脓毒症患者血清PCT、CRP、IL-6和IL-10水平检测及临床意义

Expression of serum PCT,CRP,IL-6 and IL-10 in patients with sepsis and their clinical diagnostic value

目的:探讨脓毒症患者血清中降钙素原(PCT),C反应蛋白(CRP),白细胞介素-6(IL-6),白细胞介素-10(IL-10)的表达水平及临床诊断价值。方法:选取40例脓毒症患者作为脓毒症组,同期40例非感染性全身炎症反应综合征(SIRS)患者作为非脓毒症组;另选取同期40例健康体检者作为正常对照组;根据28 d后是否存活将脓毒症组分为存活组(n=24)和死亡组(n=16)。分析比较各组入院24 h内PCT、CRP、IL-6、IL-10的水平,并绘制工作特征曲线(ROC曲线)分析上述指标对脓毒症的诊断价值。结果:脓毒症组血清中PCT、CRP、IL-6、IL-10水平均显著均高于非脓毒症组和正常对照组(均P<0.01)。脓毒症组40例研究对象中死亡16(40.00%)例,死亡组血清中PCT、CRP、IL-6及IL-10水平均显著高于存活组,差异有统计学意义(t=3.23,P<0.01;t=2.26,P=0.03;t=2.39,P=0.02;t=2.19,P<0.05);ROC分析结果显示:PCT的诊断曲线下面积(AUC)最大为0.84,灵敏度为87.50%,特异度为81.25%,最佳临界值为1.13 ng/ml;CRP的AUC为0.76,灵敏度为75.00%,特异度为86.25%,最佳临界值为63.95 mg/ml;IL-6的AUC为0.80,灵敏度为72.50%,特异度为88.75%,最佳临界值为105.20 pg/ml;IL-10的AUC为0.76,灵敏度为82.50%,特异度为80.00%,最佳临界值为84.13 mg/ml。结论:血清PCT、CRP、IL-6及IL-10水平在在脓毒症患者中明显升高,并与脓毒症患者的预后有一定的相关性;PCT的灵敏性优于CRP、IL-6及IL-10,IL-6的特异性优于其他指标,因此,PCT、CRP、IL-6及IL-10对脓毒症早期诊断均有一定的价值。

Objective:To investigate the expression of procalcitonin(PCT),C reactive protein(CRP),interleukin-6(IL-6) and interleukin-10(IL-10) in serum of patients with sepsis and their clinical diagnostic value.Methods:40 patients with sepsis were selected as the sepsis group,40 patients with noninfective SIRS during the same period were selected as the non sepsis group,another 40 healthy people during the same period were selected as the normal control group.The sepsis group was divided into survival group(n=24) and death group(n=16) according to whether they survived 28 days later.The levels of PCT,CRP,IL-6 and IL-10 within 24 hours after admission were analyzed and compared,and the ROC curve was drawn to analyze the diagnostic value of the above indexes for sepsis.Results:The serum levels of PCT,CRP,IL-6 and IL-10 in sepsis group were significantly higher than those in non sepsis group and normal control group(P<0.01).In sepsis group,16 of 40 subjects died and the levels of PCT,CRP,IL-6 and IL-10 of death group were higher than those of survival group(P<0.05).The results of ROC analysis showed that the AUC of PCT was 0.84,the sensitivity was 87.50%,the specificity was 81.25%,and the best critical value was 1.13 ng/ml;the AUC of CRP was 0.76,the sensitivity was 75.00%,the specificity was 86.25%,and the best critical value was 63.95 mg/ml;the AUC of IL-6 was 0.80,the sensitivity was 72.50%,the specificity was 88.75%,and the best critical value was 105.20 pg/ml;the AUC of IL-10 was 0.76,the sensitivity was 82.50%,the specificity was 80.00%,and the best critical value was 84.13 mg/ml.Conclusion:The levels of serum PCT,CRP,IL-6 and IL-10 are significantly increased in sepsis patients,and and have a certain correlation with the prognosis of sepsis patients.The sensitivity of PCT is better than CRP,IL-6 and IL-10,and the specificity of IL-6 is better than other indexes.Therefore,PCT,CRP,IL-6 and IL-10 have certain diagnostic value for the early diagnosis of sepsis.