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目的:研究脓毒症患者血清C-反应蛋白(CRP)、皮质醇(COR)的动态变化特点及其对脓毒症患者预后评估的临床价值。方法:97例脓毒症患者住ICU期间每天采血进行CRP、COR检测,记录CRP、COR的动态变化。分析患者血清CRP、COR的动态变化特点及其与预后的关系。结果:治疗后病死患者的血清CRP和COR水平显著高于存活患者(P<0.05)。按CRP、COR动态变化趋势的不同分为4种类型:Ⅰ型:持续升高型;Ⅱ型:升高-回落型;Ⅲ型:反复波动型;Ⅳ型:正常或轻度升高型。CRPⅠ型患者的病死率显著高于CRPⅡ型和CRPⅣ型(P<0.001)。CORⅠ型、CORⅢ型患者的病死率分别显著高于CORⅡ型和CORⅣ型(P<0.001)。进一步分析,CRP和COR均明显升高组的病死率显著高于CRP或COR任一明显升高组及CRP和COR均非明显升高组(P<0.001);CRP或COR任一明显升高组的病死率亦显著高于CRP和COR均非明显升高组(P<0.001)。结论 :脓毒症患者CRP、COR的动态变化有一定的特点,监测两者的动态变化能够对脓毒症的预后做出较准确的评估。
Objective: To study the dynamic changes of serum C-reactive protein (CRP) and cortisol (COR) in patients with sepsis and its clinical value in the prognosis evaluation of patients with sepsis. Methods: 97 cases of sepsis patients living in the ICU daily blood samples for CRP, COR, recording CRP, COR dynamic changes. To analyze the dynamic changes of serum CRP and COR in patients and its relationship with prognosis. Results: Serum levels of CRP and COR were significantly higher in survivors after treatment than those in survivors (P <0.05). According to CRP, COR dynamic changes in the different types are divided into four types: Ⅰ type: rising type; Ⅱ type: rising - falling type; Ⅲ type: repeated fluctuation type; Ⅳ: normal or slightly elevated type. The mortality of CRP I patients was significantly higher than that of CRP II and CRP IV (P <0.001). The mortality of CORⅠand CORⅢ patients was significantly higher than that of CORⅡand CORⅣ (P <0.001). Further analysis, CRP and COR were significantly higher mortality was significantly higher than any group CRP or COR increased significantly and CRP and COR were not significantly increased (P <0.001); CRP or COR were significantly increased The case fatality rate was also significantly higher than the CRP and COR were not significantly increased (P <0.001). Conclusion: The dynamic changes of CRP and COR in patients with sepsis have certain characteristics. Monitoring the dynamic changes of both can make a more accurate assessment of the prognosis of sepsis.