血清超敏C反应蛋白、血清样淀粉酶A与降钙素原对脓毒症患者的预测价值

Predictive value of serum high-sensitivity C-reactive protein, serum amyloid A and procalcitonin in patients with sepsis

目的探讨血清超敏C反应蛋白(hs-CRP)、血清样淀粉酶A(SAA)以及血清降钙素原对脓毒症患者病情评估及预后判断的价值。方法收集2012年6月至2014年7月因脓毒症入院的67例患者资料。根据患者最终是否发展为脓毒性休克分为脓毒性休克组(31例)及非脓毒性休克组(36例)。记录并比较所有患者治疗前和治疗后3 d以及7 d的血清hs-CRP、SAA、降钙素原及WBC计数,及治疗前后急性病生理学和长期健康评价(APACHE)Ⅱ评分的情况。绘制ROC曲线,分析hs-CRP、SAA及降钙素原对脓毒症及脓毒症并发休克患者的预测价值。结果非脓毒性休克组患者血清hs-CRP治疗前、治疗后3 d及7 d分别为(99±10)、(50±13)、(24±13)mg/L,SAA分别为(225±34)、(158±44)、(96±35)mg/L,降钙素原分别为(27.8±2.3)、(13.3±6.0)、(5.8±5.4)ng/ml,WBC计数分别为(13.2±1.8)、(11.3±1.6)、(9.3±1.4)×109/L,APACHEⅡ评分治疗前后分别为(28.3±2.9)、(14.7±2.5)分。脓毒性休克组患者血清hs-CRP治疗前、治疗后3 d及7 d分别为(112±10)、(80±12)、(43±16)mg/L,SAA分别为(292±13)、(229±34)、(167±44)mg/L,降钙素原分别为(31.0±2.1)、(21.4±4.2)、(14.4±5.8)ng/ml,WBC计数分别为(14.7±2.4)、(12.9±2.1)、(11.7±2.8)×109/L,APACHEⅡ评分治疗前后分别为(30.7±3.0)、(17.0±2.5)分。非脓毒性休克组患者各时间点的hs-CRP(t=5.267、9.862、5.548,P均<0.05),SAA(t=10.176、7.213、7.453,P均<0.05),降钙素原(t=5.727、6.271、6.227,P均<0.05),WBC计数(t=2.985、3.435、4.449,P均<0.05)及APACHEⅡ评分(t=3.364、3.724,P均<0.05)均明显低于脓毒性休克组患者。ROC曲线分析结果提示SAA对诊断脓毒症及脓毒性休克有较高的敏感度,分别为(0.8±0.3)及(0.7±0.3)。结论 SAA可以作为脓毒症患者预后的预测指标。

Objective To investigate the levels of high-sensitivity C-reactive protein（hsCRP）, serum amyloid A（SAA） and procalcitonin for estimation of severity and prognosis in patients with sepsis. Methods A total of 67 patients with sepsis from June 2012 to July 2014 were divided into the septic shock group（31 cases） and non-septic shock group（36 cases）according to diagnostic criteria of septic shock. The levels of hs-CRP, SAA, procalcitonin and WBC were detected before and on 3d, 7d after the treatment, and the acute physiology and chronic health evaluation Ⅱ（APACHEⅡ） scores were recorded before and after the treatment.The ROC curves were used to analyze the predictive value of hs-CRP, SAA and procalcitonin in septic patients with shock. Results In the non-septic shock group, the levels of hs-CRP were（99 ± 10）,（50 ± 13） and（24 ± 13） mg / L, SAA were（225 ± 34）,（158 ± 44） and（96 ± 35） mg / L,procalcitonin were（27.8 ± 2.3）,（13.3 ± 6.0） and（5.8 ± 5.4） ng / ml, WBC were（13.2 ± 1.8）,（11.3 ± 1.6）and（9.3 ± 1.4） × 109/ L before and on 3 d, 7 d after the treatment, and the APACHE Ⅱ scores were（28.3 ± 2.9） and（14.7 ± 2.5） before and after the treatment. In the septic shock group, the levels of hs-CRP were（112 ± 10）,（80 ± 12） and（43 ± 16） mg / L, SAA were（292 ± 13）,（229 ± 34）and（167 ± 44） mg / L, procalcitonin were（31.0 ± 2.1）,（21.4 ± 4.2） and（14.4 ± 5.8） ng / ml, WBC were（14.7 ± 2.4）,（12.9 ± 2.1） and（11.7 ± 2.8） × 109/ L before and on 3 d, 7 d after the treatment,and the APACHEⅡ scores were（30.7 ± 3.0） and（17.0 ± 2.5） before and after the treatment. The circulating levels of hs-CRP（t = 5.267, 9.862, 5.548, all P 0.05）, SAA（t = 10.176, 7.213,7.453, all P 0.05）, procalcitonin（t = 5.727, 6.271, 6.227, all P 0.05）, WBC count（t = 2.985,3.435, 4.449, all P 0.05） and APACHE II scores（t = 3.364, 3.724, all P 0.05） in the nonseptic shock group were all lower than those in the septic shock group at each time point. The sensitivity were（0.8 ± 0.3） and（0.7 ± 0.3）, respectively. The ROC curves showed that the SAA had higher sensitivity in predicting sepsis and septic shock. Conclusion SAA can predict the prognosis of patients with sepsis and septic shock.