血清降钙素原和D-二聚体检测在急诊脓毒症患者病情及预后评估中的应用价值

Application value of serum procalcitonin and D-dimer detection in the evaluation of the condition and prognosis of patients with emergency sepsis

目的探讨血清降钙素原(PCT)和D-二聚体(D-D)检测在急诊脓毒症患者病情及预后评估中的应用价值。方法选取2017年1月至2018年4月首都医科大学附属北京友谊医院收治的脓毒症患者80例,回顾性分析患者的临床资料,根据病情严重程度将患者分为脓毒症组(n=35)、严重脓毒症组(n=25)、感染性休克组(n=20)。随访1年,根据患者治疗结局分为死亡组(n=24)与存活组(n=56),比较各组患者的血清PCT、D-D水平。结果感染性休克组患者的血清PCT[(17.97±1.84) ng/ml]、D-D [(5.13±0.58)mg/L]水平及死亡率(30.00%)显著高于脓毒症组患者的血清PCT [(3.47±1.06) ng/ml]、D-D[(1.60±0.34) mg/L]水平、死亡率(2.86%),差异具有统计学意义(P<0.05)。严重脓毒症组患者的血清PCT[(10.55±1.49) ng/ml]、D-D[(3.35±0.42)mg/L]水平及死亡率(20.00%)显著高于脓毒症组患者的血清PCT、D-D水平和死亡率(2.86%)差异具有统计学意义(P <0.05)。死亡组患者的血清PCT[(6.01±1.27) ng/ml]、D-D [(2.14±0.72) mg/L]水平显著高于存活组患者的血清PCT[(19.34±2.11) ng/ml]、D-D[(5.78±1.24) mg/L]水平差异具有统计学意义(P<0.05)。脓毒症患者治疗后的简易精神状态评价量表(MMSE量表)评分显著高于严重脓毒症和感染性休克组,急性生理与慢性健康评分(APACHEII)评分、序贯器官衰竭估计评分(SOFA)均显著低于严重脓毒症和感染性休克组,三组比较差异具有统计学意义(P<0.05)。结论检测血清PCT和D-D水平可有效评估急诊脓毒症患者的病情,并可有效预测患者的预后具有重要的临床意义。

Objective To evaluate the clinical value of serum procalcitonin(PCT) and d-dimer(d-d) in patients with emergency sepsis.Methods 80 patients with sepsis admitted in our hospital from January 2017 to April 2018 were selected and their clinical data were retro?spectively analyzed.Patients were divided into sepsis group(n=35),severe sepsis group(n=25) and septic shock group(n=20) according to the severity of their condition.The patients were followed up for 1 year and were divided into the death group(n=24) and the survival group(n=56) according to the treatment outcome.The serum PCT and d-d levels of the patients in each group were compared.Results Serum PCT[(17.97±1.84) ng/ml vs.(3.47±1.06) ng/ml],d-d [(5.13±0.58) mg/L vs.(1.60±0.34) mg/L] and mortality(30.00% vs.2.86%) in septic shock group were significantly higher than those in sepsis group(P <0.05).The serum PCT [(10.55±1.49) ng/ml],d-d [(3.35±0.42) ng/ml],and mortality(20.00%) in the severe sepsis group were significantly higher than those in the sepsis group,and the differences were statistically significant(P <0.05).The levels of serum PCT [(6.01±1.27) ng/ml vs.(19.34±2.11) ng/ml] and dd [(2.14±0.72) mg/L vs.(5.78±1.24) mg/L] in the death group were significantly higher than those in the survival group(P <0.05).The MMSE score after treatment for patients in sepsis group was significantly higher than that of severe sepsis and septic shock group.The APACHEⅡ score and SOFA score for patients in sepsis group were significantly lower than those of severe sepsis and septic shock groups,and the differences between the three groups were statistically significant(P <0.05).Conclusion Serum PCT and d-d can effectively evaluate the condition of emergency sepsis patients,and can effectively predict the prognosis of patients,which is clinically important.