降钙素原和常用炎症指标在脓毒症诊断及预后中的价值

The diagnostic value and prognostic significance of serum procalcitonin and Common inflammatory markers in patients with sepsis

目的探讨降钙素原(PCT)及常用炎症指标在脓毒症诊断及预后判断中的价值。方法采用回顾性病例对照研究。依据2001年SCCM/ESICM/ACCP/ATS/SIS国际脓毒症会议关于脓毒症诊断标准,将入选病例分为非感染性全身炎症反应综合征(SIRS)组,一般脓毒症组,严重脓毒症组,测定入院24 h内或临床怀疑脓毒症时血清PCT浓度及常用炎症指标并进行相关分析。结果 127例患者入选,其中非感染性SIRS组42例,一般脓毒症组47例,严重脓毒症组38例。一般脓毒症患者与非感染性SIRS患者相比,血清PCT[(1.82±1.57)μg/L vs.(0.63±0.65)μg/L,P<0.01],CRP[(84.87±64.58)mg/L vs.(51.31±59.02)mg/L,P<0.05]水平升高,严重脓毒症患者与一般脓毒症患者相比,血清PCT[(10.55±9.58)μg/L vs.(1.82±1.57)μg/L,P<0.01],CRP[(123.38±78.17)mg/L vs.(87±64.58)mg/L,P<0.05]明显升高?诊断脓毒症的ROC曲线下面积PCT 0.916±0.028,最佳截断值为0.885μg/ml,灵敏度91.8%、特异度81.0%,PCT与CRP联合诊断脓毒症的灵敏度达96.5%。预后良好组患者血清PCT水平明显低于预后不良组患者[(2.76±4.22)μg/L vs.(9.38±9.72)μg/L,P<0.01]。结论血清PCT是诊断脓毒症敏感度、特异度均较高的指标;PCT与CRP联合可提高诊断脓毒症的敏感性;PCT浓度的升高可反映脓毒症严重程度的增加;PCT的浓度越高,提示患者预后越差。

Objective To explore the diagnostic value and prognostic significance of serum procalcitonin and common inflammatory markers in patients with sepsis. Methods Patients were studied in a retrospective case-control method. According to the 2001 SCCM / ESICM / ACCP / ATS / SIS International Sepsis Definitions Conference,patients were divided into three groups： non-infectious SIRS group,sepsis group and severe sepsis group. Concentration of common inflammatory markers and PCT were determined at 24 hours or when sepsis was clinical suspected and their correlation was analyzed. Results 127 patients were enrolled,including 42 in non-infectious SIRS group,47 in sepsis group and 38 in severe sepsis group. The PCT and CRP levels of patients with sepsis and severe sepsis were significantly higher than that in non-infectious SIRS group[（ 1. 82 ± 1. 57） vs.（ 10. 55 ± 9. 58） vs.（ 0. 63 ± 0. 65） μg/L,（ 84. 87 ± 64. 58） vs.（ 123. 38 ± 78. 17） vs.（ 51. 31 ± 59. 02） mg/L,P〈0. 01 or P〈0. 05,respectively]. According to the receiver operating characteristic curves（ ROC curves） analysis principle,ROC curves were drawn and areas under these curves（ AUC） was calculated. In the diagnosis of sepsis,AUC values was 0. 916 ± 0. 028 for PCT,the best cutoff values was 0. 885 μg / L,sensitivity 91. 8%,specificity 81. 0%. The sensitivity of serum PCT joint CRP to diagnosis of sepsis was 96. 5%. The PCT levels of the patients with good prognosis were lower than those with poor prognosis[（ 2. 76 ± 4. 22） vs.（ 9. 38 ± 9. 72） μg / ml,P〈0. 01]. Conclusion Compared with commoninflammatory markers,serum PCT is a more sensitive and specific indicator in diagnosis of sepsis and to differentiate from non-infectious SIRS. PCT and CRP can increase the sensitivity of joint determination of sepsis. PCT can be used to reflect objectively the severity of sepsis and is helpful for prediction of prognosis in patients with sepsis.