内毒素、降钙素原及白介素-27在细菌性脓毒症患者诊断中的应用价值

Application of endotoxin,procalcitonin and interleukin 27 in patients with bacterial sepsis

目的分析血清内毒素、降钙素原(PCT)及白细胞介素-27(IL-27)在细菌性脓毒症患者诊断中的应用价值。方法 2015年1—12月山东省邹城市兖矿集团总医院急诊医学科重症监护病房(ICU)诊治脓毒症患者75例(观察组),另选取非感染性全身炎性反应综合征(SIRS)患者70例(对照组)及健康体检者70例(健康对照组),观察组根据血液培养结果将患者分为革兰阳性(G^+)细菌感染组(G^+菌亚组,n=30)及革兰阴性(G^-)细菌感染组(G^-菌亚组,n=45),分别测定各组血清中内毒素、PCT及IL-27水平。应用受试者工作特征曲线(ROC曲线)评价血清内毒素、PCT及IL-27在细菌性脓毒症患者中的应用价值。结果观察组血清内毒素、PCT、IL-27水平显著高于健康对照组(P<0.05),且血清内毒素、PCT高于对照组(P<0.05),而IL-27比较差异无统计学意义(P>0.05);对照组血清IL-27水平高于健康对照组,而内毒素、PCT水平比较差异无统计学意义(P>0.05)。G^+菌亚组血清内毒素、PCT、IL-27水平显著低于G-菌亚组(P<0.05)。经ROC曲线分析可知,血清内毒素、PCT、IL-27在G^-菌亚组中的诊断灵敏度及特异度分别为75.2%和91.8%、71.8%和96.8%、75.8%和90.2%;血清内毒素、PCT、IL-27在G^+菌亚组中的诊断灵敏度及特异度分别为66.3%和85.5%、39.2%和85.6%、40.8%和82.2%。结论血清内毒素、PCT、IL-27可作为脓毒症与非细菌性SIRS的鉴别指标,且在G-菌中诊断价值较高,可为脓毒症临床诊断提供指导。

Objective To investigate the application value of serum levels of endotoxin,（PCT） and interleukin 27（IL-27） in the patients with bacterial sepsis.Methods Seventy-five cases of sepsis（observation group） of intensive care unit（ICU） and 70 cases of non-infectious systemic inflammatory response syndrome（SIRS group） and 70 healthy volunteers（control group） were select as study from ICU from January 2015 to December 2015.The bacterial infection groups according to blood culture results were divided into Gram positive（G^＋） bacteria infection group（G^＋ group,n=30） and Gram negative（G^-） bacteria infection group（G^- group,n=45）.The levels of endotoxin,PCT and IL-27 of each group were measured.The value of endotoxin,PCT and IL-27 in bacterial sepsis patients were valuated with ROC curve.Results The observation group serum endotoxin,PCT,IL-27 level was significantly higher than the healthy control group（P〈0.05）,and serum endotoxin,PCT higher than the control group（P〈0.05）,but no significant difference of IL-27（P〉0.05）;the control group serum IL-27 levels higher than the healthy control group,while no significant differences in the levels of endotoxin,PCT（P〉0.05）.The levels of serum endotoxin,PCT,IL-27 were significantly lower than those in the G^- subgroup（P〈0.05） in the subgroup of G^＋.By ROC curve analysis,serum endotoxin,PCT and IL-27 in the G^- subgroup of bacteria diagnostic sensitivity and specificity were 75.2%and 91.8%,71.8%and 96.8%,75.8%and 90.2%;PCT,IL-27,serum endotoxin in the diagnosis sensitivity of G^＋ bacteria in subgroup and specificity were 66.3%and 85.5%,39.2%and85.6%,40.8%and 82.2%.Conclusion The serum endotoxin,PCT,IL-27 can be used as the identification index of sepsis and non bacterial SIRS,and the value of G^- bacteria is higher,which can provide guidance for clinical diagnosis of sepsis.