PCT和hsCRP在肺炎合并脓毒血症患者的病情严重程度以及预后评价中的价值

Value of Procalcitonin and High-sensitivity C-reactive Protein Levels in the Severity and Prognostic Evaluation in Patients with Pneumonia Complicated with Sepsis

目的分析探讨降钙素原(procalcitonin,PCT)、高敏C反应蛋白(high-sensitivity C-reactive protein,hs CRP)的水平变化在肺炎合并脓毒血症患者的病情严重程度以及预后评价中的价值。方法选取作者医院2012-04/2014-04月因肺炎合并脓毒症住院治疗的80例患者,分为脓毒症组、严重脓毒症组和脓毒性休克组,同时选取同期单纯肺炎患者50例作为对照组。根据脓毒症患者2周内是否死亡,分为存活组和死亡组。结果三组脓毒症患者的PCT、hs CRP和急性生理学及慢性健康状况评分Ⅱ(acute physiology and chronic health evaluationⅡ,APACHEⅡ)评分均显著高于对照组,P<0.01;随着脓毒症病情的加重,患者的PCT、hs CRP和APACHEⅡ评分依次升高,P<0.01。死亡组的PCT、hs CRP水平及APACHEⅡ评分均显著高于存活组,P<0.01。分析ROC曲线,可得PCT、hs CRP水平及APACHEⅡ评分诊断严重脓毒症和脓毒性休克的最佳截点分别为≥2 ng/m L、≥75 mg/L、≥11分,诊断敏感度分别为61.33%、80.24%、和89.97%,特异度分别为88.01%、67.94%和81.79%。结论 PCT、hs CRP的水平变化在肺炎合并脓毒血症患者的病情严重程度以及预后评价中判断中具有一定价值和诊断意义。

Objective To analyze the value of procalcitonin(PCT) and(high-sensitivity C-reactive protein,hs CRP)levels in the severity and prognostic evaluation in patients with pneumonia complicated with sepsis.Methods A total of 80 patients with pneumonia complicated with sepsis in our department from April 2012 to April 2014 were divided into sepsis group,severe sepsis group and septic shock group.Another 50 patients with simply pneumonia over the same period were selected as a control group.The patients with sepsis were divided into survival group and death group according to death or not within 2 weeks.Results PCT,hs CRP and acute physiology and chronic health evaluation Ⅱ(APACHE Ⅱ) scores in the three groups of sepsis patients were significantly higher(P < 0.01).With the aggravation of sepsis,PCT,hs CRP and APACHE Ⅱ score increased successively(P < 0.01).PCT,hs CRP levels and APACHE Ⅱ scores were significantly higher in the death group than those in the survival group(P < 0.01).From ROC curve analysis,PCT,hs CRP levels and APACHE Ⅱ score diagnosis of severe sepsis and septic shock can be obtained.The best cut-off point were ≥2 ng / ml,≥75 mg / L,≥11 points,and the diagnostic sensitivity was 61.33%,80.24%,and 89.97%,specificity was 88.01%,67.94% and 81.79%.Conclusion PCT and hs CRP levels have a certain value in the diagnosis and the severity evaluation in patients with pneumonia complicated with sepsis.