前肾上腺髓质素作为脓毒症危险分层新标志物的探讨

目的 探讨前肾上腺髓质素(pro-ADM)在脓毒症预测和危险分层中的价值.方法 采用前瞻性分析方法将51例入住重症加强治疗病房的危重病患者按国际脓毒症标准分为全身炎症反应综合征(SIRS)组(25例)、脓毒症组(12例)、严重脓毒症组(9例)、脓毒性休克组(5例)4组.取静脉血,采用新型夹心免疫荧光测量法检测pro-ADM浓度,并与急性生理学与慢性健康状况评分系统I(APACHE I)评分及降钙素原(PCT)、C-反应蛋白(CRP)和白细胞介素-6(IL-6)水平相比较.结果 ①SIRS组、脓毒症组、严重脓毒症组、脓毒性休克组血浆pro-ADM浓度逐渐升高,分别为0.34、2.23、4.57和8.21 μg/L,其中以脓毒性休克组pro-ADM浓度最高(P均＜0.05);②在所有脓毒症患者中,与其他标志物相比,死亡患者的pro-ADM浓度比存活患者明显升高(2.01 μg/L比9.75 μg/L,P＜0.05),APACHE I评分也明显升高(23.44分比38.21分,P＜0.05);③在脓毒症存活患者的受试者工作特征曲线分析中,pro-ADM、PCT、APACHE I评分的曲线下面积(分别为0.87、0.81和0.81)较CRP和IL-6(分别为0.53和0.71)明显增多.结论 pro-ADM浓度测定在脓毒症的预测和危险分层中是一个新的有用的标志物.     

血清MCP-1、sICAM-1及PCT对老年社区获得性肺炎严重程度的诊断价值

目的探讨血清单核细胞趋化蛋白-1(MCP-1)、可溶性细胞间黏附分子-1(sICAM-1)及降钙素原(PCT)对老年社区获得性肺炎(CAP)严重程度的诊断价值。方法选择该院2013年1月至2015年9月就诊的老年CAP患者256例,按照病情严重程度分为非重症患者128例和重症患者128例,同时选取健康体检人群80例作为对照组,检测研究对象血清MCP-1、sICAM-1和PCT的水平。通过受试者工作特征曲线(ROC)评价血清MCP-1、sICAM-1和PCT对老年CAP患者严重程度的诊断价值。结果老年CAP患者白细胞计数(WBC)、血清PCT、CRP、MCP-1和sICAM-1的水平显著高于对照组(P0.05),且重症组患者WBC、血清PCT、CRP、MCP-1和sICAM-1的水平及肺炎严重程度评分(PSI评分)也显著高于非重症组(P0.017)。血清MCP-1、sICAM-1和PCT水平均与PSI评分呈正相关(r=0.647、0.555、0.523,P0.01)。受试者工作特征曲线分析结果显示,血清MCP-1曲线下面积(AUC)为0.936,高于sICAM-1(AUC=0.882)和PCT(AUC=0.864)。结论血清MCP-1、sICAM-1和PCT可以作为判断老年CAP患者病情严重程度的标志物,但是MCP-1效果优于sICAM-1和PCT。     

B型钠尿肽预测社区获得性肺炎严重程度的意义

目的 通过对社区获得性肺炎(community-acquired pneumonia,CAP)患者BNP(B型钠尿肽)与肺炎严重程度之间相关性的研究,评估BNP预测CAP严重程度的意义.方法 2011年12月至2012年12月就诊我科并确诊CAP患者202例,测定BNP、C-反应蛋白(CRP)、白细胞计数(WBC),以及肺炎严重度评分(PSI)所需相关指标,计算PSI评分并分级.分析不同肺炎严重程度分级之间BNP水平、C-反应蛋白、白细胞计数的差异,以及BNP与PSI的相关性.进一步根据PSI水平分为高风险组(PSI分级Ⅳ、Ⅴ级)和低风险组(PSI分级Ⅰ～Ⅲ级);根据患者预后分为存活组和死亡组.比较两组间BNP差异、BNP水平与肺炎严重程度的受试者工作特征(ROC)曲线.结果 BNP水平随着CAP严重程度增加而升高(r =0.782,P＜0.001);高风险组患者BNP水平显著高于低风险阻[(263.2±119.6)pg/mLvs.(71.5±54.3) pg/mL,P＜0.001].相比存活组,死亡组BNP水平更高[(343.86±125.49)vs.(183.00±121.71) pg/mL,P＜0.001].BNP与PSI评分、CRP以及WBC呈正相关(r=0.782,P＜0.001,r=0.560,P＜0.001和r=0.513,P＜0.001).BNP对于CAP严重程度的预测有较高的准确性(AUC =0.952),区分高、低风险的BNP最佳截点为125.0 pg/mL,敏感性0.891,特异性0.946.BNP能预测死亡(AUC =0.823),其预测死亡最佳截点为299.0 pg/mL,敏感性0.675,特异性0.816,阴性预测值0.926,阳性预测值0.426.结论 BNP与CAP严重程度呈正相关关系,BNP大于125.0 pg/mL的CAP患者建议住院治疗,BNP大于299.0 pg/mL的CAP患者具有死亡高风险.BNP预测CAP严重程度具有一定实用性.     

