血清降钙素原在重症病人感染早期诊断中的意义

Clinical value of a semi-quantitative procalcitonin test in the early diagnosis of sepsis

目的:评价半定量测定血清降钙素原(PCT)对重症病人感染的早期诊断及其与疾病严重程度的相关性。方法:取121例体温>38℃、符合全身炎症反应综合征临床表现并疑似感染的ICU重症病人入选,测定其血清PCT、C反应蛋白(CRP)、白细胞计数及分类,同时记录APACHEⅡ评分及全身性感染相关器官衰竭评分(SOFA)。用半定量免疫色谱法测定血清PCT,散射免疫比浊法测定血清CRP。结果:121例入选病人按临床表现和细菌学检测结果分为感染组和非感染组。感染组的APACHEⅡ和SOFA评分明显高于非感染组(P<0.05)。两组的血清PCT分布有显著性差异(χ2=46.736,P=0.000),参照受试者工作特征曲线,以血清PCT≥2ng/mL为阳性标准诊断感染的敏感度(80.65%)、特异性(77.78%)、阴性预测值(92.11%)及准确度(78.51%)均高于以CRP和WBC为诊断标准者。血清PCT与APACHEⅡ、SOFA评分呈明显正相关关系(P<0.01)。结论:与CRP、WBC等传统炎症指标相比,血清PCT在重症病人严重感染的早期诊断中有一定诊断价值;且动态监测PCT水平有助于评估治疗效果。PCT与严重感染的脏器功能障碍程度及疾病的严重程度相关,是评估感染严重程度的较好参数。

Objective To evaluate the predictive effect of a semi-quantitative procalcitonin （PCT-Q） measurement in the diagnosis of severe sepsis, and the relationship between serum PCT and the severity of sepsis. Methods According to the definition of sepsis defined by ACCP/SCCM Consensus Conference, 121 ICU patients with signs of suggestive sepsis were enrolled in the study. The serum PCT, C-reactive protein （CRP）, white blood cell （WBC） count and percentage of neutrophil estimation of each patient were measured, APACHE 11 score and SOFA score were calculated at the same time. Results According to the results of bacteria study and clinical manifestation, the 121 patients were divided into 2 groups： sepsis group and non-infectious systemic inflammatory response syndrome （SIRS） group. The results showed that APACHE I1 score and SOFA score were significantly higher in the patients with sepsis than those with non-infectious SIRS （P〈0.05）. The level of PCT was significantly different between the two groups as studied by the statistical method of Pearson chi-square test （~2=46.736,P=-0.000）. Receiver operating characteristic curves （ROC curve） were drawn and areas under these curves were calculated. For the assessment of sepsis, at a cutoff level of PCT ≥ 2 ng/mL, the sensitivity was 80.65%, the specificity was 77.78%, negative predictive value was 92.11%, and an accuracy rate of 78.51%. Serum PCT has a positive relationship with APACHE Ⅱ score and SOFA score （P〈0.01）. Conclusions Compared to conventional CRP and WBC, PCT could be a better marker for assessing sepsis of critically ill patients, and also for assessing the response to medication.