血清降钙素原对不同致病菌感染所致脓毒症的早期诊断及临床研究

Value of serum procalcitonin in early diagnosis of sepsis caused by different pathogenic bacteria infection and its clinical study

目的探讨血清降钙素原(PCT)、超敏C反应蛋白(hs-CRP)、白细胞计数(WBC)、中性粒细胞百分比(NEU%)在不同致病菌感染所致脓毒症早期诊断的临床价值,为脓毒症患者提供风险评估。方法回顾性分析2013年10月至2015年10月在徐州市中医院重症医学科(ICU)就诊的血流感染致脓毒症117例患者的临床资料,所有患者在抗菌药物使用之前进行血培养,根据血培养结果分为革兰阳性菌(G+菌)组和革兰阴性菌(G-菌)组,所有患者均进行PCT、hs-CRP、WBC、NEU%检测,分析两组患者检测结果的差异,评价PCT与急性生理与慢性健康状况评分系统Ⅱ评分(APACHE-Ⅱ评分)和序贯器官衰竭评分(SOFA评分)的相关性。结果 117例脓毒血症的患者中G+菌组78例,G-菌组39例;与G+菌组比较,G-菌组PCT检测变化明显,差异有统计学意义(P<0.05),而hs-CRP、WBC、NEU检测结果变化不大(P>0.05);G-菌组血清PCT与SOFA评分呈正相关(r=0.536,P<0.05),而与APACHE-Ⅱ评分无相关性(P>0.05);G+菌组血清PCT与APACHE-Ⅱ评分、SOFA评分均无相关性(P>0.05)。结论 PCT在不同致病菌感染所致脓毒症的早期鉴别诊断和预后监测中有一定价值,且对G-菌更灵敏。

Objective To investigate the clinical value of serum procalcitonin（PCT）,C-reactive protein（hs-CRP）,white blood cell count（WBC）and neutrophil percentage（NEU%）in the early diagnosis of sepsis caused by different pathogenic bacteria infection to provide a risk assessment for sepsis patients.Methods The clinical data of 117 patients with sepsis caused by bloodstream infection in the intensive care unit（ICU）of our hospital from Oct.2013 to Oct.2015 were retrospectively analyzed.All patients were performed blood culture before antibiotics use and divided into the G^＋bacteria group and G-bacteria group according to the results of blood culture.PCT,hs-CRP,WBC and NEU% were detected in all cases.The differences in the detection results between the two groups were analyzed and the correlation between PCT with APACHE-Ⅱand SOFA scores was evaluated.ResultsAmong 117 cases of sepsis,78 cases were in the G^＋bacteria group and 39 cases were in the G-bacteria group;compared with the G^＋bacteria group,PCT in the G^-bacteria group had obvious change and the difference was statistically significant（P〈0.05）,while the detection results of hs-CRP,WBC and NEU in the G^-group had little change（P〈0.05）;the serum PCT level was positively correlated with the SOFA score in the G^-bacteria group（r=0.536,P〈0.05）,but had no correlation with the APACHE-Ⅱscore（P〈0.05）;serum PCT level had no correlation with the APACHE-Ⅱ score and SOFA score in the G＋bacteria group（P〈0.05）.Conclusion PCT has some value in the early differential diagnosis and prognosis of sepsis caused by different pathogens,and it is more sensitive to G-bacteria.