降钙素原与社区获得性肺炎病情严重度评估

目的 探讨社区获得性肺炎(CAP)病情严重度与降钙素原(PCT)的相关性,为CAP病情严重度的评估提供实验室依据.方法 收集2008-10～2009-02期间我院收治的单纯CAP病例共38例,在入院24 h、7 d分别测定PCT、C-反应蛋白(CRP)、白细胞计数(WBC),应用肺炎病情严重度评分(PSI)评估病情.结果 试验组入院24 h PCT较健康对照组升高,差异有统计学意义(P<0.01).入院24 h及7 d:PCT均与PSI相关(r=0.539,r=0.472;P＜0.05);入院7 d WBC与PSI相关(r=0.381,P＜0.05),CRP与PSI无相关性.结论 与CRP、WBC相比,PCT能够更好反映CAP病情严重程度,可用于动态监测CAP病情.     

降钙素原对老年重症肺炎患者30d病死率的影响

目的观察血清降钙素原(PCT)在评估老年重症肺炎患者30d病死率中的价值。方法选取2011年1月至2013年12月该院呼吸科及重症监护病房住院的老年重症肺炎患者132例,检测血清PCT、C-反应蛋白(CRP)水平,进行肺炎严重度指数(PSI)评分,记录治疗30d后患者的病死率。通过受试者工作特征曲线(ROC)分析PCT对30d病死率的预测价值,计算曲线下面积(AUC)。结果截至治疗30d时,有79例患者死亡,53例患者存活。死亡患者的PCT、CRP水平及PSI得分明显高于存活患者水平及得分,PCT与CRP之间不存在明显相关性,PCT与PSI之间存在明显相关性,以PCT≥2.98ng/mL为诊断分界值预测重症肺炎患者30d病死率,其AUC为0.737,和PSI的AUC(0.784)相比,差异无统计学意义(P0.05),高于CRP的AUC(0.586)。PCT与PSI的敏感度、特异度都明显高于CRP。结论 PCT水平对老年重症肺炎患者的30d病死率有较好预测价值。     

外周血炎症因子联合检测在儿童社区获得性肺炎诊断中的临床应用

目的:探讨外周血炎性因子降钙素原(PCT)、C-反应蛋白(CRP)、白介素-6(IL-6)、白细胞(WBC)联合检测在儿童社区获得性肺炎(CAP)诊断中的临床应用价值。方法:选取我院儿科病房收治的103例儿童CAP(病例组)及同期健康体检儿童50例(对照组)为研究对象,电化学发光法检测血清PCT、IL-6、CRP,全自动血液分析仪检测WBC的水平,Pearson相关分析PCT和IL-6与传统炎症指标CRP和WBC的相关性,绘制PCT、IL-6、CRP、WBC“受试者工作特征”(Receiver OperatingCharacteristic)曲线,回顾性统计分析各炎症指标联合检测对儿童CAP的诊断价值。结果:儿童CAP组PCT、CRP、IL-6、WBC水平分别为[(1.371.24)ng/ml、(43.81±15.31)mg/L、(67.87±22.41)pg/ml、(11.253.33)10⁹/L]明显高于健康对照组[(0.33±0.18)ng/ml、(12.06±3.46)mg/L、(8.59±2.89)pg/ml、(7.85±2.99)10⁹/L],均P<0.01;Pearson相关分析PCT、IL-6与CRP和WBC呈明显正相关(r=0.836、0.689、0.686、0.539),均P<0.01;ROC曲线求取PCT、CRP、IL-6和WBC诊断儿童CAP最佳截断值分别为0.50 ng/ml、8.56 mg/L、8.70pg/ml、和8.60×10⁹/L,PCT、CRP、IL-6和WBC诊断儿童CAP敏感性分别为73.79%、98.60%、89.32%和82.52%,特异性86.00%、44.00%、62.00%和60.60%,四项指标联合检测诊断儿童CAP的ROC曲线面积最大(0.917),敏感性、特异性分别为82.52%、84.00%。结论:PCT和IL-6诊断儿童CAP价值优于CRP和WBC,但多指标联合检测可以做到相互补充、相互印证,提高诊断儿童CAP准确度。     

