PCT、IL-6、CRP、WBC及其清除率等指标在ICU脓毒血症患者中的作用

The Clinical Value Studies of Plasma Procalcitonin,Interleukin-6,C-reactive Protein,WBC and their Clearances of Dynamic Changes in ICU Patients with Sepsis

目的:通过对重症监护病房(ICU)脓毒血症患者血清降钙素原(PCT)、白介素-6(IL-6)、C-反应蛋白(CRP)、白细胞(WBC)的检测及动态观察,探讨炎性指标及其清除率在患者管理中的临床价值。方法:选取2019年7月—2020年12月我院重症监护病房(ICU)收治的212例感染性脓毒血症患者,根据感染的程度分为一般脓毒血症组(全身炎症反应综合征)72例,重症脓毒血症组81例及感染性休克组59例。根据其预后情况可分为存活组191例,死亡组21例。同时收集120例同期在ICU住院但不符合脓毒血症诊断的患者为对照组。分别对不同组进行PCT、IL-6、CRP、WBC持续监测并比较统计分析,并监测随着住院时间延长不同脓毒血症组、存活组和死亡组PCTc、IL-6c、CRPc、WBCc清除率的改变并比较分析。结果:不同脓毒血症组APACHEⅡ评分、PCT、IL-6、CRP、WBC均显著高于对照组(P<0.05),且随着脓毒血症病情的加重各指标水平越高。脓毒血症组随着住院治疗时间的延长,PCT、IL-6、CRP持续地下降。存活组和死亡组1d时PCT、IL-6、CRP、WBC水平比较,无显著性差异(P>0.05);但通过存活组和死亡组在3d、5d PCTc、IL-6c、CRPc、WBCc清除率分别比较,均有显著性差异(P<0.05)。结论:PCT、IL-6、CRP、WBC的联合检测对脓毒血症患者有重要的诊断价值,持续监测可为临床提供疗效评价及预后判断,PCTc、IL-6c等清除率指标是一个更敏感及可靠的指标在评估脓毒血症患者的预后及治疗中受到关注。

Objective:Through the detection and dynamic observation of serum procalcitonin(PCT),interleukin-6(IL-6),C-reactive protein(CRP),and white blood cells(WBC)levels in patients with sepsis in the ICU,to explore clinical value of inflammatory markers and their clearances of dynamic changes in patient management.Methods:212 of patients who entered into the ICU from July 2019 to December 2020 were collected and divided into three groups,according to the degree of infection:general sepsis group(72 cases),severe sepsis group(81 cases)and sepsis shock group(59 cases).According to the prognosis can be divided into survival group(191 cases)and death group(21 cases).At the same time,120 cases hospitalized in the ICU during the same period but not consistent with sepsis were selected as the control group.PCT,IL-6,CRP and WBC level of the different groups and their clearances of dynamic changes were determined and compared with each other.The changes of PCTc,IL-6c,CRPc and WBCc clearance rates in different sepsis groups,survival groups and death groups were monitored and compared with the prolongation of hospital stay.Results:Compared to control group,APACHEⅡscore,PCT,IL-6,CRP,WBC levels of in different sepsis groups were significantly higher(P<0.05),and PCT,IL-6,CRP,WBC levels increased as the degree of infection.In sepsis group,PCT,IL-6 and CRP decreased continuously with the prolongation of hospitalization time.Serum levels PCT,IL-6,CRP,WBC on the 1st day were not significant between survival group and death group(P>0.05);but comparing the clearances of dynamic changes of PCTc,IL-6c,CRPc,and WBCc between survival group and death group at the 3rd and 5th days,there were significant differences(P<0.05).Conclusion:The combined detection with PCT,IL-6,CRP,WBC have important value for sepsis patients,continuous monitoring can provide clinical efficacy evaluation and prognosis judgment,clearances of dynamic changes indicators such as PCTc and IL-6c are a more sensitive and reliable indicators and have attracted attention in evaluating the prognosis and treatment of sepsis patients.