[1]詹雪,GARCIA Mateo（美国）,王郝.降钙素原清除率、24 h乳酸清除率和MEDS评分与脓毒症预后关系研究[J].陕西医学杂志,2025,54(8):1045-1049.[doi:DOI:10.3969/j.issn.1000-7377.2025.08.007]
　ZHAN Xue,GARCIA Mateo,WANG Hao.Relationship between procalcitonin clearance,24-hour lactate clearance rate，MEDS score and the prognosis of sepsis[J].,2025,54(8):1045-1049.[doi:DOI:10.3969/j.issn.1000-7377.2025.08.007]
点击复制

降钙素原清除率、24 h乳酸清除率和MEDS评分与脓毒症预后关系研究

《陕西医学杂志》[ISSN:1000-7377/CN:61-1281/TN]

卷:
54
期数:
2025年8期
页码:
1045-1049
栏目:
临床研究
出版日期:
2025-08-05

文章信息/Info

Title:
Relationship between procalcitonin clearance,24-hour lactate clearance rate，MEDS score and the prognosis of sepsis
作者:
詹雪1; GARCIA Mateo2（美国）; 王郝1
（1.首都医科大学附属北京积水潭医院重症医学科，北京 102208；2.宾夕法尼亚大学，美国 宾夕法尼亚州 19104-6303）
Author(s):
ZHAN Xue1; GARCIA Mateo2; WANG Hao1
（1.Department of Critical Care Medicine,Beijing Jishuitan Hospital,Capital Medical University,Beijing 102208,China;2.University of Pennsylvania,Pennsylvania 19104-6303,the United States of America）
关键词:
脓毒症; 降钙素原清除率; 乳酸清除率; 急诊脓毒症死亡风险评分; 预后; 预测价值
Keywords:
Sepsis; Procalcitonin clearance; Lactate clearance rate; Mortality in Emergency Department Sepsis Score; Prognosis; Predictive value
分类号:
R 631
DOI:
DOI:10.3969/j.issn.1000-7377.2025.08.007
文献标志码:
A
摘要:
目的：探讨降钙素原清除率（PCTc）、24 h乳酸清除率（LCR）和急诊脓毒症死亡风险评分（MEDS）与脓毒症预后的关系。方法：选取脓毒症患者119例，根据患者生存情况分为预后良好组（84例）和预后不良组（35例）。比较两组不同时间PCTc、24 h LCR、MEDS评分及其他临床资料。采用二元Logistic回归分析脓毒症患者预后不良的影响因素。Spearman法分析PCTc、24 h LCR、MEDS评分与脓毒症患者预后的相关性。PCTc、24 h LCR联合MEDS评分对脓毒症患者预后不良的预测价值通过绘制受试者工作特征（ROC）曲线进行分析。结果：与预后良好组比较，预后不良组患者糖尿病及脓毒症休克比例、急性生理学与慢性健康状况评分系统Ⅱ（APACHEⅡ）、机械通气时间、ICU住院时间、MEDS评分升高，PCTc-3、PCTc-5、PCTc-7、24 h LCR降低（均P＜0.05）。糖尿病史、APACHEⅡ评分、机械通气时间、ICU住院时间、脓毒症休克、PCTc-3、PCTc-5、PCTc-7、24 h LCR、MEDS评分是脓毒症患者28 d内预后不良的独立影响因素（均P＜0.05）。MEDS评分与脓毒症患者预后不良呈正相关，PCTc、24 h LCR与脓毒症患者预后不良呈负相关（均P＜0.05）。PCTc-3、PCTc-5、PCTc-7、24 h LCR、MEDS评分联合检测脓毒症患者28 d内预后不良的曲线下面积（AUC）为0.911，高于五项指标单独检测（均P＜0.05）。结论：PCTc、24 h LCR、MEDS评分与脓毒症患者预后有关，且三者联合预测预后的效果较好。
Abstract:
