PCT、hs-CRP及sPLA2-ⅡA检测在脓毒症临床评价中的应用价值

Application value of PCT,hs-CRP and sPLA2-ⅡA in clinical evaluation of sepsis

目的探讨降钙素原(procalcitonin,PCT)、高敏C-反应蛋白(hypersensitive C reactive protein,hs-CRP)和血清ⅡA型分泌磷脂酶(groupⅡA secreted phospholipase A2,sPLA2-ⅡA)在脓毒症临床评价中的应用价值。方法通过回顾性分析选取164例确诊为脓毒症的患者作为观察组,按血培养结果分为革兰阴性杆菌组、革兰阳性球菌组、真菌组,选取非脓毒症感染者125例作为对照组;比较观察组与对照组之间PCT、hs-CRP及sPLA2-ⅡA血清水平差异,并进一步比较观察组的各组之间PCT、hs-CRP及sPLA2-ⅡA血清水平差异;急性生理学和慢性健康评定量表(APACHE-Ⅱ评分)评估患者病情严重程度,Pearson系数分析PCT、hs-CRP及sPLA2-ⅡA与APACHE-Ⅱ评分的相关性;ROC曲线分析PCT、hs-CRP、sPLA2-ⅡA及三者联合对脓毒症的诊断价值。结果革兰阴性杆菌组与革兰阳性球菌组中PCT、hs-CRP及sPLA2-ⅡA表达均高于对照组(P<0.05),真菌组中sPLA2-ⅡA表达高于对照组(P<0.05),APACHE-Ⅱ评分≥15分的患者中sPLA2-ⅡA表达显著高于对照组(P<0.01);PCT、hs-CRP及sPLA2-ⅡA均与APACHE-Ⅱ评分正相关,且sPLA2-ⅡA相关性(r=0.562,P<0.01)高于PCT(r=0.400,P<0.01)与hs-CRP(r=0.562,P<0.01);sPLA2-ⅡA(AUC=0.86)对脓毒症的诊断价值高于PCT(AUC=0.71)与hs-CRP(AUC=0.65),且三者联合检测(AUC=0.93)具有更高诊断效力。结论相较于PCT及hs-CRP,sPLA2-ⅡA检测在脓毒症临床评价中具有潜在的应用价值。

Objective To investigate application value of procalcitonin(PCT),hypersensitive C reactive protein(hs-CRP)and groupⅡA secreted phospholipase A2(sPLA2-ⅡA)in the clinical evaluation of sepsis.Methods A total of 164 patients diagnosed with sepsis were retrospectively analyzed and selected as the observation group.They were divided into gram-negative bacilli group,gram-positive cocci group and fungus group.Another 125 patients without sepsis were selected as the control group.The differences inexpression levels of serum PCT,hs-CRP and sPLA2-ⅡA were compared between observation group and the control group,and the differences in expression levels of serum PCT,hs-CRP and sPLA2-ⅡA among observation groups were compared.Acute physiology and chronic health evaluationⅡ(APACHE-Ⅱ)scoring system was used to evaluate the severity of the disease,and the correlation between PCT,hs-CRP,sPLA2-ⅡA and APACHE-Ⅱscore was analyzed by Pearsoncoefficient analysis.The diagnostic value of PCT,hs-CRP,sPLA2-ⅡA and their combination for sepsis was analyzed by receiver operating characteristic(ROC)curve.Results The expressions of PCT,hs-CRP and sPLA2-ⅡA in gram-negative bacilli group and gram-positive cocci group were higher than those in the control group(P<0.05),and the expression of sPLA2-ⅡA was higher in fungus group than in the control group(P<0.05).The expression of sPLA2-ⅡA in patients with APACHE-Ⅱscore≥15 was significantly higher than that in control group(P<0.01).PCT,hs-CRP and sPLA2-ⅡA were all positively correlated with APACHE-Ⅱscore,and the correlation of sPLA2-ⅡA(r=0.562,P<0.01)was higher than that of PCT(r=0.400,P<0.01)and hs-CRP(r=0.562,P<0.01).sPLA2-ⅡA(AUC=0.86)had higher diagnostic value for sepsis than PCT(AUC=0.71)and hs-CRP(AUC=0.65),and the combined detection of the three(AUC=0.93)had higher diagnostic efficacy.Conclusion Compared with PCT and hs-CRP,sPLA2-ⅡA detection has potential application value in clinical evaluation of sepsis.