血浆PCT和CRP水平的动态变化对脓毒症严重程度的评估及其相关性研究

Dynamic monitoring of blood PCT and CRP levels in the evaluation of the severity of sepsis and the clinical significance

目的探讨动态监测血浆PCT和CRP水平在评估脓毒症患者严重程度的临床意义及其相关性研究。方法选择2009年9月至2011年9月我院ICU入住的脓毒症患者114例,在入科的第1,3,5,7天抽取外周血检测PCT、CRP水平,同时行血培养,根据血培养结果分为血培养阳性组和血培养阴性组,根据脓毒症严重程度分为脓毒症组、严重脓毒症组、脓毒性休克组,比较各组PCT、CRP水平有无差异及各指标之间的相关性。结果 (1)在脓毒症血培养阳性组第1、3、5、7天PCT水平及第1、3天的CRP水平明显高于血培养阴性组,ROC曲线图显示,在诊断是否存在血行性感染上,PCT具有较高的特异性和敏感性;(2)在脓毒症组、严重脓毒症组、脓毒性休克组,随着感染程度加重,PCT水平与CRP水平均呈上升趋势,以PCT和CRP来诊断严重脓毒症或脓毒性休克的ROC曲线图所示,PCT较CRP具有较高的敏感性和特异性。结论脓毒症患者血浆PCT水平较CRP水平与疾病严重程度有着更明显的相关性,动态监测PCT水平变化趋势有助于脓毒症严重程度的判断及指导治疗。

Objective To investigate the prognostic value of dynamic monitoring of blood PCT,CRP levels in the severity and prognosis of sepsis;Methods 114 sepsis patients were collected in our hospital ICU from September 2009 to September 2011,Blood samples for testing PCT,CRP level were taken on the 1,3,5,7 day of hospitalization,and Blood culture were collected,according to blood culture results divided into two groups,blood cultures positive and blood culture-negative group,according to the severity of sepsis,divided into sepsis group,severe sepsis group and septic shock group,compared the plasma PCT,CRP level,between each group.Results（1） The PCT levels of 1,3,5,7 days and CRP levels of 1,3 days in the blood cultures-positive group were significantly higher than blood culture-negative group,the specificity and sensitivity of PCT were higher than the CRP under the area of ROC curve in the diagnosis of bloodstream infection;（2） Among the sepsis group,severe sepsis group and septic shock group,with the severity of infection increased,PCT levels and CRP levels showed an upward trend,and the PCT levels have higher specificity and sensitivity associated with the severity of sepsis than the CRP under the area of ROC curve.Conclusion The plasma PCT levels in patients with sepsis compared with CRP levels have a more significant correlation with the diagnosis of bloodstream infection and the severity of sepsis,dynamic monitoring of PCT levels can help in the evaluation of the severity of sepsis and the therapy of sepsis.