ICU脓毒症患者血清降钙素原的动态变化及其意义

Dynamic variation of serum procalcitonin of ICU patients with sepsis and its clinical significance

目的持续监测重症监护病房（ICU）脓毒症患者中降钙素原（PCT）的浓度，阐明脓毒症炎症因子PCT的变化规律，并指导脓毒症的诊断和判断预后。方法选取2012年11月-2013年6月收集ICU中的132例脓毒症患者，抽取人院第1～7天入选患者全血，检测其PCT浓度，采用SPSS17．0软件进行统计分析，计量资料以均数±标准差表示，组间比较用t检验。结果总共纳入合格患者132例，其中脓毒症组52例，严重脓毒症组43例，脓毒性休克组37例；28d内的病死率为21．21％，痰细菌培养阳性率为31．06％，人院第1、2、3、4天PCT浓度在不同严重程度差异有统计学意义，脓毒性休克组PCT浓度显著高于严重脓毒症组和脓毒症组；在第5～7d无明显差异；脓毒症程度与时间具有关联性（P〈0．05）；第1天PCT的诊断价值在截点值为6．68ng／ml时的AUC=0．968（P〈0．05），其敏感性93．7％，特异性74．3％。结论PCT的升高随着机体感染程度的不同而不同，动态监测PCT水平能判断患者预后，PCT能作为炎症反应的一项有用的监测指标。

OBJECTIVE To continuously monitor the concentration of procalcitonin （PCT） in the ICU patients with sepsis and define the rule of variation of inflammatory factors of sepsis so as to guide the diagnosis and judgment of prognosis of sepsis. METHODS A total of 132 cases of ICU patients with sepsis, who were treated in the hospital from Nov 2012 to Jun 2013 were enrolled in the study, then the whole blood was extracted from the from the first day to the seventh day of admission, the concentration of PCT was tested, the statistical analysis was performed with the use of SPSS17.0 software, the measurement data were defined by using standard deviation, and t-test was performed for the comparison. RESULTS Totally 132 patients were eligible for the enrollment, including 52 cases of sepsis, 43 cases of severe sepsis, and 37 cases of septic shock. The 28-day mortality was 21.21%0, the positive rate of sputum culture was 31. 06%. The difference in the concentration of PCT at the 1st , 2nd; 3rd, and 4th day of admission between the three groups was statistically significant; the concentration of PCT of the septic shock group was significantly higher than that of the severe sepsis group and the sepsis group; there was no significant difference in the concentration of PCT at the fifth , sixth ,and seventh day of admission; the severity of sepsis was related to the time of admission （P〈0.05）. The diagnostic value of PCT on the first day in the area under the ROC curve（AUC） was 0. 968 at cut-off= 6.68 ng/mL （P〈0.05）, its sensitivity was 93.7%, specifici- ty 74.3%. CONCLUSION The severity of sepsis varies with the elevation of concentration of PCT, dynamic monitoring of PCT level may contribute to the judgment of prognosis, and PCT can be used as a useful indicator for the monitoring of inflammatory response.