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外周血CD14^＋单核细胞HLA-DR对老年创伤脓毒症的预后预测分析
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外周血CD14^＋单核细胞HLA-DR对老年创伤脓毒症的预后预测分析
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Journal Article
外周血CD14^＋单核细胞HLA-DR对老年创伤脓毒症的预后预测分析
2016
Overview
目的评价外周血CD14＋单核细胞HLA-DR（HLA-DR＋/CD14＋）对老年创伤脓毒症预后的预测价值。方法采用回顾性病例分析的方法,收集广州军区广州总医院重症医学科2011年1月-2015年12月收治的年龄≥60岁的老年创伤患者的临床资料。HLA-DR＋/CD14＋、降钙素原（PCT）和C反应蛋白（CRP）为入科第一天指标。采用Spearman相关分析对HLA-DR＋/CD14＋与ICU停留时间、总住院时间、APACHEⅡ的相关性进行分析。采用ROC曲线分析HLADR＋/CD14＋、PCT、CRP、APACHEⅡ评分对老年创伤脓毒症患者预后的预测价值。结果死亡患者APACHEⅡ评分（27.38±8.68）显著高于存活患者（17.49±6.25,P=0.000）,HLA-DR＋/CD14＋（37.70%±13.96%）明显低于存活患者（59.80%±18.02%,P=0.000）。创伤脓毒症患者APACHEⅡ评分（26.16±8.44）明显高于非脓毒症患者（17.90±7.04,P=0.000）;HLA-DR＋/CD14＋（38.61%±14.48%）则明显低于非脓毒症患者（59.79%±18.17%,P=0.000）;PCT（34.45±68.29）明显高于非脓毒症患者（4.25±8.26,P=0.003）;CRP（129.88±103.25）亦明显高于非脓毒症患者（76.04±73.48,P=0.011）。Spearman相关分析显示,HL A-DR＋/CD14＋与ICU停留时间呈负相关（r=–0.304,P=0.008）,与总住院时间无相关性（r=0.188,P=0.106）,与APACHEⅡ评分呈负相关（r=–0.559,P=0.000）。HLA-DR＋/CD14＋对老年创伤脓毒症发生预测的AUC为0.807（SE=0.051,95%CI 0.706~0.907,P=0.000）,最适诊断界点为40.0%,敏感性和特异性分别为88.0%和60.0%。PCT对老年创伤脓毒症发生预测的AUC=0.714（SE=0.063,95%CI 0.591~0.837,P=0.003）,最适诊断界点为1.01ng/ml,敏感性和特异性分别为84.0%和65.0%。HLA-DR＋/CD14＋预后预测的AUC=0.813（SE=0.049,95%CI0.716~0.910,P=0.000）,最适诊断界点为36.0%,敏感性
