降钙素原对危重症患者合并脓毒症早期诊断及预后预测的意义

Early diagnostic and prognostic value of procalcitonin in critical ill patients with sepsis

目的探讨降钙素原(procalcitonin,PCT)对危重症患者合并脓毒症的早期诊断意义。方法 30例符合全身炎症反应综合征诊断的急诊 ICU 住院患者。根据入院时的临床表现及相关检验分为脓毒症组18例和非脓毒症组12例,所有患者入院第1、3、7天分别抽血检测降钙素原、C 反应蛋白和外周血白细胞计数,同时行血、痰细菌培养、胸片检查,采用急性生理和慢性健康状况评分(APACHEⅡ)评估患者病情程度。随访28 d 判断预后。结果降钙素原在脓毒症组升高明显(最高10.13 ng/ml),非脓毒症组变化不明显,降钙素原高于0.5 ng/ml 诊断脓毒症的敏感性为97.0%,特异性为91.7%,其阳性预测值达到82.1%,均高于 C 反应蛋白和白细胞计数。降钙素原的浓度与预后有关,死亡组明显高于存活组。降钙素原和白细胞计数在两组均升高,但各组间差异无统计学意义。结论降钙素原可以作为判断脓毒症的早期指标,而且可能反映病情程度,预测预后。

Objective To investigate the diagnostic value of procalcitonin （PCT） as an early indicator for sepsis. Methods Serum levels of PCT and C-creative protein （CRP） and white blood cell （WBC） count were measured in 30 patients in critical condition hospitalized at an intensive care unit （ICU） with diagnosis of systemic inflammatory response syndrome （ SIRS ）. They were divided into two groups, sepsis and non-sepsis, based on their clinical manifestations and results of lab tests. Blood specimen was collected from each patient for measurement of PCT, CRP and WBC count on the 1^st, 3^rd and 7^th day after hospitalization and bacteriological culture for blood and sputum, and chest X-ray was performed, as well. Acute physiology, age and chronic health evaluation （APACHE Ⅱ ） was made on the 1^st, 3^rd and 7^th day after hospitalization to assess their ill condition. Their prognosis were judged on the 28^th day of the follow-up. Results Serum level of PCT increased significantly in the sepsis group （ with the highest of 10. 13 ng/ml）, as compared with that in the non-sepsis group. Sensitivity, specificity and predictive value of a positive test for a cut-off value of serum level of PCT at 0. 5 ng/ml were 97.0% ,91.7% and 82. 1% , respectively, which were all better than those of serum level of CRP and WBC count. Serum level of PCT in the patients was significantly associated with their prognosis, and PCT in those died was significantly higher than that in those survived. Whereas, serum level of CRP and WBC count elevated in both groups, but the difference between the two groups did not reach a level of statistical significance. Conclusion Serum level of PCT can be used as an early indicator for judgment of sepsis for a patient with infection and reflection of severity of illness.