脓毒症患者血清降钙素原检测的临床价值

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

目的探讨降钙素原（PCT）对脓毒症早期诊断和预后评估的价值。方法采用前瞻性研究方法，随机选取脓毒症患者100例（总脓毒症组）、全身炎症反应综合征患者（SIRS组）37例、健康体检者（对照组）31例，又根据病情严重程度不同，将100例脓毒症患者，分成脓毒症组36例、严重脓毒症组40例、脓毒性休克组24例，分别测定各组血清PCT、C反应蛋白（CRP）、感染相关器官功能衰竭评分（SOFA评分），并进行相互比较，观察其与脓毒症诊断及预后的关系。结果PCT、CRP在SIRS组[（3．1±2．3）μg／L、（34．7±28．0）mg／L]、总脓毒症组[（10．8±8．1）μg/L、（106．8±69．3）mg／L]较对照组[（0．3±0．2）μg/L、（4．1±2．9）mg／L]明显升高（均P〈0．01），总脓毒症组与SIRS组比较，差异有统计学意义（P〈0．01）。PCT在脓毒症各组中随病情加重有不断升高趋势，且病死率也不断上升。最佳诊断脓毒症界值为：PCT〉4．4μg／L，CRP〉51．8mg／L，SOFA〉4．0分。结论PCT、CRP可以作为脓毒症早期诊断指标，有较高的特异性，PCT与SOFA评分联合检测是评估脓毒症病情严重程度的理想的量化指标。

Objeative To study the diagnostic and prognostic value of procalcitonin（PCT） in patients with sepsis in early stage. Methods In the perspective study, 168 patients enrolled were classified into three groups, ncluding 31cases in control group,37 cases in SIRS group and 100 cases in general sepsis group. The latter were composed of moderate sepsis sub-group with 36 cases, severe sepsis sub-group with 40 cases and septic shock sub-group with 24 cases. Indexes of inflammation, SOFA and concentration of PCT in all patients were determined and their correlation with sepsis prognosis was analyzed. Results The level of PCT and CRP is 3.1± 2. 3 μg/L and 34. 7 ± 28.0 mg/L in SIRS group, is 10. 8 ± 8.1 μg/L and 106. 8 ± 69. 3 mg/L in general sepsis group respectively. Which are higher than the level of PCT（0. 3 ±0.2 μg/L）and C RP（4. 1± 2.9 mg/L）in control group （P 〈 0. 01 ）. Higher concentration of PCT and CRP were found in general sepsis groups than those in SIRS group. The difference is prominent. Moreover, an increasing trend of PCT with the more serious of＇illness was found in subgroup analysis, but not in CRP. According to the receiver operating characteristic curves （ ROC curves）, The best cutoff values in the diagnosis of sepsis were 〉 4. 395 μg/L for PCT, 〉 51.8 mg/L for CRP and 〉 4. 0 for SOFA score. Conclusion PCT and CRP are useful diagnostic parameters with high specificity in early sepsis. PCT combining with SOFA score can be used as ideal quantitative index to estimate the severity of sepsis and prognosis in patients with sepsis.