2020 年第 12 期 第 15 卷

感染可能性评分及血清胆碱酯酶和淀粉样蛋白A与危重症感染患者生存情况的关系

Relationship of infection probability score, serum cholinesterase, serum amyloid protein A and survival in critical infection patients

作者：赵茜郭慧吕畅马志超马佳倩李建国

英文作者：Zhao Qian Guo Hui Lyu Chang Ma Zhichao Ma Jiaqian Li Jianguo

单位：河北省人民医院急诊科，石家庄050051

英文单位：Department of Emergency Heibei General Hospital Shijiazhuang 050051 China

关键词：危重症感染；感染可能性评分；胆碱酯酶；淀粉样蛋白A

英文关键词：Criticalinfection;Infectionprobabilityscore;Cholinesterase;AmyloidproteinA

• 摘要：

• 目的 探讨感染可能性评分(IPS)及血清胆碱酯酶、淀粉样蛋白 A(SAA)水平与危重症感染患者生存情况的关系。方法回顾性分析2017年12月至2018年12月河北省人民医院收治的208例危重症患者临床资料，包括120例危重症感染者（感染组）和88例危重症非感染者（非感染组）；根据感染组患者的预后，分为死亡组（78例）和存活组（42例），比较患者IPS、急性生理学与慢性健康状况评分系统Ⅱ (APACHEⅡ)评分、序贯器官衰竭估计(SOFA)评分以及血清胆碱酯酶、SAA水平，并对预后危险因素进行Logistic回归分析。结果 感染组患者IPS评分、APACHEⅡ评分高于非感染组，血清胆碱酯酶水平低于非感染组，SAA水平高于非感染组（均P<0.05）。Pearson相关性分析结果 显示，危重症感染患者胆碱酯酶水平与APACHEⅡ评分呈负相关(r=-0.553)，IPS评分与SOFA评分、APACHEⅡ评分呈正相关（r=0.589、0.632），SAA水平与SOFA评分、APACHEⅡ评分呈正相关（r=0.477、0.436），差异均有统计学意义（均P<0.05）。IPS评分、SOFA评分、APACHEⅡ评分、胆碱酯酶水平、SAA水平、是否成功撤机和有创机械通气、脓毒性休克以及ICU住院时长均对危重症感染患者预后产生影响（均P<0.05）。Logistic回归分析结果 显示IPS、SOFA评分、APACHEⅡ评分、胆碱酯酶水平、SAA水平、脓毒性休克、未成功撤机是影响危重症感染患者预后的独立危险因素（均P<0.05）。结论 危重症感染者IPS、血清胆碱酯酶和SAA水平与疾病严重程度以及预后存在明显相关性，均属于预后独立预测因素。

• Objective To explore the relationship among infection probability score (IPS) ,serum cholinesterase (SchE), serum amyloid protein A (SAA) and the survival of patients with critical infection. Methods A total of 208 critically ill patients admitted to Heibei General Hospital from December 2017 to December 2018 were enrolled, including 120 critical ill patients with infection (infected group) and 88 critical ill patients-without infected (non-infected group).  According to the survival prognosis of the patients in infected group, they were divided into the death group(78 cases) and the survival group(42 cases). The IPS score, acute physiology and chronic health evaluation Ⅱ (APACHE Ⅱ) score, sepsis-related organ failure assessment (SOFA) score, SchE and SAA levels were detected and compared. Pearson correlation analysis was used to analyze the correlation between IPS, SchE level, SAA level, and APACHE Ⅱ as well SOFA scores respectively. Prognostic risk factors were analyzed by Logistic regression. Results The IPS and APACHEⅡscores and SAA level in the infected group were higher than those in the non-infected group, the level of SchE was lower than that in the non-infected group (all P<0.05). Pearson correlation analysis showed that SchE level was negatively correlated with APACHE Ⅱ score (r=-0.553), IPS was positively correlated with SOFA and APACHE Ⅱ score (r=0.589, 0.632) and SAA level was positively correlated with SOFA and APACHE Ⅱ score (r=0.477, 0.436), the differences were statistically significant(all P<0.05). IPS score, SOFA score, APACHE Ⅱ score, cholinesterase, SAA, and the success of ventilator and invasive mechanical ventilation, septic shock and ICU hospitalization duration have impact on the prognosis of patients with severe disease infection (all P<0.05). Logistic regression analysis showed that IPS score, SOFA score, APACHE Ⅱ score, SchE, SAA, septic shock and failure of withdrawal were independent risk factors affecting the prognosis of critical infection patients (all P<0.05). Conclusion IPS, SAA and SchE levels in critical infection patients are significantly correlated with disease severity and prognosis, and they are independent prognostic predictors.