANG Yichao，et al．Serum levels of calreticulin in co rrelation with disease activity in patients with rheumatoid arthritis［J］．J Cl in Immunol，2013，33(5)：947-953．
[5］EKLUND K K，NIEMI K，KOVANEN P T．Immune functions of serum amyloid A ［J］．Crit Rev Immunol，2012，32(4)：335-348．
[6］SINGER M，DEUTSCHMAN C S，SEYMOUR C W，et al．The third internatio nal consensus definitions for sepsis and septic shock(Sepsis-3)［J］．Jourrnal of the Am erican Medical Association，2016，315(8)：801-810．
[7］中国医师协会急诊医师分会，中国研究型医院学会休克与脓毒症专业委员会．中国 脓毒症/脓毒性休克急诊治疗指南(2018)［J］．中国急救医学，2018，38(9)：741-756． Emergency Physicians Branch of Chinese Medical Association，Shock an d Sepsis Committee of Chinese Research Hospital Society．Guidelines for emergen cy treatment of sepsis/septic shock in China(2018)［J］．Chinese Journal of Crit ical Care Medicine，2018，38(9)：741-756．
[8］刘大为．实用重症医学［M］．北京：人民卫生出版社，2010：1036． LIU Dawei．Practice of critical care medicine［M］．Beijing：People ’s Health Publishing House，2010：1036．
[9］RIU J A，YANG J H，LEE D，et al．Clinical usefulness of procalcitonin an d C-reactive protein as outcome predictors in critically ill patients with seve re sepsis and septic shock［J］．PLoS One，2015，10(9)：e0138150．
[10］GARCIA de GUADIANA-ROMUALDO L M，REBOLLO-ACEBES S，ESTEBAN-TO RRELLA P，et al．Prognostic value of lipopolysaccharide binding protein and procalcitonin in patients with severe sepsis and septic shock admitted to inten sive care［J］．Med Intensiva，2015，39(4)：207-212．
[11］LIU Shiwen，HOU Yunxiu，CUI Haili．Clinical values of the early detectio n of se rum procalcitonin，C-reactive protein and white blood cells for neonates with i nfectious diseases［J］．Pak J Med Sci，2016，32(6)：1326-1329．
[12］ANAND D，DAS S，BHARGAVA S，et al．Procalcitonin as a rapid diagn ostic biomarker to differentiate between culture-negative bacterial sepsis and systemic inflammatory response syndrome：aprospective，observational，cohort stu dy［J］．J Crit Care，2015，30(1)：7-12．
[13］NGUYEN K D，MACAUBAS C，TRUONG P，et al．Serum amyloid A induces m itogenic signals in regulatory T cells via monocyte activation［J］．Mol Immunol ，2014，59 (2) ：172-179．
[14］韦广莹，卢荣恒，李晶．血清超敏C反应蛋白、血清样淀粉酶A与降钙素原对脓毒 症患者的预测价值［J］．中华危重症医学杂志(电子版)，2015，8(4)：235-240． WEI Guangying，LU Rongheng，Li Jing．Predictive value of serum high-s ensitivity C-reactive protein，serum amyloid A and procalcitonin in patients wi th sepsis［J］．Chinese Journal of Critical Care Medicine(Electronic Edition)，2 015，8(4)：235-240．
[15］YU MH，CHEN MH，HAN F，et al．Prognostic value of the biomarkers seru m amyloid A and nitric oxide in patients with sepsis［J］．Int Immunopharmacol， 2018，62(4)：287-292．
[16］TOWNSEND TR．Can serum amyloid A concentration s aid diagnosis of synovial sepsis［J］．Vet Rec，2017，181(16)：423-424．

相似文献/References:

[1]罗 强,刘振杰,徐 宁,等.联合检测SAA,hs-CRP,PCT和WBC在广东地区不同年龄人群感染患者诊断价值的多中心分析[J].现代检验医学杂志,2015,30(04):39.[doi:10.3969/j.issn.1671-7414.2015.04.010]
　LUO Qiang,LIU Zhen-jie,XU Ning,et al.Multicenter Study on Serum Amyloid A Protein, High-Sensitivity C-Reactive Protein and Procalcitonin in Combining Diagnosis of Infection in Different Population from Guangdong[J].Journal of Modern Laboratory Medicine,2015,30(01):39.[doi:10.3969/j.issn.1671-7414.2015.04.010]
[2]焦荣红a,沈海涛,王淑芬a,等.类风湿关节炎患者血清淀粉样蛋白A和C反应蛋白水平与疾病活动度的关系[J].现代检验医学杂志,2019,34(01):55.[doi:10.3969/j.issn.1671-7414.2019.01.014]
　JIAO Rong-honga,SHEN Hai-tao,WANG Shu-fe na,et al.Relationship between Serum Amyloid A and C-reactive Protein in Patients with Rheumatoid Arthritis and Activity of Disease[J].Journal of Modern Laboratory Medicine,2019,34(01):55.[doi:10.3969/j.issn.1671-7414.2019.01.014]
[3]李福刚,雷 蕾,石晓强,等.血清淀粉样蛋白A(SAA)水平检测在临床实验诊断及健康监测中的应用[J].现代检验医学杂志,2019,34(03):1.[doi:10.3969/j.issn.1671-7414.2019.03.001]
　LI Fu-Gang,LEI Lei,SHI Xiao-qiang,et al.Serum Amyloid A(SAA)Test in Clinical Diagnosis and Health Monitoring[J].Journal of Modern Laboratory Medicine,2019,34(01):1.[doi:10.3969/j.issn.1671-7414.2019.03.001]
[4]宋事竑,曾而明.血清淀粉样蛋白A 与血管新生最新研究进展[J].现代检验医学杂志,2020,35(02):157.[doi:10.3969/j.issn.1671-7414.2020.02.043]
　SONG Shi-hong,ZENG Er-ming.Recent Advances in Serum Amyloid A and Angiogenesis[J].Journal of Modern Laboratory Medicine,2020,35(01):157.[doi:10.3969/j.issn.1671-7414.2020.02.043]

备注/Memo

备注/Memo:
基金项目：上海市卫生和计划生育委员会项目(编号：2018 40314)。
作者简介：戴晓勇(1974-)，男，本科，主治医师，研究方向：急 诊及危重症方向，E-mail：xiaoyong_dai8@126.com。
通讯作者：石斌(1969-)，主任医师，E-mail：24639385@qq. com。
更新日期/Last Update: 2019-02-28