降钙素原与D-二聚体在评估急诊脓毒症患者病情及预后的研究

Clinical significance of procalcitonin and D-dimer in evaluation of condition and prognosis of sepsis patients in emergency department

目的明确降钙素原及D-二聚体在评估急诊脓毒症患者病情以及预测患者预后的能力,以期掌握脓毒症患者病情并指导临床工作。方法采取前瞻性病例观察研究,在患者确诊为脓毒症后24h内检测D-二聚体含量及降钙素原浓度,并进行APACHEⅡ评分,探讨D-二聚体联合降钙素原与脓毒症患者严重程度的关系,并以患者临床死亡或存活为观察终点,将患者分为存活组及死亡组,通过ROC曲线分析D-二聚体联合降钙素原对脓毒症患者预后的判断能力。结果脓毒症患者病情越严重,降钙素原和D-二聚体含量越高(P<0.05),而且死亡组患者的PCT、D-二聚体水平明显高于存活组(P<0.05);以患者死亡为最终截点,降钙素原、D-二聚体预测患者死亡的ROC曲线下面积分别为0.779和0.730;当降钙素原浓度为7.1ng/ml时,提示患者预后不良的敏感性为78.6%,特异性为72.7%;当D-二聚体浓度为2.75mg/L时,提示脓毒症患者预后不良的敏感性为78.6%、特异性为65.5%。结论降钙素原以及D-二聚体可有效评估脓毒症患者的病情程度,并可预测患者的预后。

OBJECTIVE To define the value of procalcitonin and D-dimer in the evaluation of illness condition of the sepsis patients in emergency department and in the predication of prognosis so as to provide guidance for clinical treatment of the sepsis patients.METHODS By means of prospective case-control survey,the concentrations of procalcitonin and D-dimer were determined within 24 hours after the patients were confirmed as the sepsis,the A-PACHEⅡ scoring was performed,the relationship between the D-dimer combined with procalcitonin and the se-verity of sepsis was observed,the patients were divided into the survival group and the death group on the basis of observation endpoint,which was set by the clinical death or survival;the ROC cure was employed to analyze the ability of D-dimer combined with procalcitonin in prediction of the prognosis of the sepsis patients.RESULTS The severer the illness condition of the sepsis patients,the higher the contents of procalcitonin and D-dimer were （P〈0.05）;the concentration of the procalcitonin and D-dimer of the death group was significantly higher than that of the survival group （P〈0.05）.With the death set as the final cutoff point,the areas under the ROC curve in predi-cating the mortality of the sepsis patients by procalcitonin and D-dimer were 0.779 and 0.730,respectively.The sensitivity and specificity of procalcitonin in predication of adverse prognosis were respectively 78.6% and 72.7%when the concentration was 7.1 ng/ml;the sensitivity and specificity of D-dimer in predication of adverse progno-sis of the sepsis patients were respectively 78.6% and 65.5% when the concentration was 2.75 mg/L. CONCLUSION Procalcitonin and D-dimer can not only effectively assess the illness condition of the sepsis patients but also predict the prognosis of the patients.