脓毒血症患者乳酸清除率、红细胞分布宽度 和血乳酸水平及与预后的关系

Relation between levels of blood lactic acid, blood lactic acid clearance rate and red blood cell distribution width in sepsis patients and prognosis

摘要:

目的 探讨脓毒血症患者乳酸清除率（LCR）、红细胞分布宽度（RDW）和血乳酸（Lac）水平 及与临床预后的关系。方法 选取2016 年5 月—2018 年9 月保定市第一中心医院收治的脓毒血症患者92 例 作为观察组，同期该院92 例健康体检者作为对照组。将观察组患者按照病情严重程度分为脓毒症亚组46 例、 严重脓毒症亚组29 例和脓毒性休克亚组17 例。检测两组治疗前血清RDW、Lac 水平。检测观察组治疗后 血清RDW、Lac，并计算LCR。比较两组治疗前RDW、Lac 水平，比较观察组中各亚组患者治疗前后血清 LCR、RDW 及Lac 水平。采用Pearson 法分析LCR、RDW、Lac 与脓毒血症患者病情严重程度的相关性， 生存曲线分析血清RDW、Lac 与脓毒血症患者预后的关系。结果 观察组患者治疗前RDW、Lac 水平高于 对照组（P <0.05）。严重脓毒症亚组、脓毒性休克亚组患者治疗前后血清RDW、Lac 水平高于脓毒症亚组 （P <0.05）；而LCR 低于脓毒症亚组（P <0.05）。各亚组患者治疗后血清RDW、Lac 水平低于同组治疗前 （P <0.05）。Pearson 相关性分析显示，RDW、Lac 与脓毒血症患者病情严重程度呈正相关（r =0.776 和0.817， P <0.05）；而LCR 与脓毒血症患者病情严重程度呈负相关（r =-0.851，P <0.05）。低Lac 患者中位生存时间 长于高Lac 患者（36 d VS 28 d）（P <0.05）。低RDW 患者中位生存时间长于高RDW 患者（38 d VS 30 d） （P <0.05）。结论 LCR、RDW、Lac 水平能有效反映脓毒血症患者的病情严重程度，RDW 和Lac 水平能有 效评估脓毒血症患者预后。

Abstract:

Objective To explore the relation between levels of blood lactic acid (LAC), blood lactic acid clearance rate (LCR) and red blood cell distribution width (RDW) in sepsis patients and prognosis. Methods Ninetytwo sepsis patients admitted to our hospital were collected from May 2016 to September 2018 as the observation group, the other 92 people with normal physical examination results in the same period as the control group. The observation group was divided into sepsis group (n = 46), severe sepsis group (n = 29) and sepsic shock group (n = 17) according to the severity of the disease. Before treatment, LAC and RDW were detected in the two groups. After treatment, LAC and RDW were detected and LCR was calculated in the observation group. The levels of LAC, RDW in the two groups before treatment were compared. The levels of LAC, LCR and RDW in the every subgroups were compared before and after treatment. Pearson correlation was used to analyze the correlation between LAC, LCR, RDW and severity of sepsis, and the relationship between LAC, RDW and prognosis of sepsis was analyzed by survival curve. Results The levels of LAC and RDW in the observation group were higher than control group before treatment (P < 0.05). Before and after treatment, the levels of LAC and RDW in severe sepsis subgroup and septic shock subgroup were higher than those in sepsis subgroup (P < 0.05), while LCR level was lower than that in sepsis subgroup (P < 0.05). After treatment, the levels of LAC and RDW in all subgroups were lower than those before treatment (P < 0.05). Pearson correlation analysis showed that LAC (r = 0.817) and RDW (r = 0.776) were positively correlated with the severity of sepsis (P < 0.05), and LCR (r = ﹣ 0.851) was negatively correlated with the severity of sepsis (P < 0.05). The median survival time of patients with low LAC was 36 days, which was higher than 28 days of patients with high LAC (χ2= 4.695, P = 0.022). The median survival time of patients with low RDW was 38 days, higher than 30 days of patients with high RDW (χ2= 3.668, P = 0.035). Conclusions The levels of LAC, LCR and RDW can reflect the severity of sepsis patients effectively, and the levels of LAC and RDW can effectively evaluate the prognosis of sepsis.