PDW、RDW和MCV在评估脓毒症严重程度及预后中的价值
Journal of practical shock（2018）
Abstract
目的 探讨血小板体积分布宽度(PDW)、红细胞体积分布宽度(RDW)、平均红细胞体积(MCV)在脓毒症患者严重程度和预后中的评估作用.方法 纳入脓毒症患者171例,将其按照病情严重程度分为脓毒症组103例,脓毒症休克组68例,纳入同期非脓毒症患者94例.根据患者28天生存情况分为生存组和死亡组.记录患者入院第一个24h的血常规、PCT、Lac,24h情况最差急性生理学和慢性健康状态评分系统Ⅱ (APACHE Ⅱ)评分和序贯器官衰竭评分(SO-FA).比较对照组与脓毒症组及各亚组间Lac、PDW、RDW、MCV、PCT、APACHEⅡ、SOFA以及PDW、RDW、MCV联合指标的差异.受试者工作特征曲线分析Lac、PDW、RDW、MCV、PCT、APACHEⅡ、SOFA以及PDW、RDW、MCV联合在脓毒症严重程度及预后中的价值.结果 1.脓毒症Lac、PDW、RDW、MCV、PCT、APACHEⅡ、SOFA、28d生存率均高于对照组,差异有统计学意义(P＜ 0.05);2.随着病情严重程度加重,脓毒症患者Lac、PDW、RDW、MCV、PCT、APA-CHEⅡ、SOFA、PDW+RDW+MCV、28d病死率呈递增趋势,脓毒症休克组各指标明显高于脓毒症组;PDW +RDW +MCV联合的ROC曲线下面积为0.850,大于PCT (0.788),相当于APACHE评分(0.850),小于SOFA评分(0.958);3.脓毒症死亡组患者Lac、PDW、RDW、MCV、PCT、APACHEⅡ、SOFA、PDW+RDW+MCV明显高于生存组,PDW+RDW+MCV的联合ROC曲线下面积为0.950,大于PCT (0.844)、APACHEⅡ评分(0.924)及SOFA评分(0.934).结论 1.PDW、RDW、MCV在脓毒症患者严重程度及预后具有评估意义;2.PDW、RDW、MCV联合在评估脓毒症严重程度方面,效果可能与APACHEⅡ评分相当;在评估脓毒症预后方面,效果可能与SOFA评分相当.
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