目的

探讨血清胆碱酯酶（cholinesterase，ChE）、空腹血糖（fasting plasma glucose，FPG）水平对脓毒症患者并发多器官功能障碍综合症（multiple organ dysfunction syndrome，MODS）的预测价值。

方法

回顾性收集2011年6月至2014年5月浙江省青田县人民医院收治的脓毒症患者170例,其中56例发生MODS，记录MODS病情严重度评分；非MODS组114例作为对照组，两组患者于入院次日清晨抽取空腹静脉血，测定血清中ChE 及FPG水平，比较两组ChE、FPG等各项相关临床数据，采用SPSS16.0软件进行二分类的非条件Logistic逐步回归模型分析，Pearson相关分析及受试者特征操作（receiver operating characteristic，ROC）曲线分析。

结果

单因素分析显示，既往有慢性病史、感染、白细胞计数、血清白蛋白、ChE、FPG、肌酐、动脉血pH 值、动脉氧分压、APACHEII评分、格拉斯哥昏迷指数（Glasgow coma scale，GCS）评分等项指标两组间差异具有统计学意义（P＜0.05）；性别、年龄、吸烟饮酒史、手术情况、细菌培养生长情况、体温、心率、呼吸频率、平均动脉压、血小板计数、血红蛋白、血清总胆红素、血钠、血钾等指标两组间差异无统计学意义（P＞0.05）。多因素Logistic回归分析显示，FPG、ChE、血肌酐、动脉氧分压、GCS评分对发生MODS有显著影响。FPG和ChE的ROC曲线下面积（area under the ROC curve，AUC）分别为AUC_FPG=0.849（95% CI 0.791～0.908和AUC_ChE=0.958（95% CI 0.929～0.987）；Pearson相关分析显示，高水平FPG和低浓度ChE与MODS病情严重度评分有相关性（P＜0.05）。

结论

ChE和FPS可作为脓毒症患者可能发生MODS的预测参考指标。

Objective

To explore the predictive value of serum cholinesteruse (ChE) and fasting plasma glucose (FPG) level in sepsis patients with multiple organ dysfunction syndrome (MODS).

Methods

A total of 170 sepsis patients admitted into the People’s Hospital of Qingtian County between June 2011 and May 2014 were enrolled in this study. They were divided into MODS group (n=56, recording the MODS scores) and the control group without MODS (n=114). The levels of serum ChE and FPG were tested from the venous blood in the followed morning after admission. The related clinical data were analyzed by Logistic regression, Pearson correlation analysis,and receiver operating characteristic (ROC) curve analysis.

Results

The univariate analysis indicated there were significant differences in past history, infection, white blood count (WBC), serum albumin (Alb), ChE, FPG, serum creatinine (Cr), arterial pH, arterial oxygen pressure, APACHE II score and Glasgow coma scale (GCS) between two groups (P＜0.05); while no significant differences were found in sex, age, history of smoking and drinking, surgery,bacterial culture, body temperature, breathing rate, heart rate, average arterial pressure, total bilirubin, blood platelet count, hemoglobin, serum natrium, serum kalium between two groups (P＞0.05). Multivariate Logistic regression showed that FPG, ChE, arterial oxygen pressure, Cr, and GCS affected the occurrence of MODS. The area under the ROC curve (AUC) of ChE and FPG were AUC_FPG=0.849 (95% CI 0.791～0.908) and AUC_ChE=0.958 (95% CI 0.929～0.987) respectively. At the same time, high level of FPS and low level of ChE were significantly correlated with MODS score.

Conclusion

ChE and FPG might predict the occurrence of MODS in sepsis patients..