脓毒血症患者血清降钙素原与心肌肌钙蛋白Ⅰ动态变化及临床意义

Dynamic changes of levels of serum procalcitonin and cardiac troponin Ⅰ in sepsis patients and clinical significance

目的动态监测脓毒血症患者血清降钙素原(PCT)、心肌肌钙蛋白I(cTnI)水平变化及其临床意义,为脓毒血症患者临床治疗及预后评估提供参考。方法选择2012年1月-2015年6月医院心内科收治的80例脓毒血症患者为研究对象,设为脓毒血症组,对血液标本进行菌株分离鉴定;另选取80例一般感染患者为一般感染组,80名健康体检人员作为对照组,观察3组受试者入组后1、3、7d血清PCT、cTnI水平变化;采用SPSS21.0软件进行统计分析。结果 80例脓毒血症患者血培养阳性47例,检出病原菌51株,其中革兰阴性菌、革兰阳性菌分别占68.63%、31.37%;革兰阴性菌主要以鲍氏不动杆菌、肺炎克雷伯菌为主,革兰阳性菌主要以金黄色葡萄球菌为主;左室舒张末径、左房内径水平脓毒血症组>一般感染组>健康对照组(P<0.05),左室射血分数、短轴缩短率水平脓毒血症组<一般感染组<健康对照组,组间比较差异均有统计学意义(P<0.05);血培养阳性组第1、3、7天PCT水平均显著高于同期血培养阴性组(P<0.05),血培养阳性组PCT、cTnI水平第1天>第3天>第7天(P<0.05);各时间点血清PCT、cTnI水平脓毒血症组>一般感染组>健康对照组(P<0.05)。结论脓毒血症患者血清PCT、cTnI水平明显升高,动态监测脓毒血症患者血清PCT、cTnI水平变化有助于病情监测及预后评估。

OBJECTIVE To conduct the dynamic monitoring of the levels of serum procalcitonin（PCT）and cardiac troponin I（cTnI）in sepsis patient and analyze the clinical significance so as to provide guidance for clinical treatment of the sepsis patients and evaluation of prognosis.METHODS A total of 80 sepsis patients who were treated in department of cardiology from Jan 2012 to Jun 2015 were recruited as the study objects and assigned as the sepsis group,and the blood specimens were cultured for isolation and identification of pathogens;totally 80 patients with common infections were chosen as the common infection group,and 80 healthy people who underwent the physical examination were set as the control group.The changes of levels of serum PCT and cTnI were observed and compared among the three groups of subjects after the admission for 1,3,and 7days;the statistical analysis was performed with the use of SPSS21.0software.RESULTS The blood specimens were cultured positive in 47of80 sepsis patients;totally 51 strains of pathogens were isolated,of which 68.63% were gram-negative bacteria,and 31.37% were gram-positive bacteria.The Acinetobacter baumannii and Klebsiella pneumoniae were the major species of gram-negative bacteria;the Staphylococcus aureus was dominant among the gram-positive bacteria.The levels of left ventricular end-diastolic diameter and left atrial diameter were higher in the sepsis group than in the common infection group and in the control group（P〈0.05）.The left ventricular ejection fraction and fractional shortening were lower in the sepsis group than in the common infection group and in the control group,and there was significant between-group difference（P〈0.05）.The levels of PCT of the blood culture-positive group were significantly higher than those of the blood culture-negative group on Day 1,3,and 7（P〈0.05）.The levels of PCT and cTnI of the blood culture-positive group were higher on Day 1than on Day 3and Day 7（P〈0.05）.The levels of serum PCT and cTnI of the sepsis group were higher than those of the common infection group and the control group at the time points（P〈0.05）.CONCLUSION The levels of serum PCT and cTnI of the sepsis patients are remarkably elevated,and the dynamic monitoring of the levels of serum PCT and cTnI may facilitate the surveillance of illness condition and evaluation of prognosis of the sepsis patients.