%0 Journal Article %T 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 %A 王春梅 %A 唐伦先 %A 徐慧晖 %A 张晓明 %A 白建文 %J 同济大学学报(医学版) %D 2018 %R 10.16118/j.1008-0392.2018.01.017 %X 目的 探讨降钙素原(procalcitonin, PCT)及乳酸（lactate,Lac）水平在老年脓毒症患者体内变化规律及其与预后的关系。方法 选取住院的脓毒症患者(普通脓毒症32例和脓毒性休克26例)，29例社区获得性肺炎作为肺炎对照组和22例健康老年体检者作为健康对照组。分别检测普通脓毒症及脓毒性休克患者入院后第1、3及7天和健康对照组及肺炎对照组外周血Lac、PCT和CRP水平。所有患者随访28d，根据预后分为存活组和死亡组。结果 普通脓毒症及脓毒性休克各时间点外周血PCT、CRP、Lac水平均显著高于对照组（P均＜0.05或P＜0.01）。入院后第1天，普通脓毒症死亡组PCT水平明显升高（P＜0.05），而脓毒性休克组死亡组PCT却下调（P＜0.05）。脓毒性休克存活组第3天乳酸清除率（lactate clearance rate, LCR）明显高于死亡组（P＜0.05）。ROC曲线分析显示： 入院后第1天，PCT对老年脓毒症患者及脓毒症休克患者死亡预测的AUC分别为0.741和0.817；入院后第3天，LCR对老年脓毒性休克患者死亡预测的AUC为0.903，PCT和第3天LCR对评估预后均有较好敏感性及特异性。结论 老年脓毒症患者外周血Lac、PCT和CRP高于社区获得性肺炎患者，且PCT、LCR可以预测脓毒性休克患者死亡风险。</br>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 d1 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=0.0065). 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 d1 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 %K 脓毒症 乳酸 降钙素原 老年人< %K /br> %K sepsis procalcitonin lactate elderly %U http://tjyxxb.cnjournals.cn/ch/reader/view_abstract.aspx?file_no=20180117&flag=1