在脓毒症诊断和危险分层中的应用价值

The value of neopterin used in diagnosis and risk stratification of sepsis

目的探讨新喋呤（neopterin，Np）在脓毒症早期诊断和危险分层中的应用价值。方法研究纳入于2013年4月至2014年2月就诊于山西医科大学第二医院急诊科的82例患者并分为两组，分别为非脓毒症组8例、脓毒症组74例。患者入院后24h内进行急性生理学与慢性健康状况Ⅱ评分（APACHEⅡ评分），并检测血浆Np和降钙素原（procalcitonin，PCT）水平，分析两组患者血浆中Np水平、PCT水平以及两者与APACHEⅡ评分的关系；74例脓毒症患者根据APACHEⅡ评分分为三组：Ⅰ组（评分〈15分，27例），Ⅱ组（评分15—24分，32例），Ⅲ组（评分≥25分，15例），比较各组间血浆Np水平、PCT水平差异，将Np水平分别与血浆PCT水平和APACHEⅡ评分进行相关性分析。结果脓毒症组血浆Np水平、PCT水平及APACHEⅡ评分较非脓毒症组有所升高（P〈0．05）；脓毒症组血浆中Np水平、PCT水平随病情严重程度提高逐渐升高（P〈0．05）；脓毒症组血浆中Np水平与PCT水平、APACHEⅡ评分均呈正相关（P〈0．01）；Np的受试者工作特征曲线（ROC）下面积为0．79，PCT的ROC下面积为0．75，两者均具有较高诊断准确性。结论新喋呤在脓毒症早期诊断和危险分层中有重要应用价值。

Objective To explore the value of neopterin （Np） in early diagnosis and risk stratification of sepsis. Methods A total of 82 patients admitted to the emergency department from April 2013 to February 2014 were enrolled in the study. They were divided into two groups： sepsis-free group （n = 8） and sepsis group （n = 74 ）. Patients APACHE Ⅱ scores were calculated within 24 hours after admission, and then their plasma levels of Np and procalcitonin （PCT） were detected and analysis was carried out to find the correlation between plasma levels of Np, PCT and acute physiology and chronic health evaluation Ⅱscore （ APACHEⅡ score） in two groups. And 74 patients in sepsis group were further divided into three subgroups according to their APACHEⅡscore ： Ⅰ subgroup （score 〈 15 , n = 27）, Ⅱ subgroup （score 15 to 24 , n =32）, and m subgroup （score 〉 25 or more, n = 15）. The differences in plasma Np and PCT levels were compared among three subgroups and correlation analysis of Np levels with PCT levels and APACHE Ⅱscores was carried out. Results The plasma levels of Np, PCT and APACHE Ⅱscores in sepsis group were higher than those in sepsis-free group （ P 〈0. 05 ）. In sepsis group, the plasma levels of Np and PCT were gradually increased with the increasing severity of sepsis （ P 〈 0. 05 ） ; In sepsis group, the plasma levels of Np, PCT and APACHEⅡscores were positively correlated （ P 〈0. 01 ）. The area under receiver operating characteristic curve （ ROC ） of Np was 0. 79 and the area under ROC of PCT was 0. 75, both of which had high diagnostic accuracy. Conclusions Neopterin has greatly useful value in early diagnosis and risk stratification of sepsis.