广西医学

目的　探讨血清降钙素原、C反应蛋白（CRP）水平联合急性生理学与慢性健康状况评价Ⅱ（APACHEⅡ）评分对热射病患者预后的预测价值。方法　选取80例热射病患者作为研究对象。根据终点事件（出院或死亡）发生时患者的预后将其分为死亡组34例、存活组46例。比较两组患者血清降钙素原、CRP水平，以及APACHEⅡ评分。采用多因素Logistic回归模型分析热射病患者预后的影响因素，绘制受试者工作特征（ROC）曲线评估血清降钙素原、CRP水平与APACHEⅡ评分预测热射病患者预后的价值。结果　多因素 Logistic回归分析结果显示，血清降钙素原、CRP水平，APACHEⅡ评分是热射病患者预后的影响因素（P<0.05）。血清降钙素原水平、血清CRP水平、APACHEⅡ评分单独及三者联合预测热射病患者预后的ROC曲线下面积分别为0.789、0.719、0.826、0.877，灵敏度分别为76.47%、70.59%、82.35%、91.18%，特异度分别为61.76%、53.51%、91.18%、96.70%，三者联合预测的ROC曲线下面积更大（P<0.05）。结论　血清降钙素原、CRP水平与APACHEⅡ评分是热射病患者预后的影响因素，三者联合预测患者预后的效能较高。

Objective To explore the predictive value of serum procalcitonin and C⁃reactive protein (CRP) levels combined with Acute Physiology and Chronic Health Evaluation Ⅱ(APACHEⅡ ) score on prognosis in patients with heat apoplexy. Methods A total of 80 patients with heat apoplexy were selected as the research subjects. According to patients' prognosis at the occurrence of outcome events (discharge or death), patients were assigned to death group (34 cases) or survival group (46 cases). The levels of serum procalcitonin and CRP, and APACHEⅡ score were compared between patients of the two groups. The multivariate Logistic regression model was used to analyze the independent influencing factors for prognosis in patients with heat apoplexy. The value of levels of serum procalcitonin and CRP, and APACHEⅡ score for predicting prognosis in patients with heat apoplexy was evaluated by drawing receiver operating characteristic (ROC) curve. Results The results of multivariate Logistic regression analysis revealed that serum procalcitonin and CRP levels, and APACHEⅡ score were the independent influencing factors for prognosis in patients with heat apoplexy (P<0.05).Areas under the ROC curve of serum procalcitonin level, serum CRP level, APACHEⅡ score for alone and jointly predicting prognosis in patients with heat apoplexy were 0.789, 0.719, 0.826, and 0.877, respectively, the sensitivities were 76.47%, 70.59%, 82.35%, and 91.18%, respectively, and the specificities were 61.76%, 53.51%, 91.18%, and 96.70%, respectively, area under the ROC curve of the combined prediction of the three was greater (P<0.05). Conclusion Serum procalcitonin and CRP levels, and APACHEⅡ score were the influencing factors for prognosis in patients with heat apoplexy, and prognostic efficiency of the combined prediction of the three is relatively high.