IL-6、PCT、CRP对不同类别细菌感染脓毒症患者早期诊断的价值

The value of IL-6,PCT and CRP in the early diagnosis of sepsis in patients with different types of bacterial infections

目的分析白介素-6(IL-6)、降钙素原(PCT)、C反应蛋白(CRP)对不同类别细菌感染脓毒症患者的早期诊断价值。方法选择2015年2月—2017年2月陕西省核工业215医院重症医学科收治脓毒症细菌感染患者108例作为脓毒症感染组,根据血培养结果将其分为G^+细菌亚组47例、G^-细菌亚组61例,根据细菌的种类不同分为球菌亚组47例、杆菌亚组57例和其他菌亚组4例,另选取同期非脓毒症感染组患者50例和健康志愿者50例作为健康对照组,观察各组受试者IL-6、PCT、CRP水平,分析其对细菌感染脓毒症早期诊断的价值。结果脓毒症感染组IL-6、PCT、CRP水平显著高于非脓毒症感染组及健康对照组(F=150.0、332.9、111.6,P均=0.000)。G^+细菌亚组PCT水平显著低于G^-细菌亚组(t=5.469,P=0.000),2组IL-6和CRP水平比较无明显差异(t=0.132、0.583,P=0.895、0.561)。球菌亚组PCT水平显著低于杆菌亚组及其他菌亚组(F=14.250,P=0.000),3亚组IL-6和CRP水平比较无明显差异(F=0.250、0.164,P=0.779、0.849)。ROC曲线分析结果,PCT、IL-6和CRP诊断细菌感染脓毒症的曲线下面积(AUC)分别为0.912、0.867和0.818。PCT的cut-off值为0.5 ng/ml,敏感度为90.75%,特异度为76.00%,阳性似然比为5.38,阴性似然比为0.11及约登指数为0.67。结论 PCT在不同类别的细菌感染脓毒症临床诊断中的诊断价值显著优于IL-6、CRP,PCT可独立作为不同类别的细菌感染脓毒症患者早期辅助诊断指标。

Objective To investigate the value of IL-6, PCT and CRP in the early diagnosis of bacterial infection in different types of sepsis. Methods 108 patients with septic bacterial infection were enrollecl in the critical care medicine de- partment of No. 215 Hospital of Shaanxi Nuclear Industry from February 2015 to February 2017, According to the blood culture results, they were divided into 47 groups：G ~ bacterial infection group and 61 G- bacterial infection group, According to the species of bacteria, they were divided into 47 groups, 57 cases in Bacillus group and 4 cases in other bacteria group, The oth- er selected in our hospital 50 cases of patients with non sepsis and 50 healthy volunteers as control group, observed in patients with IL-6, PCT, the expression of CRP, IL-6, PCT analysis and CRP index in early diagnosis of sepsis and bacterial infec- tion. Results The levels of IL-6, PCT and CRP in sepsis group were significantly higher than those in non sepsis group and healthy control group （ F = 150.0, 332.9, 111.6, P = 0.000）. G ~ PCT group was significantly lower than that of G- bacte- ria bacteria group （ t = 5. 469, P = 0. 000）, no significant difference was found between the two groups of IL-6 and CRP levels （t = 0. 132, 0.583, P = 0.895, 0.561 ）. The levels of PCT in the coccus group were significantly lower than those in the oth- er groups （ F = 14. 250, P = 0. 000）, and there was no significant difference in the levels of IL-6 and CRP between the 3 groups （ F = 0. 250, 0. 164,P = 0. 779, 0. 849）. The results of ROC curve analysis showed that the ability of PCT index to di- agnose bacterial sepsis was better than that of IL-6 and CRP （P 〈 0.05 ）. The area under the ROC curve of PCT , IT-6, CRP in G＋/G- bacteria group, were 0. 912, 0.867 and 0. 818. The PCT cut-off value is 0.5ng/ml, the sensitivity was 90.75% , specificity was 76.00%, the positive likelihood ratio was 5.38, negative likelihood ratio was 0.11 and the Youden index was 0. 67. Conclusion The diagnostic value of PCT in the clinical diagnosis of bacterial infection with different categories is significantly better than that of IL-6 and CRP, and PCT can be used as an early assistant diagnostic indicator for different types of bacterial infections in sepsis patients.