血清嗜铬粒蛋白A浓度对急症危重患者死亡的预测价值

摘要

目的：探讨ICU重症患者入院后2 h内的血清嗜铬粒蛋白A (Chromogranin A，CGA)水平对患者死亡的预测价值。方法入选连续入住ICU、排除全身反应性疾病的急症危重患者80例(病例组)，同时选取健康对照者20例(对照组)，比较研究对象的CGA、降钙素原（Procalcitonin，PCT）、血肌酐、白细胞计数等水平，探讨CGA水平对患者预后及死亡的影响；连续观察随访30 d，记录分析死亡情况。结果病例组患者入院后2 h内的CGA、血肌酐、PCT、WBC等指标均明显高于健康对照组(P＜0.05)；CGA水平与血肌酐、PCT、WBC均呈正相关(P＜0.05)；CGA=136μg/L为截断值时，CGA对死亡的预测灵敏度、特异度均最高(P＜0.05)；CGA水平升高与较差的预后有关(P＜0.05)。结论急症危重患者入院后2 h内的血清CGA水平与病情的危重症程度、机体炎性反应水平呈正相关，对预测患者的死亡有效，较高的CGA水平与患者较差的预后有关，应开展该类患者CGA的早期监测，为临床决策提供依据。%Objective To investigate the predictive value of serum chromogranin A concentration in 2h after admission for the mortality of acute critically ill patients.Methods 80 acute critically ill patients (observation group) and 20 health persons (control group) were compared with the CGA, procalcitonin (PCT), serum creatinine and white blood cell count. CGA levels were examined for 30 days and the death information were recorded. Effects of CGA lev-els was analyzed for the prognosis and mortality of the cases. Results CGA, serum creatinine , PCT, and WBC of the patients were significantly higher than that of the controls (P<0.05). There was a positive correlation among those four factors (P<0.05 ). When CGA was 136μg/L, the sensitivity and specificity of death prediction were the highest (P<0.05). The elevated CGA levels can predict poor prognosis (P<0.05). Conclusion The chromogranin A concentra-tion in 2h after admission of acute critically ill patients had a positive correlation with the body's inflammatory re-sponse levels which is effective to predict mortality of the patients. Higher CGA levels in patients have poor progno-sis. Early CGA monitoring should be carried out to provide a basis for clinical decision-making .