脓毒症的诊断和预后评估中presepsin的临床价值

Diagnostic and prognostic value of presepsin for sepsis

目的研究presepsin对脓毒症的诊断和预后评估价值。方法诊断准确性试验。以PATHFAST检测系统检测了2012年1月至2013年12月期间来北京军区总医院二六三临床部就诊的57例脓毒症患者、64例系统性炎症反应综合征（SIRS）患者和120名健康个体的血浆presepsin水平。采用ROC曲线法评价了presepsin对脓毒症的诊断价值，并与PCT进行比较。以logistic回归分析presepsin与脓毒症的关系。此外，还分析了presepsin与脓毒症患者临床特征的关系。结果脓毒症患者presepsin水平1266（754～2181）pg／ml较SIRS患者517（349～939）pg／ml和健康个体（182±56）pg／ml明显增高（Z值分别为5．94和10．71，P均〈0．01）。presepsin和PCT诊断脓毒症的曲线下面积分别为0．81[95％可信区间（CI）：0．74～0．89]和0．78（95％C1：0．71～0．86），差异无统计学意义（X2=0．60，P=0．47）。在校正了PCT以后，presepsin〉1060pg／ml仍然与脓毒症独立相关，优势比（OR）为7．80（95％CI：3．07～20．32）。严重脓毒症患者presepsin 2723（2002—4234）pg／ml高于脓毒症患者1145（656～1436）pg／ml（Z=4．00，P〈0．01）。住院期间死亡的脓毒症患者presepsin 2365（1256—3567）pg／ml高于存活的患者1146（660—1452）pg／ml（z=2．99，P=0．003）。presepsin与PCT呈正相关（r=0．75，P〈0．01）。presepsin的参考范围为72～292pg／ml。结论presepsin是诊断脓毒症的有益标志物，其诊断价值和PCT并不完全重叠，二者联合诊断更有助于提高脓毒症的诊断准确性。此外，presepsin还具有潜在的预后评估价值。

Objective To investigate the diagnostic and prognostic value of presepsin for sepsis. Methods Diagnostic accuracy test. The plasma presepsin levels of 57 sepsis patients, 64 systemic inflammatory response syndrome （SIRS） patients and 120 healthy individuals admitted to the 263 Clinical Branch, General Hospital of Beijing Military Region between January 2012 and December 2013were detected by PATHFAST system. Receiver operating characteristic （ROC） curve analysis was used to assess and compare the diagnostic value of presepsin and procalitonin （PCT）. Logistic regression model was used to estimate the association between presepsin and sepsis. In addition, the correlations between presepsin and the clinical characteristics were analyzed in sepsis patients. Results Sepsis patients [ 1 266 （754 -2 181 ） pg/ml] had higher presepsin level than SIRS [ 517 （349 -939）pg/ml] and healthy individual controls [ （182±56）pg/ml] （Z value was 5.94 and 10. 71, respectively, P value was 〈0. 01 for all）. The areas under curve （AUCs） of presepsin and PCT were 0. 81 （95% CI：0. 74 -0. 89） and 0. 78 （95% CI： 0. 71 - 0. 86）, respectively, with no statistical significance （X2 = 0. 60, P = 0.47 ）. After adjusted for PCT, presepsin 〉 1 060 pg/ml was independently associated with sepsis, with odds ratio （OR） of 7. 80 （95% CI： 3.07 - 20. 32）. Severe sepsis patients [ 2 723 （2 002 - 4 234） pg/ml ] had higher presepsin than sepsis patients[ 1 145 （656 - 1 436） pg/ml] （Z =4. 00, P 〈0. 01 ）. The patients with inhosptal mortality [2 365 （ 1 256 -3 567）pg/ml] had higher presepsin than survival ones[ 1 146 （660 - 1 452） pg/ml] （Z =2.99, P = 0. 003 ） . Presepsin was positively correlated with PCT （ r = 0. 75, P 〈 0. 01 ） . The reference for presepsin was 72 to 292 pg/ml. Conclusions Presepsin was an useful biomarker for sepsisdiagnosis. The diagnostic value of presepsin and PCT was not completely overlap, and combinational using of these two biomarkers may improve the diagnostic accuracy of sepsis. In addition, presepsin had potential value for prognosis estimation.