Objective:To investigate the relationship between procalcitonin clearance (PCTc),24-hour lactate clearance rate (LCR),and Mortality in Emergency Department Sepsis Score (MEDS) and the prognosis of sepsis.Methods：A total of 119 patients with sepsis were selected and divided into two groups according to their survival status:the good prognosis group (84 cases) and the poor prognosis group (35 cases).The PCTc at different time points,24-hour LCR,MEDS score,and other clinical data were compared between the two groups.Binary logistic regression analysis was used to identify the influencing factors of poor prognosis in patients with sepsis.The correlation between PCTc,24-hour LCR,MEDS score,and the prognosis of patients with sepsis was analyzed using the Spearman method.The predictive value of PCTc,24-hour LCR and MEDS score for poor prognosis in patients with sepsis was analyzed by ROC curves.Results:Compared with the good prognosis group,the poor prognosis group had higher proportions of diabetes and septic shock,higher APACHEⅡ score,longer mechanical ventilation time,longer ICU stay,higher MEDS score,and lower PCTc-3,PCTc-5,PCTc-7 and 24-hour LCR (all P<0.05).History of diabetes,APACHEⅡ score,mechanical ventilation time,ICU stay,septic shock,PCTc-3,PCTc-5,PCTc-7,24-hour LCR and MEDS score were independent influencing factors for poor prognosis within 28 days in patients with sepsis (all P<0.05).MEDS score was positively correlated with poor prognosis in patients with sepsis,while PCTc and 24-hour LCR were negatively correlated with poor prognosis (all P<0.05).The AUC for predicting poor prognosis within 28 days in patients with sepsis using a combination of PCTc-3,PCTc-5,PCTc-7,24-hour LCR and MEDS score was 0.911,which was higher than that of each indicator alone (all P<0.05).Conclusion:PCTc,24-hour LCR and MEDS score are related to the prognosis of patients with sepsis,and the combination of the three has a better predictive effect on prognosis.

