血清PCT、hs-CRP、WBC联合检测在脓毒症患者感染类型鉴别及预后判断中的价值

Diagnostic value of combination with procalcitonin,hypersensitive C reactive protein and white blood cell count on infection type and prognosis of sepsis patients

目的探讨血清PCT、hs-CRP、WBC联合检测对脓毒症患者感染类型及病情严重程度的诊断价值。方法选取2013年7月—2015年1月收治的脓毒症患者72例为研究对象,设为脓毒症组,回顾性分析其临床资料,根据血培养结果分为G^+菌亚组和G^-菌亚组,根据预后情况分为存活亚组和死亡亚组,并选取同期来院体检的54例健康者作为健康对照组,分析比较各组血清PCT、hs-CRP及WBC水平。结果脓毒症组患者的血清PCT、hs-CRP及WBC水平均远远高于健康对照组,差异具有统计学意义(t=37.832、31.303、9.836,P<0.01)。G^+菌亚组患者的血清PCT、hs-CRP水平远远高于G^-菌亚组,差异具有统计学意义(t=18.438、2.393,P<0.01或<0.05),而G^+菌亚组与G-菌亚组患者的WBC计数比较差异无统计学意义(t=1.910,P>0.05)。脓毒症存活亚组患者的血清PCT、hs-CRP与WBC水平经治疗呈时间依赖性下降,而死亡亚组不存在时间效应,且存活亚组3项指标在各时间点检测均远远低于死亡亚组,2组间比较差异具有统计学意义(P<0.01)。结论血清PCT指标对于区分脓毒症G^+菌和G^-菌感染类型具有一定价值,联合检测PCT、hs-CRP、WBC有助于诊断脓毒症病情严重程度,指导早期治疗。

Objective To investigate the procalcitonin（PCT）,hypersensitive C reactive protein（hs-CRP） and WBC combination in detection of sepsis in patients with different type and severity of infection.Methods From July 2013 to Januarv 2015,72 cases of sepsis patients were selected as the research object,enrolled as sepsis group,retrospective analyzed the clinical data,according to the blood culture results,they were divided into G-＋ bacteria subgroups and G-- bacteria subgroup,according to prognosis,they were divided into survival subgroup and death subgroup,and selected the same period 54 cases of healthy persons as healthy control group,to analyze and compare the levels of serum PCT,hs-CRP and WBC levels.Results In patients with sepsis,serum PCT,hs-CRP and WBC levels were much higher than those in healthy control group,the difference were statistical significance（t=37.832,t =31.303,t =9.836,P〈0.01）.G-＋ bacteria subgroup patients＇ serum PCT,hs-CRP level were much higher than that of the G-- bacteria subgroup,the difference were statistical significance（t =18.438,t =2.393,P〈0.01 or 0.05）,and G-＋ bacteria subgroup and G-- subgroup＇s WBC count had no statistical significance differences（t =1.910,P〈0.05）.Sepsis survival subgroups serum PCT,hs-CRP and WBC were presented with time dependent decrease after treatment,and death subgroup has no time effect,and survival subgroup＇s 3 indexes were much more lower than death subgroup in each time point,the difference between the two groups were statistical significance（P〈0.01）.Conclusion The index of serum PCT in distinguish between G-＋ and G-- bacterial infection type for septic patients have a better clinical value.PCT,hs-CRP and WBC combined examination can help for evaluating the severity of sepsis and guide the early treatment.