联合肝素结合蛋白和降钙素原诊断脓毒症及分级的临床应用价值

Combined detection of heparin-binding protein and procalcitonin in diagnosis and classifications of sepsis

目的探讨肝素结合蛋白（HBP）、降钙素原（PCT）、C 反应蛋白（CRP）、WBC 在脓毒症诊断及分级中的临床应用价值.方法选取脓毒症患者22 例、重症脓毒症患者25 例、脓毒症休克患者20例、局部感染患者21例以及健康体检者29例,测定各组患者血清HBP、PCT、CRP 及全血WBC 水平,并对部分病例进行HBP 与PCT 的跟综监测.结果（1）脓毒症组HBP、PCT、CRP水平明显高于局部感染和健康对照组,差异均有统计学意义（均P〈0.05）;脓毒症、重症脓毒症、脓毒性休克组中PCT 水平分别为2.3（0.6～5.1）、6.2（2.8～16.1）、15.3（4.4～49.0）ng/ml,各组间差异有统计学意义（P〈0.05）;脓毒症组HBP 为283.1（168.9～397.6）ng/ml,高于脓毒性休克组的111.6（62.6～250.5）ng/ml（P〈0.05）.CRP 在脓毒症分级中无统计学意义（P〉0.05）.（2）跟综监测显示,在脓毒症的进展过程中,PCT 水平进行性升高,而HBP 水平却下降.（3）HBP 与PCT 联合诊断脓毒症的效能高于单一指标的应用.结论在HBP、PCT 是脓毒症诊断的有效标志物,HBP 和PCT 联合检测有助于脓毒症的诊断,PCT进行性升高而HBP 下降提示疾病预后不良.

】Objective To assess the detection of heparin-binding protein （HBP）, procalcitonin （PCT）, white blood cell（WBC）, C-reactive protein （CRP） in diagnosis and classification of sepsis. Methods Sixty seven septic patients, including 22with sepsis, 25 with severe sepsis and 20 with septic shock, 21 patients with local infection, 29 healthy controls were enrolled inthe study. Levels of HBP, PCT, WBC and CRP were determined. Results The levels of HBP, PCT and CRP in the sepsis groupwere significantly higher than those in local infection group or control group （P〈0.05）. The PCT levels in the groups of sepsis,severe sepsis, and septic shock were 2.3（0.6-5.1）ng/ml, 6.2（2.8-16.1）ng/mL and 15.3（4.4-49.0）ng/mL, respectively（P〈0.05）,HBP level in sepsis group was higher[283.1（168.9-397.6）ng/mL] than that in septic shock group[111.6（62.6-250.5）ng/mL]（P〈0.05）, however there was no significant difference in CRP levels among 3 sepsis groups （P〉0.05）. The effectiveness of HBPand PCT combination in the diagnosis of sepsis was higher than that of single index. Conclusion HBP and PCT areeffective markers for diagnosis and classification of sepsis, the combination of two indexes would increase the diagnosticeffectiveness.【