降钙素原的变化趋势与脓毒性休克抗菌药物治疗效果的相关性分析及其与预后的关系

Correlation analysis on the trends of procalcitonin and the effect of antimicrobial drug treatment of septic shock and its relationship with prognosis

目的探讨降钙素原（PCT）的变化趋势与脓毒性休克抗菌药物治疗效果的相关性及其与预后的关系。方法选择本院重症医学科2012年1月～2014年1月脓毒症休克患者146例,入院后1、3、5、7 d晨间空腹取静脉血,采用双抗夹心免疫化学发光法检测PCT,采用散射免疫比浊法检测C-反应蛋白（CRP）,采用血细胞分析仪检测白细胞计数（WBC）。检测患者治疗0、24、48、72 h血清PCT值,并将结果与前一次结果比较计算出PCT下降百分比,用ΔPCT表示,评估PCT的变化趋势与抗菌药物治疗效果的相关性。记录患者28 d死亡率,并将其记为死亡组,生存患者记为生存组,比较两组入院后1、3、5、7 d的PCT、CRP及WBC水平,评估PCT与预后的关系。结果PCT的变化趋势与抗菌药物的治疗效果有相关性。随入住ICU时间的延长,生存组PCT、CRP呈下降趋势,死亡组PCT、CRP呈上升趋势,入院3 d起,两组PCT差异有统计学意义（P〈0.05,P〈0.01）,5 d后两组CRP差异有统计学意义（P〈0.05）;两组入院后1、3、5、7 d的WBC差异无统计学意义（P〉0.05）。结论在脓毒性休克抗菌药物治疗的同时连续监测PCT的变化趋势可指导临床合理用药,PCT水平的持续升高提示患者预后不良,血清PCT可作为预测脓毒性休克患者预后的指标。

Objective To investigate the correlation between the trends of procalcitonin（PCT） and the effect of antimicrobial drug to septic shock and its relationship with prognosis. Methods 146 cases of patients with septic shock in our hospital Critical Care Medicine from January 2012 to January 2014 were selected,morning fasting venous blood was collected 1,3,5,7 days after admission,dual anti-sandwich immunoassay chemiluminescence was used to detect PCT,scattering immunonephelometryusing was used to detect C-reactive protein（CRP）,hematology analyzer was used to detect white blood cell count（WBC）.Serum PCT was detected in patients 0,24,48 and 72 hours after treatment,and the results were compared with the previous results to calculate the percentage of PCT decreasing by ΔPCT,the correlation between trend of PCT the effect of antimicrobial drug was assessed.The mortality of patients after 28 days treatment was recorded,and were recorded as death group,the survival patients were recorded as survival group,and the PCT,CRP and WBC levels 1,3,5,7 days after admission were compared,the relationship between PCT and prognosis were assessed.Results PCT trends and antimicrobial treatment was correlated.With prolonged ICU stay time,the PCT and CRP of survival group was decreased,which of death group was increased,hospitalized 3 days on,PCT of two groups had significant difference（P〈0.05,P〉0.01）,hospitalized 5 days on,CRP of two groups had significant difference（P〈0.05）;WBC of two groups 1,3,5,7-day after admission had no significant difference（P〉0.05）. Conclusion Meanwhile antimicrobial drug treatment of septic shock,continuously monitoring the trends of PCT can guide rational drug use,PCT levels continue to rise indicates a poor prognosis,serum PCT can be as a predictor of prognosis in patients with septic shock.