内皮细胞特异性分子-1、血清降钙素原、免疫炎性因子C反应蛋白、白细胞介素-6在脓毒症中的诊断价值

The diagnostic values of endothelial cell specific molecule - 1, procalcitonin, C reactive protein, interleukin -6 in patients with sepsis

目的探讨内皮细胞特异性分子-1（ESM-1）、血清降钙素原（PCT）、免疫炎性因子C反应蛋白（CRP）、白细胞介素-6（IL-6）在脓毒症中的诊断价值。方法选取2014年7月至2016年2月收入我院重症外科患者90例，其中脓毒症32例、普通感染58例，入科时采用双抗体夹心酶联免疫吸附试验（ELISA）法检测血清ESM-1浓度；电化学发光定量法检测PCT、IL-6浓度；速率散色比浊法检测CRP浓度。采用受试者工作特征曲线（ROC曲线）比较上述指标的诊断价值。结果脓毒症组中ESM-1、PCT、CRP、IL-6分别为3．93ng／ml、4．05ng／ml、83．20mg／L、61．80g／L，均高于普通感染组0．69ag／ml、0．41ng／ml、64．35mg／L、17．20ng／L，差异均有统计学意义（P=0．001、0．001、0．003、0．001）。ESM-1、PCT、CRP、IL-6的ROC曲线下面积（AUC）分别为0．911、0．893、0．667、0．760；ESM-1的AUC高于CRP，差异有统计学意义（P=0．001）；ESM-1的AUC高于IL-6，差异有统计学意义（P=0．003）；PCT的AUC高于CRP，差异有统计学意义（P=0．001）；PCT的AUC高于IL-6，差异有统计学意义（P=0．002）；ESM-1与PCT的AUC比较差异无统计学意义。当ESM-1的最佳诊断点为2．215ng／ml时，敏感度为81．3％，特异性为93．1％，约登指数为0．744，阳性预测值、阴性预测值分别为0．867、0．900，阳性似然比、阴性似然比分别为11．781、0．201。当PCT的最佳诊断点为1．875ng／ml时，敏感度为84．4％，特异性为82．8％，约登指数为0．672，阳性预测值、阴性预测值分别为0．730、0．906，阳性似然比、阴性似然比分别为4．894、0．189。结论ESM-1、PCT作为诊断脓毒症的早期指标，诊断价值优于CRP、IL-6。

Objective To evaluate the diagnostic values of endothelial cell specific molecule - 1 （ ESM - 1 ）, procalcitonin （ PCT）, C reactive protein （ CRP）, interleukin - 6 （ IL - 6） in patients with sepsis. Methods This study totally enrolled 90 patients who were admitted to our hospital from July 2014 to February 2016 were divided into sepsis group （n = 32）, and common infection group （n = 58）. Serum levels of ESM - 1 were detected by enzyme - linked immunosorbent assay （ELISA） ; The levels of PCT and IL- 6 were measured by automatic electrochemiluminescene （ECL） analyzer; The levels of CRP were measured by rate immunonephelometric analyzer. The diagnostic powers of this four biomarkers were con- structed by receiver operating characteristic （ROC） curve. Results The values of ESM - 1, PCT, IL - 6 and CRP in sepsis group were 3.93 ng/ml, 4. 05 ng/ml, 83.20 mg/L, 61.80 ng/L, respectively; The values of ESM - 1, PCT, IL - 6 and CRP in common infection group were 0. 69 ng/ml, 0. 41 ng/ml, 64. 35 mg/L, 17.20 rig/L, respectively; P =0. 001, 0. 001, 0. 003, 0. 001, respectively; there were statistically significant differences. The area under the ROC curve （AUC） of ESM - 1, PCT, CRP, IL -6 were 0. 911, 0. 893, 0. 667, 0. 760 ; The AUC of ESM - 1 was higer than that of CRP （P = 0. 001 ） ; The AUC of ESM - 1 was higer than that of IL - 6 （P = 0. 003 ） ; The AUC of PCT was higer than that of CRP （ P = 0. 001 ） ; The AUC of PCT was higer than that of IL - 6 （P = 0. 002） ; There was no significant differenee in ESM - 1 and the PCT. As an early diagnostic indicator of sepsis, the cut - off value of ESM - 1 was 2. 215 ng/ml, with sensitivity of 81.3%, specificity of 93. 1% , Youden index was 0. 744, positive predictive value was 0. 867, negative predictive value was 0. 900, positive likelihood ratio was 11. 781, negative likelihood ratio was 0. 201. As an early diagnostic indicator of sepsis, the cut - off value of PCT was 1. 875 ng/ml, with sensitivity of 84.4%, specificity of 82. 8%, Youden index was 0. 672, positive predictive value was 0. 730, negative predictive value was 0. 906, positive likelihood ratio was 4. 894, negative likelihood ratio was 0. 189. Conclusion ESM - 1, PCT as early biomarkers for sepsis are superior to CRP, IL - 6, both have high value for the early diagnosis of the patients with sepsis.