参考文献/References:

[1]KAMRAN F,TJANDRA D,VALLEY T S,et al.Reformulating patient stratification for targeting interventions by accounting for severity of downstream outcomes resulting from disease onset:A case study in sepsis[J].J Am Med Inform Assoc,2025,32(5):905-913.
[2]RUDD K E,JOHNSON S C,AGESA K M,et al.Global,regional,and national sepsis incidence and mortality,1990-2017:Analysis for the global burden of disease study[J].Lancet,2020,395(10219):200-211.
[3]赵菊馨,吴金海,夏川川,等.早期血液净化治疗脓毒症患者的临床疗效观察[J].中国中西医结合急救杂志,2024,31(6):665-669.
[4]王静霞,张涛,胡春琼,等.亚胺培南西司他丁钠联合小剂量氢化可的松治疗脓毒症休克患者的可行性[J].中华医院感染学杂志,2024,34(18):2727-2731.
[5]董立鹏,武新慧,赵聪聪,等.不同种类液体复苏对早期脓毒症和脓毒性休克患者多糖包被的影响及临床意义：一项单中心、前瞻性、随机对照试验[J].中华危重病急救医学,2025,37(3):237-244.
[6]陈晓蕾,吴卉卉,张其霞,等.智能预警系统在脓毒症休克患者集束化治疗中的应用效果[J].中华全科医学,2025,23(1):140-142,152.
[7]刘江萍,李雅珺,郑雅文,等.血浆肝素结合蛋白联合白蛋白对脓毒症患者28 d死亡的预测价值[J].中华危重病急救医学,2024,36(12):1233-1237.
[8]袁小丽,王晶,张蕴.四种重症评分对肾脓肿患者死亡风险预测价值[J].中国临床医生杂志,2021,49(8):944-948.
[9]SINGER M,DEUTSCHMAN C S,SEYMOUR C W,et al.The third international consensus definitions for sepsis and septic shock (sepsis-3)[J].JAMA,2016,315(8):801-810.
[10]高戈,冯喆,常志刚,等.2012国际严重脓毒症及脓毒性休克诊疗指南[J].中华危重病急救医学,2013,25(8):501-505.
[11]PISANO A,VENDITTO M,PALMIERI C,et al.Novel therapies and interventions in sepsis and septic shock[J].BJA Educ,2025,25(5):206-217.
[12]唐瑶瑶,郭莹,秦红霄,等.HVHF联合CHVHF对脓毒症相关ARDS患者炎症反应和呼吸功能的影响[J].中华临床医师杂志:电子版,2024,18(12):1097-1103.
[13]李晓飞,王静.中性粒细胞CD64与白细胞介素-6和降钙素原对ICU脓毒症患者的诊断及预后评估[J].中华危重病急救医学,2023,35(5):463-468.
[14]李丽丽,吴晨晨,闫艳玲.连续性肾脏替代治疗联合血液灌流对脓毒症患者临床疗效的影响[J].中国中西医结合急救杂志,2023,30(3):304-307.
[15]程小彬,李刚,卿慧玲.不同剂量血必净注射液对脓毒症患者炎症指标和替代治疗及预后的影响[J].中国中西医结合急救杂志,2023,30(2):132-135.
[16]韩媛媛,热孜亚·萨贝提,冒智捷,等.组合式血液净化治疗对脓毒症患者血清炎症因子水平和临床预后的影响[J].中华危重症医学杂志:电子版,2023,16(4):272-278.
[17]傅元冬,许飚,杨佩,等.PCT清除率联合前白蛋白评估老年脓毒症患者的预后价值[J].东南国防医药,2023,25(2):129-134.
[18]吴泽华,李跃东,戴莹莹,等.降钙素原、C反应蛋白、白细胞计数和中性粒细胞比率在重症医学科脓毒症治疗预后判断中的临床价值[J].陕西医学杂志,2024,53(4):540-543.
[19]魏东梅,邵龙刚.芒柄花黄素对脓毒症小鼠炎性反应及MAPK/NF-κB通路影响的实验研究[J].陕西医学杂志,2023,52(5):503-507.
[20]ZHU Z,LIU L.Exploring the potential role of the cholinergic anti-inflammatory pathway from the perspective of sepsis pathophysiology[J].J Intensive Care Med,2025,40(5):571-580.
[21]郭星云,林海菊,凌坤,等.基线GLR LCR RRI联合预测脓毒症相关性急性肾损伤CRRT患者28 d病情转归效能研究[J].安徽医学,2025,46(2):220-225.
[22]孙钦,姚智远,夏文芳.血乳酸清除率对连续肾脏替代疗法治疗的脓毒症患者预后的影响[J].中国临床研究,2024,37(11):1691-1694.
[23]罗智浩,李高俊,韩旻君,等.增液承气汤对脓毒症肠功能障碍大鼠炎症反应、免疫及肠功能的影响[J].陕西中医,2024,45(12):1614-1618.
[24]龙敏,张玉琴,岳煜,等.黄连解毒汤联合西药治疗脓毒症心肌损伤疗效研究[J].陕西中医,2022,43(3):329-333.
[25]闫圣涛,练睿,孙力超,等.降钙素原和危重症评分在腹腔感染脓毒症病原学诊断及预后评估中的价值[J].中华危重病急救医学,2021,33(7):792-797.

相似文献/References:

