PCT、CRP、SAA及FIB水平检测对脓毒血症的诊断价值

Diagnostic Value of Levels of Procalcitonin,C- reactive Protein,Serum Amyloid A and Fibrinogen for Diagnosis of Sepsis

目的 探讨血清降钙素原（PCT）、C反应蛋白（CRP）、血清淀粉样蛋白A（SAA）及纤维蛋白原（FIB）的水平检测对脓毒血症的诊断价值.方法 选取2013年9月~2015年2月笔者医院呼吸科和重症医学科感染性疾病患者352例,按病情严重程度分为脓毒血症组（109例）和非脓毒血症组（243例）,检测入院当日CRP、SAA、PCT及FIB水平.采用受试者工作特征曲线（ROC）和Pearson相关分析,评估上述指标对脓毒血症的诊断价值.结果 脓毒血症组PCT、CRP、SAA、FIB均数水平均高于非脓毒血症组.PCT的ROC曲线下面积（AUC）最大（0.906）,而CRP、SAA的AUC面积分别为0.745、0.707,FIB的AUC最低（0.627）.当PCT截断点为1.11ng/ml时,诊断脓毒血症的敏感度及特异性分别为89.0%和73.7%,Youden指数为0.627,阳性及阴性似然比分别为3.38和0.30.PCT与CRP、SAA均呈显著正相关（r=0.318、0.224,P均=0.000）,而PCT与FIB的相关性较弱（r=0.120,P=0.024）.结论 PCT优于目前临床上常用的炎性反应参数,可作为脓毒血症早期辅助诊断的手段之一.

Objective To study the diagnostic value of the levels of procalcitonin （PCT）, C-reactive protein（CRP）,serum amyloid A （SAA） and fibrinogen （FIB） for diagnosis of sepsis. Methods A total of 352 cases with infectious diseases in the department of respiratory and intensive care unit from September 2013 to February 2015 were collected, and according to the severity they were divided into sepsis group （109 cases） and non-sepsis group （243 cases）.CRP, SAA, PCT and FIB levels in serum were detected. Receiver operating characteristic curve （ROC） and Pearson correlation analysis were used to assess the diagnostic value of indicators in sepsis. Results The mean levels of CRP, SAA, PCT, FIB levels in sepsis group were higher than non-sepsis group.The area under the curve （AUC） shown in PCT was the largest（0.906）, and CRP, SAA＇s AUC area were 0.745,0.707, FIB＇s AUC was the lowest（0.627）. When the cut-off point of PCT was 1.11ng/ml, the sensitivity and specificity in sepsis patients were 89.0% and 73.7%, while Youden index was 0.627, and the positive likelihood ratios was 3.38, negative likelihood ratios was 0.30, respectively. PCT and CRP, SAA showed a significant positive correlation（r=0.318,0.224, both P=0.000）, while the PCT and FIB have a weak correlation （r=0.120, P=0.024）. Conclusion PCT is a better inflammatory reactive parameter than other parameters currently applied in practice and may serve as a means of diagnosis in the early stage of sepsis.