降钙素原和白介素-6在老年复杂性腹腔感染患者预后评估中的意义

The Value of Procalcitonin and Interleukin-6 in Prognostic Evaluation of Elderly Patients with Complicated Intra-abdominal Infections

中文关键词: 降钙素原  白介素-6  APACH Ⅱ评分  腹腔感染  老年患者

英文关键词: procalcitonin (PCT)  interleukin-6 (IL-6)  APACHE II score  intra-abdominal infection  elderly patient

中文摘要:

      目的 探讨降钙素原(PCT)联合白介素-6(IL-6)对老年复杂性腹腔感染患者预后的评估意义.方法 回顾性分析2013年1月-2016年9月上海交通大学附属第一人民医院ICU病房腹腔感染患者的临床资料,年龄≥60岁,按其预后分为存活组和危亡组2组.观察性别、年龄、主要诊断、住院天数;入院24 h内APACHEⅡ评分和SOFA评分;入院24h内PCT、IL-6、C反应蛋白(CRP)、内毒素、白细胞计数、中性粒细胞比例;腹腔病原菌培养结果.结果 共计纳入67例老年腹腔感染患者,平均住院天数11(8,18)d,死亡率43.30％.入院24 h内的PCT、IL-6均与APACHII评分和SOFA评分呈正相关.死亡组APAPCH II评分和SOFA评分高于存活组(P＜0.05).死亡组住院天数少于存活组(P＜0.05).死亡组PCT和IL-6高于存活组(P＜0.05).死亡组白细胞计数和中性粒细胞比例低于存活组(P＜0.05).死亡组内毒素和CRP与存活组比较差异无统计学意义(P＞0.05).死亡组患者致病菌主要以革兰氏染色阴性菌(37％)和真菌(30％)为主.PCT和IL-6的ROC曲线下面积分别为:(0.817±0.082)、(0.817±0.081),截断值分别为84.985ng/mL、IL-6 4 675 pg/mL.结论 PCT和IL-6对老年复杂性腹腔感染患者病情严重程度评估及其预后的判断可能有一定的指导作用,可帮助临床医师早期识别高危人群.

英文摘要:

      Objective To explore the value of procalcitonin (PCT) and interleukin-6 (IL-6) in the prognostic evaluation of the elderly patients with complicated intra-abdominal infections (CIAI).Methods A retrospective analysis was made to the clinical data of the cases,aged ≥60 years,with CIAI in ICU,the 1st People's Hospital affiliated to Shanghai Jiao Tong University during the period from Jan.,2013 to Sept.,2016;the cases were divided into 2 groups according to the prognosis:survival group and death group;observation was made to the sex,age,main diagnosis and hospitalization days;the scores of APACHE Iand SOFA,PCT,IL-6,C-reactive protein (CPR),endotoxin,white blood cell count,neutrophil percentage and abdominal pathogen culture result within 24 hours after admission were studied.Results In total,67 elderly patients with CIAI were enrolled;the average of hospitalization duration was 11 days (8,18),the death rate was 43.30 ％;PCT and IL-6 within 24 hours after admission were positively correlated to the scores of APACH II and SOFA;the scores of APACH H and SOFA,the levels of PCT and IL-6 in death group were higher than those in survival group (P＜ 0.05);the hospitalization duration of the cases in death group was shorter than that of the cases in survival group (P＜0.05);the white blood cell count and neutrophil percentage in death group were lower than those in survival group (P＜0.05);there existed no statistical difference in the levels of endotoxin and CRP between the 2 groups (P＞0.05);the major pathogens in death group were gram-negative bacilli (37％) and fungi (30％);the areas under ROC curve for PCT and IL-6 were (0.817 ±0.082) and (0.817 ±0.081) respectively,and the cutoff value of PCT was 84.985 ng/mL and that of IL-6 was 4 675 pg/mL.Conclusions PCT and IL-6 may be of certain guiding role in the assessment of the severity of CIAI in elderly patients and in the prognosis evaluation,and may help clinicians to identify high-risk groups earlier.