可溶性CD14亚型对老年脓毒症患者早期诊断和危险分级的临床价值

Clinical value of soluble CD14 subtype(Presepsin)in early diagnosis and risks rating of elderly sepsis patients

目的探讨可溶性CD14亚型(Presepsin)对老年脓毒症患者早期诊断和危险分级的临床价值。方法研究对象选择我院2016年6月~2019年6月收治的86例脓毒症患者为脓毒症组,根据病情程度再分为普通脓毒症组、严重脓毒症组和脓毒症休克组;选择同期我院收治的51例非感染SIRS患者为非感染SIRS组;选择50例在我院进行健康体检者作为对照组。对所有受试人群的Presepsin、降钙素原(PCT)、C反应蛋白(CRP)、白细胞计数(WBC)、乳酸(Lactate)、血小板(PLT)水平进行测定和比较。结果(1)脓毒症组、非感染SIRS组、对照组三组相关指标Presepsin、PCT、CRP、WBC、Lactate、PLT水平比较,差异有统计学意义(P<0.05);非感染SIRS组、脓毒症组Presepsin、PCT、CRP、WBC、Lactate水平明显高于对照组,PLT水平明显低于对照组,组间差异有统计学意义(P<0.05);脓毒症组Presepsin、PCT、CRP、WBC、Lactate水平明显高于非感染SIRS组,PLT水平明显低于非感染SIRS组,组间比较差异有统计学意义(P<0.05)。(2)普通脓毒症组、严重脓毒症组、脓毒症休克组三组相关指标Presepsin、PCT、CRP、WBC、Lactate、PLT水平比较,差异有统计学意义(P<0.05);严重脓毒症组、脓毒症休克组Presepsin、PCT、CRP、WBC、Lactate水平明显高于普通脓毒症,PLT水平明显低于普通脓毒症,组间比较差异有统计学意义(P<0.05);脓毒症休克组Presepsin、Lactate水平明显高于严重脓毒症组,组间比较差异有统计学意义(P<0.05),但两组之间PCT、CRP、WBC、PLT水平比较,差异无统计学意义(P>0.05)。结论Presepsin水平的测定和评估对于脓毒症的早期诊断具有显著的意义,而且其水平随病情的恶化而提高,有助于脓毒症患者的危险分级。

Objective To investigate the clinical value of soluble CD14 subtype(Presepsin)in early diagnosis and risks rating of elderly sepsis patients.Methods A total of 86 patients with sepsis admitted to our hospital from June 2016 to June 2019 were chooosen as sepsis group,then they were divided into the common sepsis group,the severe sepsis group and the sepsis shock group according to the severity of the disease.Non-infectious SIRS patients admitted to our hospital during the same period were selected as the non-infectious SIRS group(n=51).Meanwhile,patients who underwent physical examination in our hospital were selected as the control group(n=50).The levels of Presepsin,PCT,CRP,WBC,Lactate and PLT in all subjects were determined and compared.Results(1)There were statistically significant differences in the levels of Presepsin,PCT,CRP,WBC,Lactate and PLT in the sepsis group,the non-infectious SIRS group and the control group(P<0.05).The levels of Presepsin,PCT,CRP,WBC,Lactate in the non-infectious SIRS group and the sepsis group were significantly higher than those in the control group,while PLT level was significantly lower than that in the control group,with statistically significant differences(P<0.05).The levels of Presepsin,PCT,CRP,WBC,Lactate in the sepsis group were significantly higher than those in the non-infectious SIRS group,and PLT level was significantly lower than that in the non-infectious SIRS group,with statistically significant differences(P<0.05).(2)There were statistically significant differences in the levels of Presepsin,PCT,CRP,WBC,Lactate and PLT in the three groups of the common sepsis group,the severe sepsis group and the sepsis shock group(P<0.05).The levels of Presepsin,PCT,CRP,WBC,Lactate in the severe sepsis group and the sepsis shock group were significantly higher than those in the common sepsis group,and PLT level was significantly lower than that in the common sepsis group,with statistically significant differences(P<0.05).The levels of Presepsin and Lactate in the sepsis shock group were significantly higher than those in the severe sepsis group,with statistically significant differences(P<0.05),but there were no significant differences in PCT,CRP,WBC and PLT levels between the two groups(P>0.05).Conclusion The determination and evaluation of Presepsin level is of great significance for the early diagnosis of sepsis,and its level increases with the deterioration of the disease,which is helpful for the risks rating of sepsis patients.