[1]李文军,于代华,宗 雷,等.脾多肽注射液对脓毒症患者血清炎症因子及免疫功能的影响*[J].陕西医学杂志,2019,(4):463.
　LI Wenjun,YU Daihua,ZONG Lei,et al.Effect of spleen peptide injection on serum inflammatory factors and immune function in patients With Sepsis[J].,2019,(8):463.
[2]商跃云,张 慧,林书祥,等.脓毒症患儿外周血CD4+T细胞Bip、ATF6及DDIT3表达水平变化[J].陕西医学杂志,2019,(6):706.
　SHSNG Yueyun,ZHANG Hui,LIN Shuxiang,et al.Changes of immunoglobulin binding protein, activating transcription factor 6 and DNA-damage-inducible transcript 3 protein levels in CD4+T cells in children with sepsis[J].,2019,(8):706.
[3]田永超.脓毒症肠黏膜屏障功能障碍防治研究进展[J].陕西医学杂志,2020,49(4):510.
　TIAN Yongchao..Progress in prevention and treatment of intestinal mucosal barrier dysfunction in sepsis[J].,2020,49(8):510.
[4]王 婷,韦小碗,杨 亮,等.脓毒症患者血清PCT、CRP、IL-6 和IL-10水平检测及临床意义[J].陕西医学杂志,2020,49(11):1510.[doi:DOI:10.3969/j.issn.1000-7377.2020.11.037]
　WANG Ting,WEI Xiaowan,YANG Liang,et al.Expression of serum PCT,CRP,IL-6 and IL-10 in patients with sepsis and their clinical diagnostic value[J].,2020,49(8):1510.[doi:DOI:10.3969/j.issn.1000-7377.2020.11.037]
[5]肖武强,董 磊,吴先正△.急性胃肠损伤分级联合D-乳酸、内毒素水平测定对脓毒症患者预后的评估价值*[J].陕西医学杂志,2020,49(12):1577.[doi:DOI:10.3969/j.issn.1000-7377.2020.12.010]
[6]张 瑜,王 娟.脓毒症并发急性呼吸窘迫综合征患者血清血管内皮钙黏蛋白、血管生成素2表达及与预后相关性研究[J].陕西医学杂志,2022,51(2):176.[doi:DOI:10.3969/j.issn.1000-7377.2022.02.011]
　ZHANG Yu,WANG Juan.Expression of serum vascular endothelial cadherin and angiopoietin 2 in sepsis patients complicated with acute respiratory distress syndrome and their correlation with prognosis[J].,2022,51(8):176.[doi:DOI:10.3969/j.issn.1000-7377.2022.02.011]
[7]王兴程,张向宁,侯崇智,等.右美托咪定在脓毒症治疗中的作用及机制研究进展[J].陕西医学杂志,2022,51(3):382.[doi:DOI:10.3969/j.issn.1000-7377.2022.03.028]
　WANG Xingcheng,ZHANG Xiangning,HOU Chongzhi,et al.Research progress on the role and mechanism of dexmedetomidine in the treatment of sepsis[J].,2022,51(8):382.[doi:DOI:10.3969/j.issn.1000-7377.2022.03.028]
[8]梁 红,霍红艳.右美托咪定对盲肠结扎穿孔术诱导的脓毒症大鼠急性肺损伤保护作用及其与磷酸化JAK激酶2/酪氨酸磷酸化通路的关系[J].陕西医学杂志,2023,52(1):12.[doi:DOI:10.3969/j.issn.1000-7377.2023.01.003]
　LIANG Hong,HUO Hongyan.Protective effect of dexmedetomidine on CLP-induced acute lung injury in rats with sepsis and its relationship with JAK2/STAT3 pathway[J].,2023,52(8):12.[doi:DOI:10.3969/j.issn.1000-7377.2023.01.003]
[9]廖崇皓,徐岸楠,李世瑶,等.血清壳多糖酶3样蛋白1和几丁质酶1在脓毒症新生儿中的表达变化及其临床价值研究[J].陕西医学杂志,2024,(3):368.[doi:DOI:10.3969/j.issn.1000-7377.2024.03.017]
　LIAO Chonghao,XU Annan,LI Shiyao,et al.Expression changes of serum chitosinase 3-like protein 1 and chitinase 1 in neonatal sepsis and their clinical value[J].,2024,(8):368.[doi:DOI:10.3969/j.issn.1000-7377.2024.03.017]
[10]吴泽华,李跃东,戴莹莹,等.降钙素原、C反应蛋白、白细胞计数和中性粒细胞比率在重症医学科脓毒症治疗预后判断中的临床价值[J].陕西医学杂志,2024,(4):540.[doi:DOI:10.3969/j.issn.1000-7377.2024.04.023]

备注/Memo

备注/Memo:
国家自然科学基金资助项目(82072226)；国家临床重点专科建设项目(国卫办医政函〔2023〕213号，国卫办医政质量便函〔2023〕158号)
更新日期/Last Update: 2025-08-04