降钙素原对腹部手术围手术期脓毒症监测及预后的意义

Prognostic significance of serum procalcitonin in abdominal surgery perioperative patients with sepsis

目的探讨降钙素原(PCT)在腹部手术围手术期患者中的变化及其对预后判断的意义。方法入选住院的腹部手术围手术期患者102例,根据感染情况分为脓毒症组(n=64)和全身炎症反应综合征组(SIRS,n=38),脓毒症组根据预后(死亡组28例和存活组36例)及病情严重程度(一般脓毒症组21例、严重脓毒症组20例及脓毒症休克组23例)分组,比较各组PCT及急性生理和慢性健康状况评分Ⅱ(APACHEⅡ评分)的差异,分析PCT水平与APACHEⅡ评分的相关性,绘制64例脓毒症患者血清PCT值的受试者工作特征曲线(ROC),分析其对死亡的预测结果。结果脓毒症组患者PCT水平及APACHEⅡ评分明显高于SIRS组,脓毒症患者死亡组PCT及APACHEⅡ评分明显高于生存组,差异均有统计意义(P<0.05);一般脓毒组、严重脓毒症组、脓毒症休克组随病情程度加重,PCT水平及APACHEⅡ评分明显增加,组间比较差异有统计学意义(P<0.05)。PCT、APACHEⅡ评分之间呈正相关(r=0.75,P<0.05);对64例脓毒症患者死亡预测的血清PCT值的ROC曲线下总面积为0.974,血清PCT的最佳阈值为1.28ng/ml,其对死亡预测的敏感度为100%、特异度为97.2%。结论血清PCT值可作为腹部手术围手术期患者脓毒症监测及预后判断的指标,指导临床合理应用抗生素,降低病死率。

Objective To evaluate the clinical implication of serum procalcitonin in abdominal surgery perioperative patients by analyzing its change. Methods 102 patients undergoing abdominal surgery were divided into sepsis group（64 cases） and SIRS group（38 cases） according to infection status. Sepsis group were divided into death group（28 cases） and survival group（36 cases） according to their prognosis. Meanwhile sepsis group were divided into mild sepsis group（21 cases）, severe sepsis group（20 cases） and shock sepsis group（23 cases） according to patient＇s condition. PCT levels and APACHE Ⅱ score according to classification of different outcomes and intra-abdominal sepsis were compared. The correlation of PCT levels and APACHEⅡ score were also analyzed. Receiver operating characteristic curve of serum PCT levels was used to predict death for 64 sepsis patients. Results PCT levels and APACHE Ⅱ score of sepsis group were significant higher than the SIRS group,and PCT levels and APACHE Ⅱ score of death group were significantly higher than the survival group, differences were statistical significance（ P〈0. 05）. Along with the degree of illness aggravating, PCT levels and APACHE Ⅱ score increased significantly,and the differences among mild sepsis group, severe sepsis group and shock sepsis group were statistically significant（P〈0.05）. PCT levels and APACHE Ⅱ score were positive correlated（r =0.75, P〈0.05）. The total area under ROC curve of PCT levels for predicting death for 64 sepsis patients was 0.974,and 1.28 ng / ml was chosen as the optimal threshold level,with sensitivity of 100% and specificity of 97.2%. Conclusion PCT levels can be served as a vital prognostic indicator for abdominal surgery perioperative patients with sepsis,which can be considered as a guide for rational use of antibiotics,also in order to reduce mortality.