Presepsin在脓毒症早期诊断和预后评估中应用价值

Value of presepsin in the early diagnosis and prognosis evaluation of sepsis

目的探讨血浆Presepsin水平对脓毒症的诊断和预后评估的临床意义。方法 90例脓毒症患者根据是否休克分为脓毒症组和脓毒症休克组各45例,体检健康者45例为对照组,检测并比较3组血浆Presepsin、降钙素原(procalcitonin, PCT)、高敏C反应蛋白(high-sensitivity C-reactive protein, hs-CRP)水平;比较脓毒症休克组与脓毒症组小儿危重症评分、SOFA评分、白细胞计数、血小板计数、乳酸、B型钠尿肽原水平,比较脓毒症患者中死亡者(死亡组)与存活者(存活组)血浆Presepsin、PCT和hs-CRP水平、小儿危重症评分和SOFA评分,采用Spearman相关分析Presepsin与PCT、hs-CRP、小儿危重症评分、SOFA评分的相关性;采用ROC曲线评估Presepsin、PCT、hs-CRP对脓毒症的诊断效能。结果脓毒症休克组患者血浆Presepsin[(1 581.74±1 142.54)ng/L]、PCT[(3 242.61±1 693.47)ng/L]和hs-CRP[(159.47±85.78)mg/L]水平明显高于脓毒症组[(279.78±123.57)ng/L、(2 158.96±1 529.77)ng/L、(116.74±71.85)mg/L]和对照组[(67.71±33.15)ng/L、(7.79±5.52)ng/L、(2.51±1.47)mg/L](P<0.05),脓毒症组高于对照组(P<0.05);脓毒症休克组患者SOFA评分及乳酸、B型钠尿肽原水平高于脓毒症组(P<0.05),小儿危重症评分、血小板计数、白细胞计数低于脓毒症组(P<0.05);死亡组血浆Presepsin、PCT、hs-CRP水平及小儿危重症评分、SOFA评分均明显高于存活组(P<0.05);血浆Presepsin水平与血浆PCT、hs-CRP水平、SOFA评分均呈正相关(r=0.714,P<0.001;r=0.756,P<0.001;r=0.838,P<0.001),与小儿危重症评分呈负相关(r=-2.787,P<0.001);血浆Presepsin水平诊断脓毒症的AUC(0.924)、灵敏度(72.0%)和特异度(90.0%)均高于PCT(0.684、60.0%、80.0%)和hs-CRP(0.617、50.0%、70.0%)(P<0.05)。结论检测血浆Presepsin水平有助于脓毒症的早期诊断、病情程度判断和预后评估。

Objective To investigate the clinical significance of plasma presepsin level in the diagnosis and predicting prognosis of sepsis. Methods Ninety patients with sepsis were divided into sepsis group and septic shock group, with 45 patients in each group. Another 45 healthy volunteers were as controls(control group). The plasma Presepsin, procalcitonin(PCT) and high-sensitivity C-reactive protein(hs-CRP) levels were detected and compared among three groups. The Pediatric Critical Illness Score(PCIS), SOFA score, white blood cell count, platelet count, lactic acid and B-type natriuretic peptide(NT-proBNP) were compared between sepsis group and septic shock group. The levels of plasma Presepsin, PCT and hs-CRP, PCIS and SOFA score were compared between the died and survived sepsis patients. Spearman correlation analysis was used to analyze the correlation of presepsin with PCT, hs-CRP, PCIS and SOFA score. The diagnostic efficiencies of presepsin, PCT and hs-CRP on sepsis were evaluated by ROC. Results The levels of plasma presepsin((1 581.74±1 142.54) ng/L), PCT((3 242.61±1 693.47) ng/L) and hs-CRP((159.47±85.78) mg/L) in septic shock group were significantly higher than those in sepsis group((279.78±123.57) ng/L,(2 158.96±1 529.77) ng/L,(116.74±71.85) mg/L) and control group((67.71±33.15) ng/L,(7.79±5.52) ng/L,(2.51±1.47) mg/L)(P<0.05), and higher in sepsis group than those in control group(P<0.05). SOFA score, lactic acid and NT-proBNP were higher, and PCIS, platelet count and white blood cell count were lower in septic shock group than those in sepsis group(P<0.05). Presepsin, PCT, hs-CRP, PCIS and SOFA score were higher in died sepsis patients than those in survived sepsis patients(P<0.05). The plasma presepsin level was positively correlated with PCT, hs-CRP and SOFA score(r=0.714, P<0.001;r=0.756, P<0.001;r=0.838, P<0.001), and negatively correlated with PCIS(r=-2.787, P<0.001). The AUC of plasma presepsin for diagnosing sepsis(0.924), sensitivity(72.0%) and specificity(90.0%) were higher than those of serum PCT(0.684, 60.0%, 80.0%) and hs-CRP(0.617, 50.0%, 70.0%)(P<0.05). Conclusion The detection of plasma presepsin level contributes to the early diagnosis of sepsis, the judgment of the severity and the prediction of the prognosis.