血浆降钙素原浓度水平测定在脓毒血症中的应用价值

Value of plasma procalcitonin level detection in treatment of pyemia

目的探讨血浆降钙素原(PCT)在鉴别脓毒血症及判断脓毒血症严重程度方面的价值。方法选择本院收治的脓毒症患者70例,根据患者病情严重程度分为一般脓毒症组(n=23)、严重脓毒症组(n=28)和脓毒症休克组(n=19),于入院1 h内应用抗生素治疗前测定患者血浆PCT、乳酸、C反应蛋白,并计算24 h急性生理和慢性健康状态评分Ⅱ(APACHEⅡ),住院第1、2、3天均测定患者血清PCT、乳酸、C反应蛋白。结果严重脓毒症组、脓毒症休克组患者血浆PCT、乳酸、CRP和APACHEⅡ评分明显高于一般脓毒症组(P<0.05);脓毒症休克组患者血清PCT、CRP和APACHEⅡ评分明显高于严重脓毒症组(P<0.05);70例脓毒症患者死亡15例,存活55例,死亡组72 h血浆PCT、乳酸、CRP和APACHEⅡ评分明显高于存活组(P<0.01);脓毒症患者入院时PCT与APACHEⅡ评分呈正相关(r=0.528,P<0.01)。结论 PCT优于目前临床上应用的CRP炎症反应参数,可作为早期鉴别全身感染及判断脓毒血症严重程度及预后的有效指标。

Objective To explore the value of plasma procalcitonin（ PCT） detection in differentiation and judgment of severe pyemia. Methods 70 patients with pyemia were divided into general pyemia group（ n = 23）,severe pyemia group（ n = 28） and pyemia shock group（ n = 19）,and plasma PCT,lactic acid,c- reactive protein,the acute physiology and chronic health evaluation Ⅱ24 hours（ APACHE Ⅱ） and 1,2,3 days in hospital as well as serum PCT,lactic acid,c- reactive protein were detected and compared. Results Plasma PCT,lactic acid,CRP and APACHE Ⅱ score of pyemia shock patients were significantly higher than the general pyemia group（ P〈 0. 05）. Serum PCT,CRP and APACHE Ⅱ score of pyemia shock patients were significantly higher than that of severe pyemia group（ P〈 0. 05）. 15 patients with pyemia died,55 patients survived. 72 hours plasma PCT,lactic acid,CRP and APACHE Ⅱ score in death group were significantly higher than the survival group（ P〈 0. 01）. When pyemia patients were admitted to hospital,PCT were positively correlated with APACHE Ⅱ scores（ r = 0. 528,P〈 0. 01）. Conclusion PCT is superior to the current clinical application of CRP inflammatory response parameters,and it can be used as an early identification of systemic infection,judgment of pyemia severity and prognosis judgment index.