细菌性血流感染致脓毒症患者血清PCT、CRP及内毒素水平变化及临床意义

Changes of Serum PCT,CRP and Endotoxin Levels in Patients with Sepsis Induced by Bacterial Bloodstream Infection and Its Clinical Significance

目的探讨细菌性血流感染致脓毒症患者血清降钙素原(PCT)、C反应蛋白(CRP)及内毒素水平变化及临床意义。方法选择上海市浦东医院2014年6月—2016年12月就诊的108例脓毒症,按细菌培养结果分为革兰阳性菌(阳性组)38例和革兰阴性菌(阴性组)70例,选择同期健康体检者100例作为对照组。比较3组血清PCT、CRP及内毒素水平变化,并分析脓毒症患者中三者的相关性。结果阳性组和阴性组血清PCT、CRP及内毒素水平均高于对照组,阳性组低于阴性组(P<0.05)。脓毒症患者血清PCT、CRP及内毒素间均存在正相关性(P<0.05)。PCT对脓毒症诊断的灵敏度、特异度均相对较高,CRP次之。血清PCT、CRP及内毒素诊断脓毒血症的临界值分别是2.05μg/L、87.35 mg/L、16.12 ng/L。结论血清PCT、CRP及内毒素水平在革兰阴性菌中高于革兰阳性菌,对于诊断细菌性血流感染致脓毒症具有一定临床意义。

Objective To investigate changes of serum procalcitonin(PCT),C-reactive protein(CRP)and endotoxin levels in patients with sepsis induced by bacterial bloodstream infection and its clinical significance.Methods A total of 108 patients with sepsis admitted during June 2014 and December 2016 were divided into gram-positive bacteria(positive group,n=38)and gram-negative bacteria(negative group,n=70)according to results of bacterial culture,and other 100 healthy people taking medical examination at the same period were selected as control group.Changes of serum PCT,CRP and endotoxin levels were compared in three groups,and correlations among serum PCT,CRP and endotoxin levels in patients with sepsis were analyzed.Results PCT,CRP and endotoxin levels in positive and negative groups were significantly higher than those in control group(P<0.05).PCT,CRP and endotoxin levels had positive correlations in patients with sepsis(P<0.05).PCT had highly sensitivity and specificity in diagnosis of sepsis,and CRP was followed by.Critical values of PCT,CRP and endotoxin in diagnosis of sepsis were 2.05μg/L,87.35 mg/L and 16.12 ng/L respectively.Conclusion Serum PCT,CRP and endotoxin levels in gram-negative bacteria are higher than those in gram-positive bacteria,which may be a certain significance in diagnosis of sepsis induced by bacterial bloodstream infection in clinic.