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目的 研究分析血清肌碱酯酶对老年全身炎症反应综合征患者病情发展转归的预测作用.方法 将124例入住浙江大学医学院附属第二医院中心监护室(ICU)的老年SIRS患者根据预后情况分为存活组和死亡组.检测所有入院患者24 h内的血清胆碱酯酶、白蛋白、D-二聚体、乳酸、C反应蛋白(CRP),并进行APACHEⅡ和GCS评分.结果 生存组和死亡组之间比较,在年龄、性别、APACHEⅡ评分、GCS评分方面差异无统计学意义(P＞0.05).血乳酸、血D-二聚体、白蛋白、CRP、ChE在两组间比较差异具有统计学意义(P值=0.011,0.011,0.007,0.008,0.000.).预后多因素回归分析结果显示性别、年龄、白蛋白、CRP、GCS评分、APACHEⅡ评分、乳酸、D-二聚体不是决定患者预后的独立危险因素(P值分别为0.401,0.165,0.446,0.841,0.615,0.120,0.502,0.184),但ChE有显著性相关(P=0.000).ROC曲线图分析显示血清ChE对老年SIRS患者预后的ROC曲线下面积(AUC)为0.797,SE=0.04,P=0.000;ChE=103.00U/L时,敏感度为:0.793;1-特异度为0.258,可作为诊断的切点.Kendall相关分析ChE与APACHEⅡ评分、CRP、白蛋白相关性非常弱,相关系数分别为0.061,0.231,-0.090,P值分别为0.161,0.000,0.069.结论 ChE可能参与了老年SIRS的发生和发展过程,对这类患者的病情发展转归有一定的预测作用,且指标稳定,受干扰因素少.

Objective To explore the predictive value of cholinesterase (ChE) in the prognosis of gerontal patients with systemic inflammatory response syndrome. Methods The clinical data of 124 elderly patients with systemic inflammatory response syndrome collected from September 2009 through September 2010 were retrospectively analyzed. All patients were divided into death group and survival group according to the outcome of patients. The cholinesterase ( ChE), albumin, D-Dime, lactic acid and C-reactive protein (CRP) were detected, and the APACHE Ⅱ and GCS scores were documented in the first 24 hours in the ICU. Results There were no significant differences in age, gender, APACHE Ⅱ score and GCS score of patients between death group and survival group ( all P ＞ 0. 05 ), but there were significant differences in lactic acid, D-Dime, albumin, CRP and ChE between two groups ( theP values were 0.011,0.011, 0. 007,0. 008, 0. 000, respectively) . The results of multiple factors regression analysis showed that age, gender,lactic acid, D-Dime, albumin, CRP, APACHE Ⅱ score, and GCS score were not the independent risk factors of prognosis of gerontal patients with SIRS ( the P = 0. 401, 0. 165, 0. 446, 0. 841,0. 615, 0. 120,0. 502, 0. 184, respectively) except ChE ( P = 0. 000) . The receiver operating characteristic curve (ROC) of ChE in the gerontal patients with SIRS showed the area under curve (AUC) = 0.797, SE =0.04, P=0. 000, and the ChE = 103.00 U/L could be a diagnosis point with sensitivity = 0.793, 1-specificity = 0. 258. The correlation analysis showed that the APACHE Ⅱ score, CRP, and albumin were poorly correlated with ChE ( Kendall coefficients were 0. 061, 0. 231, and -0. 090, and theP = 0. 161,0. 000, and 0. 069, respectively ) . Conclusions ChE maybe played a important role in the gerontal patients with SIRS, and could be a predictive index for the prognosis of gerontal patients with systemic inflammatory response syndrome.