血清降钙素原对脓毒症严重程度评估及预后研究

Research on Prognosis and Severity Evaluation of Serum Procalcitonin to Sepsis

目的：探讨血清降钙素原（procalcitonin，PCT）在脓毒症患者中的临床应用价值，并为医院控制感染、合理使用抗生素提供科学依据。方法回顾性分析武警陕西总队医院2011年5月-2013年5月 ICU患者201例，根据感染严重程度分为4组，全身性炎症反应综合征（SIRS）63例、脓毒症（Sepsis）40例、严重脓毒症（Severe sepsis）70例、脓症性休克（Septic shock）19例，监测入住ICU 1，3，5，7，10，14和17天各组患者血中PCT，hs-CRP及WBC水平及据患者症状必要时进行血培养动态分析，以及PCT对脓毒症诊断的灵敏度、特异度、阳性预测值、阴性预测值和诊断符合率。结果 PCT水平 SIRS（1.92 ng/ml）组与脓毒症（10.8 ng/ml）组、严重脓毒症（24.0 ng/ml）和脓毒症休克（34.0 ng/ml）组相比，差异有统计学意义（q1＝13.8，q2＝15.6，q3＝17.9，P均＜0.05），四组 hs-CRP浓度、WBC计数相比，差异无统计学意义（F＝5.10，P＞0.05），PCT水平与脓毒症严重程度呈正相关性（r＝0.781）。阴性符合率血培养26.6％，且 PCT对脓毒症诊断的灵敏度、特异度、阳性预测值（PPV）和阴性预测值（NPV）分别为87.2％，85.4％，78.9％和89.3％；对脓毒症诊断符合率85.0％，PCT水平上升（≥1.0 ng/ml）是28天生存率的独立指标。结论 PCT与 hs-CRP及 WBC相比，能更好地评价脓毒症的严重程度，且动态判断脓毒症的预后情况更为敏感，与血培养联合检测，可提高脓毒症鉴别诊断准确率，同时指导临床合理应用抗生素，PCT浓度每天的变化可协助预测 ICU病房中脓毒症患者存在的死亡风险，减少并发症发生和降低死亡率。

Objective To study the serum procalcitonin （PCT）in patients with sepsis clinical application value,for the hospi-tal,infection control,to provide a scientific basis for reasonable Shaanxi General of antibiotics.Methods Retrospective anal-ysis of Shaanxi General hospital of CARF in 2011 May-2013 May 201 cases of patients with ICU,According to the severi-ty of infection were divided into 4 groups（SIRS）63 cases,（Sepsis）40 cases,（Severe sepsis）70 cases,（Septic shock）19 ca-ses,Dynamic analysis of ICU monitoring in 1,3,5,7,10,14,17 days each in the blood in patients with PCT,hs-CRP and WBC levels and blood culture,and PCT on the sensitivity,sepsis diagnostic specificity,positive predictive value,and negative predictive value,diagnostic accordance rate.Results PCT levels of SIRS and Sepsis （1.92 ng/ml）（10.8 ng/ml）group,the Severe Sepsis （24.0 ng/ml）,and Septic shock compared （34.0 ng/ml）group,the difference was statistically significant （q1=13.8,q2=15.6,q3=17.9,P〈0.05）.Four groups of hs-CRP and WBC count,and there was no statistically significant difference （F=5.10,P〉0.05）,PCT levels and the severity of sepsis in positive correlation （r=0.781）.The positive rate of blood culture in 26.6%,and PCT the on diagnosis of sepsis sensitivity,specificity,positive predictive value （PP）,negative predictive value （NPV）were 87.2%,85.4%,78.9% and 89.3%,respectively,for sepsis diagnosis coincidence rate 85%, the increase of PCT level（≥ 1 ng/ml）was anindependent index 28 natural deposit rate.Conclusion Compared with PCT hs-CRP and WBC could better evaluate the severity of sepsis,and dynamic j udgment of sepsis disease prognosis was more sensitive.Joint detection with blood culture could improve the of accuracy differential diagnosis of sepsis,and to guide clinical rational application of antibiotics.The change of concentration of PCT daily can help predict mortality risk in patients with sepsis in ICU of the hospital,reduce complications and reduce mortality.