血清PCT、hs-CRP和TNF-α水平对老年急性脑血管病诱发多器官功能不全综合征的预测价值

The predictive value of PCT,hs-CRP,TNF-α in elderly patients with multiple organ dysfunction syndrome caused by acute cerebral vascular disease

目的探讨血清降钙素原(PCT)、超敏C-反应蛋白(hs-CRP)和肿瘤坏死因子-α(TNF-α)水平对老年急性脑血管病(ACVD)诱发多器官功能不全综合征(MODS)的预测价值。方法 158例老年急性脑血管病患者按照治疗过程中有无发生MODS分为MODS组和非MODS组。采用ELISA法和免疫荧光定量法,于患者急性脑血管病发病后的6 h和1、2、3、5、7 d分别检测其外周血PCT、hs-CRP和TNF-α水平,并与70例健康对照进分析。结果老年ACVD患者与健康对照组相比,血清PCT、hs-CRP和TNF-α在各时相均明显升高(P<0.01)。MODS组患者与非MODS组患者组相比,血清PCT、hs-CRP和TNF-α在各时相升高更明显(P<0.01)。PCT、hs-CRP和TNF-α的ROC曲线下面积分别是0.887、0.796、0.753。PCT预测ACVD诱发MODS的敏感性、特异性、准确率分别是83.9%、85.5%、86.4%。结论老年ACVD患者血清PCT、hs-CRP和TNF-α水平明显升高,升高幅度与并发MODS密切相关。PCT的敏感性和特异性优于hs-CRP和TNF-α,是ACVD后预测MODS发生的较好诊断指标,可用于病情评估和疗效监测。

Objective To investigate the predictive value of serum levels of procalcitonin （PCT） ,high sensitivity C reactive protein （ hsCRP） and tumor necrosis factor-α（ TNF-α） in elderly patients with multiple organ dysfunction syndrome （MODS） caused by acute cerebral vascular disease （ACVD）.Methods A total of 158 elderly patients with ACVD were divided into MODS group and non-MODS group.The serum levels of PCT and hsCRP in peripheral blood of patients were detected by immunofluorescence assay ,and the serum levels of TNF-α were detected by enzyme linked immunosorbent assay （ELISA） on 6 hours and 1,2,3,5,7d after attack of ACVD.Moreover the examination results were analyzed and compared with those of 70 healthy subjects （ control group ） .Results As compared with those in control group ,the serum levels of PCT , hsCRP and TNF-α were significantly increased in every time point in ACVD group （ P 〈0.01）.As compared with those in non-MODS group,the serum levels of PCT ,hsCRP and TNF-α in ACVD group were significantly increased in every time point （P〈0.01）.The area under ROC curve of PCT,hsCRP and TNF-αwas 0.887,0.796,0.753,respectively.The sensitivity, specificity and accuracy of PCT for predicting MODS was 83.9%,85.5%,86.4%,respectively.Conclusion The serum levels of PCT,hsCRP and TNF-α are obviously increased in elderly patients with ACVD ,moreover,the increase extent is closely related with ACVD complicated by MODS .The sensitivity and specificity of PCT are superior to those of hsCRP and TNF-α,thus,which can be regarded as a better diagnosis index to evaluate patient ＇s condition and to assess therapeutic effects