抗休克治疗对感染性休克患者血清感染标志物水平的影响及其意义

Clinical significances of procalcitonin and C - reactive protein changes in serum levels during anti - shock treatment of patients with septic shock

目的检测液体复苏或合用升压药（多巴胺／去甲肾上腺素）抗感染性休克治疗过程中不同时点血清感染标志物降钙素原（PCT）及C反应蛋白（CRP）浓度，探讨其动态变化的临床意义。方法选取达标（中心静脉压8～12mmHg、平均动脉血压≥65mmHg）治疗22例符合本研究入选标准的感染性休克患者。采用免疫化学发光法和散射比浊法检测12例健康体检者，22例休克患者治疗前及治疗后12、24、48h血清PCT、CRP浓度，比较其变化；进一步依达标采取的治疗措施细分为单纯液体复苏和液体复苏＋升压药两个亚组，比较亚组间同时点PCT、CRP浓度。结果感染性休克患者血清PCT、CRP浓度显著高于健康体检者（均P〈0．01）；液体复苏（或）合用升压药治疗后显著降低，且随治疗时程延长，后一时点降低比前一时点更加显著（P〈0．01或P〈0．05）；但细分的两亚组同时点间比较差异无统计学意义。结论感染性休克患者血清PCT及CRP浓度显著升高，液体复苏及液体复苏＋升压药治疗后均显著降低，但降低幅度比较差异无统计学意义。动态监测感染性休克患者血清PCT及CRP浓度可反映病情、疗效及预后。

Objective To investigate the dynamic changes of serum procalcitonin （PCT） and C -reactive protein （CRP） level during the treatment （fluid resuscitation or fluid resuscitation combined with dopamine/norepinephrine） of patients with septic shock, and to explore their clinical significances. Methods According to the target of treatment （ centre venous pressure 8 - 12 mm Hg and mean arterial pressure ≥ 65 mm Hg）, 22 patients with septic shock received either fluid resuscitation or fluid resuscitation combined with dopamine （ or norepinephrine ）. The levels of serum PCT and CRP were respectively measured by immunoassay chemiluminescent and immune nephelometry, and were compared before treatment and 12, 24, 48 h after treatment by self- controlled prospective study. Then the patients were divided into two subgroups according to the treatment with fluid resuscitated or fluid resuscitation combined with drugs, and the serum PCT and CRP levels were comparatively analyzed in two subgroups. Results The serum PCT and CRP level were significantly higher in the patients with septic shock than in healthy subjects （P 〈 0.01 ）, and were markedly decreased with the duration of treatment by fluid resuscitation （ or combined with dopamine/norepinephrine） （P 〈 0.01 or P 〈 0.05 ）. Fluid resuscitation subgroup decreased more obviously than fluid resuscitation combined with drugs subgroup at all stages, but there were no statistical significances. Conclusion High levels of serum PCT and CRP in patients with septic shock can be decreased by fluid resuscitation or fluid resuscitation combined with drugs （dopamine or norepinephrine ）, but there are no statistical differences in the decrease of serum PCT and CRP level between fluid resuscitation and resuscitation combined with drugs. Combined detection of serum PCT and CRP level is helpful for diagnosis, treatment and prognosis evaluation of patients with septic shock.