PCT、CRP动力学评估脓毒血症预后及诊断意义的研究

Procalcitonin,C-reactive Protein Kinetics and Their prognostic and Diagnostic Significances in Severe Sepsis/Septic Shock Patients

目的观察血清降钙素原(PCT)、C反应蛋白(CRP)及其动力学变化,评估其在严重脓毒症/感染性休克患者的诊断及预后价值。方法本研究采用回顾性分析方法,2014年9月1日至2016年4月30日选择184例ICU中被诊断为严重脓毒症/感染性休克疾病患者,检测入院时血清PCT、CRP水平和治疗后第2,第3和第5天的PCT、CRP水平。结果通过ΔPCT、ΔCRP评估PCT、CRP的动力学在存活者与死亡组中有显著性统计学意(ΔPCT2/0,P=0.0001;ΔPCT3/0,P=0.0001;ΔPCT5/0,P=0.0001;ΔCRP2/0,P=0.0069;ΔCRP3/0,P=0.0001;ΔCRP5/0,P=0.0001),在严重脓毒症和感染性休克组中也存在显著差异(PCT5,P=0.007;ΔPCT5/0,P=0.007)。受试者工作特征曲线(ROC)模型显示,ΔPCT3/0(AUC=0.721)、ΔPCT5/0(AUC=0.77)、ΔCRP5/0(AUC=0.766)水平判断严重脓毒症/感染性休克患者预后有较好的临床意义。ΔPCT5/0(0.619)对严重脓毒症或感染性休克有一定的辅助诊断效果,其在ROC曲线上灵敏度、特异性均较高的临界点为0.624,所以,以第5天的血清ΔPCT5/0水平>0.624可作为预测感染性休克的临界点。结论血清中PCT、CRP对严重脓毒症/感染性休克早期有较好的临床诊断及预后价值,其动力学研究可以提高对严重脓毒症/感染性休克诊断及预后评估的敏感性及准确性。

Objectlve To observe the changes of serum procalcitonin （PCT）, C-reactive protein （CRP） and relevant kinetics to evaluate their diagnostic and prognostic value in severe sepsis / septic shock. Methods 184 severe sepsis/septic shock patients of ICU were enrolled in this retrospectives study from September 2014 to April 2016. Blood samples for testing PCT, CRP levels were taken on the 1,2,3,5th day of hospitalization. Results The kinetics of PCT assessed by ΔPCT, ΔCRP were significant different in the survivors vs the non- survivors subgroup（ΔPCT2/0, P =0. 0001 ; ΔPCT3/0, P =0. 0001 ; ΔPCT5/0, P =0. 0001 ; ΔCRP2/0, P = 0.0069 ; ΔCRP3/0,P = 0. 0001 ; ΔCRP5/0, P = 0.0001 ）, and in the severe sepsis vs septic shock subgroups （ PCT5, P = 0.007 ; ΔPCT5/0, P = 0.007 ）. The receiver operating curve （ROC） of the survival showed that ΔPCT3/0 （ AUC = 0.721 ）, ΔPCT5/0 （ AUC = 0.77 ） and ΔCRP5/0 （ AUC = 0.766） had a high sensitivity and specificity for predicting the prognosis of patients with severe sepsis/septic shock. There was a poor prognosis in patients with severe sepsis/septic shock when the cut- off value for ΔPCT5/0 was above 0.735 or the cut- off value for ΔCRP5 was above 0.719ng/L. ΔPCT5/0 on severe sepsis or septic shock had a better diagnostic effects than PCT5, and the sensitivity and specificity of ΔPCT5/0 was higher. The cut-off value of ΔPCT5/0 was 0. 624. When the cut-off value ΔPCT5/0 was above 0. 624, it can be used as the critical point for predicting septic shock. Conclusion The serum PCT, CRP have a promising clinical diagnosis and prognosis value in the early stage of severe sepsis/septic shock. The study of the kinetics of PCT, CRP can achieve a better sensitivity and accuracy in the diagnosis and prognosis of severe sepsis/septic shock.