脓毒症患者血浆Presepsin水平检测的临床意义

Clinical significance of presepsin level in patients with sepsis

目的：探讨脓毒症患者Presepsin变化的临床意义。方法：选取江苏大学附属医院重症监护病房2011年10月至2013年3月脓毒症患者52例，SIRS患者40例。另选30例健康正常人为对照组。检测各组入院时血浆Presepsin、及降钙素原（PCT）水平，并进行APACHEⅡ评分。对比分析各组患者血浆Presepsin水平、降钙素原水平与APACHEⅡ评分。 ROC曲线分析各指标对脓毒症的诊断性能。结果：死亡组血浆Presepsin、PCT水平及APACHEⅡ评分均显著高于存活组和对照组（P＜0．01）；脓毒症组患者血浆Presepsin、PCT水平高于SIRS组及对照组（P＜0．05）。 APACHEⅡ评分在SIRS组和脓毒症组间比较差异无统计学意义。相关分析显示：血浆Presepsin水平与PCT水平呈正相关性（r ＝0．82），与APACHEⅡ评分呈正相关性（r＝0．69）。 Presepsin的AUC为0．908（95％CI：0．848～0．967）；分界值为629 pg／mL时灵敏度为68．6％，特异度为90％。 PCT的AUC为0．862（95％CI：0．787～0．937）；分界值为1．98 ng／mL时灵敏度为92％，特异度为65％。结论：脓毒症患者血浆中Presepsin升高，Presepsin水平升高提示患者病情危重。

Objective To investigate the clinical significance of plasma presepsin levels in patients with sepsis. Methods 92 patients who were admitted to the ICU of the affiliated hospital of Jiangsu University from October 2011 to March 2013 and 30 age-matched healthy controls were enrolled in this study. The patients were divided into three groups： sepsis, SIRS, and control. Plasma presepsin and serum procalcitonin （PCT） were measured, APACHEⅡscore were calculated at enrollment, and ROC curve was used to analyze the performance index for the diagnosis of sepsis. Results Serum levels of presepsin, PCT and APACHEⅡscore were significantly higher in the death group than in the SIRS group and the control group （P〈0.01）. Serum levels of presepsin and PCT were higher in the sepsis group than in the SIRS group and the control group （P〈0.05）. There was no significant statistical difference between the SIRS group and the sepsis group in the APACHEⅡ score （detailed in table 1）. Level of plasma presepsin was significantly correlated with serum PCT （r = 0.82）; plasma presepsin level was related with the APACHEⅡ score （r = 0.69）. The area under the curve （AUC） of presepsin was 0.908 （95%CI 0.848~0.967）, greater than the AUC of PCT 0.862 （95%CI 0.787~0.937）. The cutoff value of presepsin for discrimination of bacterial and nonbacterial infectious diseases was determined to be 629 pg/mL, of which the clinical sensitivity and specificity were 68.6% and 90%, respectively; when the cutoff value of PCT was 1.98 ng/mL, the clinical sensitivity and specificity were 92%and 65%. Conclusions Level of presepsin increases in patients with sepsis, and an elevated presepsin may suggest the severity of sepsis.