降钙素原和C反应蛋白在评估脓毒症急性肺损伤病情严重程度及预后中的临床意义

The clinical significance of procalcitonin combined with C-reactive protein in assessing the severity and prognosis of patients with sepsis-induced acute lung injury

目的探讨降钙素原(PCT)和C反应蛋白(CRP)在脓毒症急性肺损伤患者中的水平变化及病情评估中的临床意义。方法以2013年1月至2019年1月重庆医科大学附属第三和第二医院收治的320例脓毒症急性肺损伤患者作为研究对象,根据病情严重程度分为低危组(125例)、中危组(110例)和高危组(85例)。按脓毒症急性肺损伤患者临床结局分为存活组(275例)和死亡组(45例)。检测各组外周血PCT、CRP水平及白细胞计数,同时记录急性生理学与慢性健康状况(APACHEⅡ)评分情况;采用受试者工作特征曲线(ROC曲线)评估外周血PCT和CRP对脓毒症急性肺损伤患者预后不佳的预测价值。结果高危组患者外周血PCT、CRP水平及APACHEⅡ评分最高,中危组次之,低危组最低,差异均有统计学意义(P<0.05);死亡组患者外周血PCT、CRP水平及APACHEⅡ评分均明显高于存活组,差异均有统计学意义(P<0.05)。Pearson相关分析显示,外周血PCT和CRP水平与APACHEⅡ评分均呈正相关(r=0.70、0.74,P<0.001)。ROC曲线分析显示,PCT的曲线下面积为0.800(95%CI:0.701~0.898),其最佳工作点为1.45 ng/mL时,诊断脓毒症急性肺损伤预后不佳的灵敏度和特异度分别为68.0%和72.3%;CRP的曲线下面积为0.724(95%CI:0.601~0.846),其最佳工作点为28.62μg/mL时,诊断脓毒症急性肺损伤预后不佳的灵敏度和特异度分别为70.8%和64.5%。PCT和CRP联合检测诊断灵敏度和特异度分别为83.9%和77.8%,ROC曲线下面积为0.857(95%CI:0.779~0.928),明显高于PCT和CRP单独检测。结论外周血PCT和CRP联合检测较单独检测能更有效评估脓毒症急性肺损伤病情严重程度及预后。

Objective To investigate the level changes and clinical significance of procalcitonin(PCT)and C-recative protein(CRP)in patients with sepsis-induced acute lung injury.Methods A total of 320 patients with sepsis-induced acute lung injury admitted to Third and Second Affiliated Hospital of Chongqing Medical University from January 2013 to January 2019 were enrolled in the study.According to the severity of disease,these patients were divided into low risk group(125 cases),middle risk group(110 cases)and high risk group(85 cases).According to the clinical outcome of sepsis-induced acute lung injury patients,they were divided into survival group(275 cases)and death group(45 cases).The levels of PCT,CRP and leucocyte count in the peripheral blood were measured,the acute physiology and chronic health status(APACHEⅡ)score was recorded,and the predictive value of peripheral PCT combined CRP in poor prognosis of patients with sepsis-induced acute injury was assessed by the receiver operating characteristic(ROC)curve.Results The levels of PCT and CRP in the peripheral blood and APACHEⅡscores in the high risk group was the highest,followed by the middle-risk group and the lowest in the low-risk group,and the differences were statistically significant(P<0.05).The levels of PCT,CRP and APACHEⅡscores in the death group were significantly higher than those in the survival group,and the differences were statistically significant(P<0.05).The correlation analysis showed that the peripheral PCT and CRP levels were positively correlated with APACHEⅡscores(r=0.70;0.74,P<0.001).The ROC curve analysis showed that the area under the curve of PCT was 0.800(95%CI:0.701-0.898)and optimal operating point was 1.45 ng/mL.The sensitivity and the specificity for diagnosing the poor prognosis of sepsis-induced acute lung injury were 68.0%and 72.3%.The area under the curve of CRP was 0.724(95%CI:0.601-0.846)and the optimal operating point was 28.62μg/mL.The sensitivity and the specificity for diagnosing the poor prognosis of sepsis-induced acute lung injury were 70.8%and 64.5%,respectively.The sensitivity and the specificity of the combined detection of PCT and CRP were 83.9%and 77.8%,and the area under the curve was 0.857(95%CI:0.779-0.928)which were higher than the single detection of PCT and CRP.Conclusion The combined detection of PCT and CRP is more effective than single detection in estimating the severity and prognosis of sepsis-induced acute lung injury.