脓毒症血浆 PA F与皮质醇水平相关性及对预后评估的意义

摘要

目的：探讨脓毒症患者血浆血小板活化因子（PAF）与皮质醇（Cor）水平的相关性，以及二者与患者预后的关系。方法选择2012年4月至2013年8月期间由重庆市急救医疗中心IC U收治的脓毒症患者102例为脓毒症组，健康志愿者40例为对照组。按脓毒症患者住院期间的预后情况，将其分为存活组及死亡组，比较对照组、脓毒症存活组及死亡组患者血浆 PA F及Cor水平，比较脓毒症存活组及死亡组患者急性生理和慢性健康评分Ⅱ（APACHEⅡ），分析对照组、脓毒症存活组及死亡组患者血浆PAF与Cor水平的相关性。结果脓毒症存活组及死亡组患者血浆PAF、Cor水平较对照组均明显增高（P＜0．05），脓毒症死亡组患者血浆PAF、Cor水平及APACHEⅡ较存活组明显增高（P＜0．05）；对照组血浆 PAF与Cor水平相关性不显著（P＞0．05），而脓毒症存活组及死亡组患者血浆PAF与Cor水平均呈正相关（P＜0．05）；受试者工作特征（ROC）曲线分析显示，PAF 、Cor及APACHEⅡ可作为脓毒症患者住院期间死亡的预测指标（曲线下面积分别为0．708、0．715、0．787）。结论脓毒症患者血浆PAF与Cor水平呈正相关，二者对评估患者住院期间的预后情况具有一定指导意义。%Objective To investigate the correlation of platelet activating factor(PAF)with cortisol(Cor) ,as well as their rela-tionship with patients after sepsis prognosis .Methods 102 patients with sepsis admitted in the ICU of Chongqing Emergency Med-ical Center from April 2012 to August 2013 were enrolled into sepsis group ,and 40 cases of volunteers served as control group .All the patients were divided into survival group and non-survival group ,according to their prognosis during hospitalization .Plasma PAF and Cor level in control group ,survival group and non-survival group were compared with each other ,and acute physiology and chronic health evaluationⅡ(APACHEⅡ)in survival group and non-survival group were compared .The correlations of plasma PAF with Cor level in control group ,survival group and non-survival group were analyzed ,respectively .Results Plasma PAF and Cor level in survival group and non-survival group were significantly higher than that in control group(P<0 .05) .Plasma PAF ,Cor lev-el and APACHEⅡ scores were higher in non-survival group than that in survival group(P<0 .05) .The correlation of plasma PAF with Cor level in control group was not significant(P>0 .05) ,while the plasma PAF level positively correlated with Cor level in survival group and non-survival group(P<0 .05) .Curves of receiver operating characteristics(ROC)showed that PAF ,Cor and A-PACHEⅡ score could be used as predictors of mortality during hospitalization(Area=0 .708 ,0 .715 ,0 .787) .Conclusion The plas-ma PAF level positively correlates with Cor level in patient with sepsis .PAF ,Cor and APACHEⅡ score have certain guiding signif-icance for the assessment of prognosis during hospitalization in patients with sepsis .