血清IL-6、CRP和PCT水平对严重多发伤后MODS的预测价值

The predictive value of serum levels of IL-6, CRP and PCT in patients with MODS after severe multiple trauma

目的探讨多发伤患者外周血血清白细胞介素-6(IL-6)、C反应蛋白(CRP)和降钙素原(PCT)对多器官功能障碍综合征(MODS)的预测价值。方法 87例多发伤患者按治疗过程中有无发生MODS分为MODS组和非MODS组。采用ELISA法测定患者伤后第1、2、3、5、和7天血清IL-6和PCT的含量,采用免疫比浊法测定血清CRP的水平,并与20例健康对照比较,应用受试者工作特征曲线(ROC曲线)进行统计学分析。结果与健康对照组相比,多发伤患者血清IL-6、CRP和PCT水平伤后早期均出现不同程度的升高(P<0.01),其中PCT水平升高最早;与非MODS组比较,MODS组各项指标均有显著差异(P<0.01)。IL-6、CRP和PCT的ROC曲线下面积分别为0.686、0.854和0.914。PCT对严重多发伤后发生MODS的诊断价值高于IL-6和CRP。结论 PCT是严重多发伤后预测MODS发生的较好辅助诊断指标,其诊断价值优于IL-6和CRP。

Objective To investigate the predictive value of serum levels of interleukin-6（IL-6）, C reactive protein（CRP） and proealcitonin（PCT） in patients with multiple organ dysfunction syndrome（MODS） after severe multiple trauma. Methods A total of 87 patients with multiple trauma were divided into MODS and non-MODS groups. The peripheral serum concentrations of IL-6 and PCT were detected by enzyme-linked immunosorbent assay at 1, 2, 3, 5 and 7d after severe multiple trauma, while CRP level was detected by immunoturbidimetry. All data were managed by receiver operating charaeteristic（ROC）. Results Compared with healthy control group, serum levels of IL-6, CRP and PCT in patients with multiple trauma were increased differently in early posttrauma period （P〈 0.01）. The serum level of PCT elevated earlier than those of IL-6 and CRP. The levels of IL-6, CRP and PC＇F in MODS group were significantly higher than those in non-MODS group （P〈 0.01）. Area under ROC curve of IL-6, CRP and PCT was 0.686, 0.854 and 0.914 respectively. PCT had more diagnostic value than IL-6 and CRP for diagnosis of MODS after severe multiple trauma. Conclusion The PCT is confirmed to be more sensitive and specific than IL-6 and CRP for diagnosis of MODS after severe multiple trauma.