血清降钙素原、白细胞介素6和C反应蛋白在脓毒血症和全身炎症反应综合征鉴别研究

Significance of PCT, IL-6 and CRP in differential diagnosis of sepsis and systemic inflammatory response syndrome

目的 探讨血清标志物降钙素原(PCT)、白细胞介素6(IL-6)和C反应蛋白(CRP)在脓毒血症与全身炎症反应综合征的差别,为脓毒血症与全身炎症反应综合征鉴别诊断提供依据。方法 收集2019年4月—2021年4月昆明医科大学第二附属医院创伤外科及重症医学科收治患者资料。PCT、IL-6采用电化学发光法测定,CRP采用免疫透射比浊法测定,血培养测试采集患者未使用抗菌药物且发热高峰时抗凝静脉血,利用3D 240-Bact/Alert(法国生物梅里埃公司)培养仪进行培养。结果 鉴别诊断脓毒血症与全身炎症反应综合征(SIRS)时,患者入住ICU 24 h内脓毒血症组PCT、CRP和IL-6水平均高于SIRS组,差异有统计学意义(P<0.05)。血清PCT浓度较IL-6和CRP更具有临床价值。PCT诊断效能更高。若患者入ICU 24 h内PCT值低于4.18 ng/mL时,可排除脓毒血症(阴性预测值97.01%)。当PCT>0.5 ng/mL作为诊断脓毒血症的cut-off值时,灵感度为95.83%,特异度为100.00%。PCT>2 ng/mL作为诊断脓毒血症的cut-off值时,灵敏度和特异度均略低。ROC曲线结果显示,PCT对诊断脓毒血症有较高的临床价值,其诊断的正确率较高。IL-6相对于CRP来说诊断效能更高。结论 PCT、CRP、IL-6联合检测时,能为临床上脓毒血症和SIRS的鉴别诊断快速提供诊治方向。单独指标中,PCT对鉴别脓毒血症和SIRS优于IL-6、CRP。

Objective To explore the clinical value of serum markers procalcitonin(PCT), interleukin 6(IL-6) and C-reactive protein(CRP) in the differential diagnosis of sepsis and systemic inflammatory response syndrome(SIRS).Methods Data of patients admitted to the Department of Trauma Surgery and Intensive Care Medicine of the Second Affiliated Hospital of Kunming Medical University from April 2019 to April 2021 were collected in this study. PCT and IL-6levels were measured by electrochemiluminescence, and CRP levels were measured by immunoturbidimetry. 8-10 mlanticoagulant venous blood was collected from patients without antibiotics and at fever peak, and cultured with 3D 240-BACT/Alert(Biomeerie, France) culture instrument.Results In the differential diagnosis of sepsis and systemic inflammatoryresponse syndrome, the levels of PCT, CRP and IL-6 in the sepsis group were significantly higher than those in the SIRS groupwithin 24 hours after admission to ICU(P<0.05). Serum PCT concentration was of more clinical value than IL-6 and CRP(P<0.05), so PCT had high diagnostic efficiency. Sepsis was excluded if the PCT value was lower than 4.18 ng/m L within 24 h afteradmission(negative predictive value 97.01%). Clinical cut-off value: When PCT>0.5 ng/m L was used as the cut-off value fordiagnosis of sepsis, the sensitivity and specificity were 95.83% and 100.00%, respectively. When PCT>2 ng/m L was used asthe critical value for the diagnosis of sepsis, the sensitivity and specificity were slightly lower. ROC curve results showed thatPCT had high clinical value in the diagnosis of sepsis, and its diagnostic accuracy was the highest. Il-6 was more diagnosticthan CRP.Conclusions The combined detection of PCT, CRP and IL-6 can provide rapid diagnosis and treatment directionfor differential diagnosis of clinical sepsis and SIRS. Among individual indicators, PCT is superior to IL-6 and CRP indifferentiating sepsis from SIRS.