降钙素原对脓毒血症患者的早期诊断及预后判断的意义

Clinical Value of Procalcitonin in Early Diagnosis and Prognosis for Patients with Sepsis

目的评价降钙素原(PCT)对脓毒血症(sepsis)早期诊断及预后判断的临床价值。方法纳入2011年6月至2012年12月我们医院收治的不同严重程度脓毒症患者35例,其中脓毒症12例,严重脓毒症13例,脓毒症休克10例,纳入同期非感染性SIRS10例。比较脓毒症与非感染性SIRS间、不同程度脓毒症间和不同预后脓毒症患者间的血清PCT、C反应蛋白(CRP)、白细胞介素-6(IL-6)、白细胞介素-8(IL-8)水平、SOFA评分。转出或病情显著改善为康复,无改善或死亡为恶化。结果脓毒症、严重脓毒症和脓毒症休克患者血清PCT值、CRP水平、IL-6、IL-8、SOFA评分均明显高于非感染性SIRS(P<0.05),不同程度脓毒症患者间PCT水平、SOFA评分均有显著性差异,随严重程度升高而升高(P<0.05)。而CRP水平、IL-6、IL-8均无显著差异(P>0.05)。脓毒症康复组血清PCT水平、SOFA评分显著低于恶化组(P<0.01),而CRP水平、IL-6、IL-8无显著差异(P>0.05)。结论 PCT、CRP、IL-6、IL-8均可反映感染性炎症,PCT可作为早期诊断脓毒血症及预后判断的指标之一。

Objective To assess the Clinical value of procalcitonin （PCT） in early diagnosis and prognosis for patients with sepsis. Methods 35 patients with different severe sepsis from June 2011 to December 2012 were included in our hospital. The final diagnosis was sepsis in 12 patients, severe sepsis in 13 and septic shock in 10. Besides, 10 non-infective systemic inflammatory response syndrome （SIRS） were enrolled as control group. The difference of serum PCT, C-reactive protein （CRP）, IL-6, IL-8 and sepsis related organ failure assessment （SOFA） scores were compared in controls and the septic patients with different severities and prognosis. Discharging from hospital for rehabilitation, no improvement or deterioration for death. Results The PCT, CRP, IL-6, IL-8 levels and SOFA scores of patients with sepsis, severe sepsis and sepsis shock were significantly higher than that in non-infective SIRS group（P〈 0.05）. The CRP level and SORA scores were also apparently increased in different septic patients and progressively elevated by the severities of patients （P〈 0.05）. However, CRP, IL-6 and IL-8 levels were not significantly different （P〉0.05）. The PCT levels and SOFA scores of patients with rehabilitation were remarkably lower than that with deterioration （P〈 0.01）. But no difference was found in the levels of CRP, IL-6 and IL-8 （P〉0.05）. Conclusion The levels of PCT, IL-6 and IL-8 can reflect the infective inflammation, and the PCT can be a promising indicator of early diagnosis and prognosis assessment for sepsis.