细菌性血流感染致脓毒症老年患者血清PCT和D-D及CRP及血小板计数变化

Changes of serum PCT,D-D,CRP and platelet count in elderly patients with sepsis caused by bacterial bloodstream infection

目的探讨细菌性血流感染致脓毒症老年患者血清降钙素原(PCT)、D-二聚体(D-D)、C反应蛋白(CRP)水平与血小板(PLT)计数变化。方法选取2017年2月-2020年11月益阳市中心医院120例细菌性血流感染致脓毒症老年患者纳入脓毒症组,参照2008年国际脓毒症学会脓毒症诊断标准及分阶段诊断系统将患者分为早期脓毒症组(n=41)、严重脓毒症组(n=45)和脓毒性休克组(n=34),另选取于本院进行健康体检的健康老年人群50名纳入对照组。比较不同组别研究对象血清PCT、D-D、CRP水平以及血小板计数差异,绘制受试者工作特征(ROC)曲线评估PCT、D-D、CRP、PLT检测对脓毒症的诊断价值,通过Spearman相关性分析PCT、D-D、CRP、PLT与疾病严重程度的关系,以及PCT、D-D、CRP水平与PLT计数水平的关系。结果脓毒症组患者血清PCT、D-D、CRP水平高于对照组,PLT水平低于对照组,差异均有统计学意义(P均<0.05)。脓毒性休克组患者血清PCT、D-D、CRP水平高于严重脓毒症组,严重脓毒症组高于早期脓毒症组;脓毒性休克组患者PLT水平低于严重脓毒症组,严重脓毒症组低于早期脓毒症组;以上差异均有统计学意义(P均<0.05)。血清PCT、D-D、CRP与PLT水平联合检测诊断脓毒症ROC曲线下面积为0.947,高于PCT、D-D、CRP、PLT单独检测的0.844、0.819、0.826、0.820(P<0.05)。Spermann等级相关性分析显示,脓毒症患者血清PCT、D-D、CRP水平与疾病严重程度成正相关(r=0.602、0.544、0.493,P<0.05);PLT水平与疾病严重程度成负相关(r=-0.630,P<0.05);PLT计数水平与血清PCT、D-D、CRP水平成负相关(r=-0.508、-0.417、-0.402,P<0.05)。结论细菌性血流感染致脓毒症患者血清PCT、D-D、CRP水平升高,PLT水平降低,其表达水平在一定程度上可反映患者疾病严重程度,可指导临床判断脓毒症发生发展。

Objective To explore the changes of serum procalcitonin(PCT),D-dimer(D-D),C-reactive protein(CRP)and platelet count(PLT)in elderly patients with sepsis caused by bacterial bloodstream infection.Methods A total of 120elderly patients with sepsis induced by bacterial bloodstream infection in Yiyang Central Hospital were enrolled as sepsis group between February 2017 and November 2020.According to sepsis diagnostic criteria and staged diagnosis system of International Sepsis Society in 2008,they were divided into early sepsis group(n=41),severe sepsis group(n=45)and septic shock group(n=34).A total of 50 healthy elderly controls were enrolled as control group.The differences of serum PCT,D-D,CRP and PLT in different groups were compared.The diagnostic value of PCT,D-D,CRP and PLT for sepsis was evaluated by receiver operating characteristic(ROC)curves.The relationship between PCT,D-D,CRP,PLT and disease severity,as well as the relationship between PCT,D-D,CRP and PLT were analyzed by Spearman correlation analysis.Results The levels of serum PCT,D-D and CRP in sepsis group were higher than those in control group,while PLT level was lower than that in control group(P all<0.05).The levels of serum PCT,D-D and CRP were the highest in septic shock group,followed by severe sepsis group and early sepsis group,while PLT was on the contrary(P all<0.05).The area under curve(AUC)of serum PCT combined with D-D,CRP and PLT in the diagnosis of sepsis was 0.947,greater than that of single index(0.844,0.819,0.826,0.820)(P<0.05).Spermann rank correlation analysis showed that levels of serum PCT,D-D and CRP were positively correlated with disease severity(r=0.602,0.544,0.493,P<0.05),while PLT level was negatively correlated with disease severity(r=-0.630,P<0.05).The results of Pearson correlation analysis showed that the PLT was negatively correlated with the serum PCT,D-D and CRP(r=-0.508,-0.417,-0.402,P<0.05).Conclusion s The levels of serum PCT,D-D and CRP were increased,while PLT level was decreased in patients with sepsis caused by bacterial bloodstream infection.Their expression levels could reflect disease severity to a certain extent and guide the clinical determination of sepsis.