急性创伤患者监测可溶性白细胞分化抗原14亚型对脓毒症的鉴别诊断及预后评价

Clinical Value of Presepsin for Acute Traumatic Sepsis in Differential Diagnosis and Prognostic Monitoring

目的评价急性创伤性患者监测血可溶性白细胞分化抗原14亚型(s CD14-ST,presepsin)对脓毒症的鉴别诊断及预后价值。方法对急性创伤性脓毒症患者57例、严重脓毒症患者15例和非脓毒症患者41例进行前瞻性研究。分别检测其入院时血清presepsin、降钙素原(PCT)、C反应蛋白(CRP)和白细胞计数(WBC),根据患者入院24h内最差临床指标计算急性生理和慢性健康状况评分Ⅱ(APACHEⅡ),比较各组指标差异。Logistic回归分析脓毒症的高危因素。绘制ROC曲线并计算曲线下面积,比较各炎症指标对脓毒症诊断的价值。对presepsin和APACHEⅡ评分进行相关性分析。比较脓毒症存活组46例患者治疗前后各炎性指标变化,进行预后监测评价。结果脓毒症和严重脓毒症患者presepsin、PCT、CRP、WBC和APACHEⅡ评分均显著高于非脓毒症组(P均<0.05),严重脓毒症患者的presepsin显著高于脓毒症组(P<0.05)。年龄、presepsin升高和PCT升高是脓毒症的独立危险因素。presepsin的ROC曲线下面积(AUCROC)为0.877,以587.50pg/ml为临界值,诊断脓毒症的敏感度为87.5%,特异性为75.6%。presepsin和APACHEⅡ评分之间呈显著正相关(r=0.654,P<0.05)。结论 presepsin可作为脓毒症早期诊断标志物之一,还可进行脓毒症预后的监测。

Objective To evaluate the serum presepsin in acute traumatic sepsis for differential diagnosis and prognostic monitoring value. Methods This prospective study was conducted in 57 acute traumatic septic patients ,15 severe septic patients and 41 acute trau- matic non septic patients. The levels of presepsin, procalcitonin（PCT） and C reactive protein（CRP） in serum were determined and white blood cell （WBC）count was tested. The acute physiology and chronic health evaluation（APACHE） Ⅱ score were calculated according to the worst clinical parameters of the patients within 24 hours in hospital. Logistic analysis was used for risk factors in sepsis. The receiver - operating - characteristic curve （ROC） was plotted and the area under the ROC curve was calculated. The diagnostic values of different parameters for sepsis were compared. The correlation between presepsin and APACHE Ⅱ was investigated. The changes of inflammation biomarkers in 46 patients with sepsis survival group before and after treatment were compared and the Prognosis was evaluated. Results The levels of presepsin, PCT, CRP, WBC and APACHE Ⅱ in the acute traumatic septic patients and severe septic patients were signifi- cantly higherthan those in the patients with acute traumatic non sepsis （ P 〈 0.05, respectively）. Presepsin in patients with severe sepsis was significantly higher than that in sepsis group. Age, high presepsin and high PCT were independent risk factors in sepsis. The area under ROC curve was 0. 877 for presepsin. The cut off value of presepsin for discrimination of sepsiswith nonsepsis was determined as 587.50pg/ml with sensitivity of 87.5% and specificity of 75.6%. Presepsin was positively correlated with APACHE Ⅱ （r = 0. 654,P 〈 0.05）. Conclusion Presepsin should be applied as a valuable biomarker for early diagnosis, also can make the sepsis prognosis.