肾综合征出血热患者降钙素原、白细胞、C反应蛋白的水平及临床意义

Levels of procalcitonin,white blood cell count and C-reactive protein in patients with hemorrhagic fever with renal syndrome and its clinical significance

目的探讨降钙素原(procalcitonin,PCT)、WBC及CRP对肾综合征出血热(hemorrhagic fever with renal syndrome,HFRS)患者病情严重程度及预后的预测价值。方法选取2016年10月—2018年7月解放军空军军医大学第二附属医院感染科收治的HFRS确诊患者为研究对象,共272例,结合目前国内制定的临床分型标准,分为轻型、中型、重型和危重型组;以住院期间及出院后28 d疾病转归界定预后(存活或死亡)。比较PCT、WBC和CRP水平在不同组间的表达差异;分析PCT、WBC及CRP对预后预测的统计学效力。结果危重型组WBC及PCT水平均显著高于轻型、中型及重型组,重型组WBC及PCT水平均显著高于轻型及中型组(P均<0.05),但WBC和PCT水平在轻、中型组间比较,差异均无统计学意义(P均>0.05);CRP水平在各组中均升高,但组间比较差异无统计学意义(P均>0.05)。PCT与PT、APTT、凝血酶时间呈正相关(r=0.517,r=0.482、r=0.672,P均<0.05),与纤维蛋白原呈负相关(r=-0.504,P<0.05)。PCT、WBC预测HFRS患者预后的AUC依次为0.792、0.769(P均<0.05)。结论与WBC、CRP相比,PCT水平升高与HFRS患者凝血指标相关性更好,且在早期预测疾病严重程度及预后方面,有更好的敏感度及特异度。

Objective To investigate the prognostic value of procalcitonin(PCT),white blood cell count(WBC)and C-reactive protein(CRP)on disease severity and prognosis in patients with hemorrhagic fever with renal syndrome(HFRS).Methods Patients diagnosed with HFRS who were hospitalized in the Department of Infectious Diseases,the Second Affiliated Hospital of Air Force Medical University from October 2016 to July 2018 were selected as the research subjects.A total of 272 patients were finally included in this study,and were divided into mild,moderate,severe and critical groups according to the current clinical classification standards established in China.Prognosis(survival or death)was defined by disease outcome during hospitalization and 28 days after discharge.The expression differences of PCT,WBC and CRP level in different groups were compared.The statistical powers of PCT,WBC and CRP on prognosis prediction were analyzed.Results WBC and PCT levels in critical patients were significantly higher than those in mild,moderate and severe patients,WBC and PCT levels in severe patients were significantly higher than those in mild and moderate patients(P<0.05),but there was no statistical significance in WBC and PCT levels between mild and moderate groups(P>0.05).CRP level increased in all groups,but there was no significant difference between groups(P>0.05).PCT was positively correlated with PT,APTT and TT(r=0.517,r=0.482,r=0.672,P<0.01),and negatively correlated with Fib(r=-0.504,P<0.01).The AUC of PCT and WBC on predicting prognosis were 0.792 and 0.769,respectively(P<0.05).Conclusions Compared with WBC and CRP,the elevation of PCT level is more correlated with coagulation indicator in HFRS patients.It has better sensitivity and specificity on early prediction of disease severity and prognosis.