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目的:应用受试者工作特征(ROC)曲线评价C反应蛋白(CRP)和降钙素原(PCT)预测脓毒症患者撤机时机的效能和价值。方法:对达到撤机标准的112例严重脓毒症或脓毒性休克患者验血查CRP、PCT后依程序撤机,根据撤机结局分为撤机成功组(74例)和撤机失败组(38例)。比较2组间CRP和PCT的差异,并绘制CRP、PCT与撤机结局的ROC曲线。结果:撤机前,撤机成功组CRP和PCT水平均较撤机失败组低,差异有统计学意义[CRP:(11.05±5.38)vs(23.93±7.18),P<0.01;PCT:(0.86±0.11)vs(2.35±1.62),P<0.05];CRP和PCT预测撤机成功的曲线下面积(AUC)分别为0.887和0.745,最佳Youden指数为0.71和0.48,对应的节点值分别为12.5mg/L和3.55μg/L。结论:CRP和PCT对撤机结局有一定预测价值,可作为脓毒症患者撤机时机的筛查指标。
OBJECTIVE: To assess the efficacy and value of C-reactive protein (CRP) and procalcitonin (PCT) in predicting the weaning timing of sepsis using the receiver operating characteristic (ROC) curve. Methods: One hundred and twenty-one patients with severe sepsis or septic shock who had met the weaning criteria were examined for CRP. After treatment, patients were weaned according to the procedure and were divided into two groups based on the weaning outcome: weaning success group (n = 74) and weaning failure group (38 cases). The differences of CRP and PCT between the two groups were compared and the ROC curves of CRP, PCT and weaning outcome were plotted. Results: Before weaning, the CRP and PCT levels in the weaning success group were lower than those in the weaning failure group (CRP: 11.05 ± 5.38 vs 23.93 ± 7.18, P <0.01; PCT: 0.86 ± 0.11) vs (2.35 ± 1.62, P <0.05]. The area under the curve (AUC) of CRP and PCT predicting weaning success rate were 0.887 and 0.745, respectively. The optimal Youden index was 0.71 and 0.48, respectively. The corresponding node values were 12.5 mg / L and 3.55 μg / L. Conclusion: CRP and PCT have some predictive value on weaning outcome, which can be used as a screening index for weaning time in patients with sepsis.