多种炎症指标联合检测对不同病原菌致脓毒血症的早期诊断价值

The value of combined detection of multiple inflammatory markers in early diagnosis of sepsis caused by different pathogens

目的评价炎症指标降钙素原(PCT)、C反应蛋白(CRP)、血清淀粉样蛋白A(SAA)、白细胞介素-6(IL-6)、肿瘤坏死因子-α(TNF-α)检测在不同病原菌引起的血流感染致脓毒血症患者中的诊断价值。方法选取2021年1月至2022年11月该院重症医学科诊治的血流感染致脓毒血症患者共140例,根据血培养结果将其分为革兰阳性菌血流感染致脓毒血症患者(革兰阳性菌血流感染组)47例和革兰阴性菌血流感染致脓毒血症患者(革兰阴性菌血流感染组)93例。选取同期在该院诊断为局部炎症感染的患者70例作为局部感染组,另选取同期来该院就诊的50例体检健康者作为对照组。比较4组炎症指标水平,分析PCT、CRP、SAA、IL-6、TNF-α与急性生理学与慢性健康状况评分系统Ⅱ(APACHE-Ⅱ)评分的相关性,使用受试者工作特征曲线(ROC曲线)确定各指标在血流感染致脓毒血症的诊断价值。结果脓毒血症患者血流感染的细菌以革兰阴性杆菌多见。革兰阳性菌血流感染组、革兰阴性菌血流感染组、局部感染组PCT、CRP、SAA、IL-6、TNF-α水平均明显高于对照组,差异有统计学意义(P<0.05);革兰阳性菌血流感染组患者PCT、CRP、IL-6水平与APACHE-Ⅱ评分分别呈正相关(r=0.427,P<0.001;r=0.328,P<0.010;r=0.283,P=0.026);ROC曲线分析显示,单项检测对革兰阳性菌血流感染致脓毒血症的诊断效能最高的指标是CRP,其单独检测的曲线下面积(AUC)为0.7857。PCT对革兰阴性菌血流感染致脓毒血症的诊断效能最高,其单独检测的AUC为0.8873。结论血清炎症指标与血液不同细菌感染导致的脓毒血症关系密切,其水平能较好地判断病情严重程度,多种炎症指标联合检测能提高对脓毒血症的早期辅助诊断价值。

Objective To evaluate the diagnostic value of procalcitonin(PCT),C-reactive protein(CRP),serum amyloid A(SAA),interleukin-6(IL-6)and tumor necrosis factorsα(TNF-α)in sepsis caused by blood stream infection caused by different pathogens.Methods A total of 140 patients with sepsis caused by bloodstream infection treated in the intensive care unit of the hospital from January 2021 to November 2022 were selected.According to the blood culture results,the patients were divided into 47 patients with sepsis caused by Gram-positive bacteria bloodstream infection(Gram-positive bacteria bloodstream infection group)and 93 patients with sepsis caused by Gram-negative bacteria bloodstream infection(Gram-negative bacteria bloodstream infection group).A total of 70 patients diagnosed with local inflammation and infection in this hospital during the same period were selected as the local infection group,and 50 healthy patients who came to this hospital during the same period were selected as the control group.The levels of the four groups of inflammatory indicators were compared,and the correlation between PCT,CRP,SAA,IL-6,TNF-αand acute physiology and chronic health status scoring systemⅡ(APACHE-Ⅱ)scores was analyzed.The diagnostic value of each indicator in bloodstream infection induced sepsis was determined by receiver operating characteristic curve(ROC curve).Results Gram-negative bacillus were more common in patients with sepsis.The levels of PCT,CRP,SAA,IL-6 and TNF-αin Gram-positive bacteria bloodstream infection group,Gram-negative bacteria bloodstream infection group and local infection group were significantly higher than those in control group,with statistical significance(P<0.05).The levels of PCT,CRP and IL-6 were positively correlated with APACHE-Ⅱscores in Gram positive bacteria bloodstream infection group(r=0.427,P<0.001;r=0.328,P<0.010;r=0.283,P=0.026);ROC curve analysis showed that CRP had the highest diagnostic efficacy for sepsis caused by gram-positive bacteria bloodstream infection,and the area under the curve(AUC)of CRP was 0.7857.PCT had the highest diagnostic efficacy for sepsis caused by Gram-negative bloodstream infection,with an AUC of 0.8873.Conclusion There is a close relationship between serum inflammatory markers and sepsis caused by different bacterial infections in blood.The expression level of serum inflammatory markers can be used to judge the severity of sepsis,combined detection of inflammatory markers can improve the value of early auxiliary diagnosis of sepsis.