内科急危重症杂志2004年第10卷第4期C一反应蛋白及前白蛋白对脓毒症患者病情的评估价值江苏省常州市第一人民医院顾淞芙，常州213003要目的摘:研究脓毒症患者C一反应蛋白(CRP)及前白蛋白(PA)的变化，探讨其与病情严重程度及预后的关系。方法:浏定40例脓毒症患者入院第1天、第4天、第7天及出院或死亡前最后一次CRP,PA，评定APACHEn评分，按预后把患者分成死亡组及非死亡组。结果:死亡组及非死亡组入院第1天及第4天CRP,PA无显著差异，第7天及最后一次死亡组CRP明显高于非死亡组，死亡组PA明显低于非死亡组。CRP与APACHEII评分呈正相关，PA与APACHEII评分呈负相关。结论:CRP与脓毒症患者病情严重程度呈正相关，PA与病情严重程度呈负相关。CRP持续高水平与PA持续低水平说明病情严重，是预后不良的表现，所以联合动态观察CRP及以对脓毒症患者的病情及预后有临床评佑价值。键词G关反应蛋白前白蛋白APACHEII评分脓毒症患者图分类号中R515.3文献标识码AEvaluativeValueof伪namicObservationofGreactiveProteinandPrealbunrininSepsisGUTian少.TheFirstpeople'sHospitalofChangzhou，Changzhou213003,ChinabstractOAbjective:TostudythechangesofGreactiveprotein(CRP)andprealbumin(PA)levelsinsepsispatientssoastoexploretherelationtotheseverityofdiseaseandprognosis.Methods:CRPandPAlevelsof40sepsispatientsweremeasuredon1st,4th,7thdayafteradmissionandthelastdaybeforedischargeordeath.MeanwhileAPACHEIIscoreweredocumented.Accordingtoprognosis,patientsweredividedintodeathgroupandnon-deathgroup.Results:ThelevelsofCRPandPAon1st,4thdaywereofnosignificantdifferencebetweenthedeathgroupandnon-deathgroup.ThelevelofCRPindeathgroupon7thdayandthelastdaywasmuchhigherthanthatinnon-deathgroup.ThelevelofPAindeathguoupwasmuchlowerthanthatinnon-deathgroup.TherewasapositivecorrelationbetweenCRPandAPACHEIIscors,whileanegativecorrelationwasfoundbetweenPAandAPACHEIIscore.Conlusions:TherewasapositivecorrelationbetweenCRPandseverityofsepsiscases,andanegativecorrelatonbetweenPAandseverityofsepsiscases.PersistenthighlevelofCRPandlowlevelofPAindi-catedseverediseasecourseandunfavourateprognosis.Itisofclinicalvaluetoevaluatetheseverityofdis-easeandpredictprognosisinsepsis场combineddynamicobservationofCRPandPAlevels.eywordsKGreactiveproteinPrealbuminAPACHE11scoreSepsispatient脓毒症(sepsis)是严重创伤、外科手术、感染的16)，其诊断参照1991年美国胸科医师学会和危重常见并发症，进一步发展可导致脓毒性休克，多脏器病医学会(ACCP/SCCM)会议的定义[[21。其中重症功能不全综合症(MODS)，病死率高[11,肺部感染18例，重症急性胰腺炎8例，弥漫性腹膜在脓毒症急性期机体几种血浆蛋白浓度可发生炎6例，感染性休克5例，复合伤3例。按预后结果变化，其变化的幅度、持续时间及变化趋势，即血浆浓把40例患者分为死亡组1