革兰阴性菌血流感染脓毒症患者的病情严重程度与炎症因子水平的相关性研究

Research on the correlation between levels of inflammatory cytokines and the severity of sepsis patients with Gram-negative bacteria bloodstream infection

目的比较降钙素原、C反应蛋白、内毒素等炎症因子在革兰阴性菌血流感染脓毒症患者中的表达差异,探讨其与疾病严重程度的相关性及其早期诊断的预测价值。方法回顾性研究入住本院的脓毒症且血培养为革兰阴性菌感染患者181例,比较不同严重程度脓毒症患者6 h内的炎症因子PCT、CRP、LPS水平差异,分析其与APACHEⅡ评分的相关性,评价其诊断效应。结果革兰阴性菌血流感染的患者血中CRP、PCT、LPS均有较高的敏感度和特异度,联合监测特异度增高。PCT、LPS、CRP与APACHEⅡ评分明显相关。PCT诊断严重脓毒症和脓毒性休克的敏感度和特异度均高于其他炎症因子。结论早期联合监测炎症因子PCT、LPS、CRP水平对诊断革兰阴性菌血流感染脓毒症有较好的诊断预测价值,其水平与脓毒症严重程度呈正相关,有望成为早期判断革兰阴性菌血流感染所致脓毒症及其病情严重程度的重要指标。

Objective To compare the expression differences of inflammatory cytokines, such as procalcitonin, C - reactive protein and sepsis, and to explore its correlation with the severity of Gram - negative bacteria bloodstream infection sepsis pa- tients, as well as the clinical significance. Methods The clinical data of 181 Gram - negative bacteria bloodstream infections with clinical diagnosis of sepsis were analyzed restrospectively. We compared the expression differences of inflammatory cyto- kines, such as procalcitonin （PCT）, C - reactive protein （CRP） and lipopolysaccharide （ LPS ） among different severity groups within 6 hours and its relevance with APACHE I1 score, so as to evaluate its diagnosis effect. Results CRP, PCT, LPS con- centrations were all high sensitive and specific in the patients with Gram -negative bacteria bloodstream infection, and the joint monitoring specificity degree increased; obvious correlation was found between serum PCT, LPS , CRP levels and APACHE I1 score ; the sensitivity and specificity of PCT in the diagnosis of severe sepsis and septic shock were all higher than other inflammatory cytokines. Conclusion It can provide more information on the early diagnosis of Gram - negative bacteria bloodstream infection sepsis patients with the joint detection of serum PCT, LPS and CRP concentrations, and the levels of these inflammatory cytokines had positive relevance with the severity of the patients, which can be an vital marker in the early diagnosis of sepsis caused by Gram - negative bacteria and the evaluation of severity.