不同指标对成年及老年社区获得性肺炎严重程度预测价值的对比分析

目的评价降钙素原(PCT)、C反应蛋白(CRP)、白细胞(WBC)对成年及老年社区获得性肺炎(CAP)严重程度的预测价值。方法 2013年5月至2014年9月入院的112例CAP住院患者分为成年组(50例)和老年组(62例)。比较2年龄组重症、非重症肺炎患者的PCT、CRP、WBC水平,并分析各炎性反应指标与肺炎严重度指数(PSI)、英国胸科协会改良肺炎(CURB-65)评分的相关性。结果成年组及老年组重症肺炎患者的PCT、CRP水平及PSI、CURB-65评分均高于同组非重症肺炎患者(P0.05)。老年组患者的PCT与PSI、CURB-65评分呈正相关(P0.05),而成年组患者PCT,2年龄组患者的CRP及WBC与PSI、CURB-65评分无显著相关(P0.05)。结论 PCT、CRP可用于评估成年人及老年人CAP的严重程度,而PCT在老年CAP患者中的预测价值较高。     

血清PCT、IL-6、CRP水平在老年社区获得性肺炎鉴别诊断中的价值

目的:探讨血清降钙素原(procalcitonin,PCT)、白细胞介素6(interleukin 6,IL-6)以及C反应蛋白(reaction protein,CRP)在鉴别老年社区获得性肺炎(community acquired pneumonia,CAP)与上呼吸道感染中的辅助诊断价值。方法:选择本院2016年1月1日至2016年12月31日,于我院住院治疗的老年CAP患者103例作为研究组,50例上呼吸道感染而排除CAP的老年人作为对照组。研究组中,痰培养结果为阳性者45例,58例为痰培养呼吸道正常菌。所有研究对象分别检测血清PCT、IL-6、CRP,并对检测结果进行统计学分析,以PCT0.25 ng/m L,IL-67 pg/m L,CRP8 mg/L为阳性,分析3个指标鉴别老年CAP的灵敏度和特异度,同时以受试者工作特征曲线(receiver operating characteristic curve,ROC曲线)评估PCT、IL-6及CRP在45例痰培养结果为阳性的细菌性老年CAP患者中诊断CAP的效能。结果:PCT、IL-6、CRP水平在对照组与研究组之间差异均有统计学意义(P0.05),CRP诊断CAP的灵敏度为92.2%,高于PCT和IL-6,PCT的特异度为94.0%,明显高于CRP和IL-6,差异均具有统计学意义(P均0.05)。PCT、IL-6、CRP联合检测(平行试验,即任意一项阳性)的灵敏度为96.1%,高于CRP的灵敏度92.2%,差异有统计学意义(P0.05),但联合检测的特异度略有下降,为68%。CAP患者血清PCT与CRP水平之间具有一定的相关性(r=0.524 7,P0.001)。三个检测指标在诊断细菌性老年CAP的ROC曲线显示,PCT的ROC曲线下面积为0.773,CRP的曲线下面积为0.534,IL-6的曲线下面积为0.542。当PCT临界值取0.21 ng/m L,其诊断细菌性老年CAP的灵敏度为84.4%,特异度为79.3%。结论:鉴别上呼吸道感染的老年患者与老年CAP患者时,PCT、IL-6以及CRP均可以作为老年CAP的辅助诊断检测指标,三者联合检测能提高诊断老年CAP患者的灵敏度,同时PCT在鉴别诊断细菌性老年CAP中的价值高于CRP和IL-6。     

血清降钙素原在儿童社区获得性肺炎诊断中的意义

目的 探讨血清降钙素原(PCT) 在儿童社区获得性肺炎(CAP)细菌性感染和病毒性感染中的鉴别诊断价值,并进一步比较C反应蛋白(CRP)、红细胞沉降率(ESR)、白细胞(WBC)计数在诊断中的准确性和用途.方法 选取79例CAP患儿(大叶性肺炎20例、支气管肺炎59例)和正常对照者21名,检测PCT、CRP、ESR和WBC计数,并绘制受试者工作特征(ROC)曲线.将79例CAP患儿按年龄分为<2岁(31例)、2~5岁(18例)、>5岁(30例),比较各项指标.结果 CAP患者血清PCT、CRP、ESR和WBC明显高于正常对照组(P=0.000、P<0.01),大叶性肺炎组PCT、CRP、ESR明显高于支气管肺炎组(P<0.01);>5岁组PCT水平明显高于<2岁组(P=0.000),而CRP、ESR和WBC在不同年龄组中均无差异(P>0.05).PCT的ROC曲线下面积为0.97[95%可信区间(CI):0.93~1.00],明显高于CRP[0.91(95%CI:0.78~0.99)]和ESR[0.87(95%CI:0.78~0.96)](P<0.01).但与WBC[0.95(95%CI:0.91~0.98)]比较差异无统计学意义(P=0.14);PCT最佳诊断Cut-off值为1 ng/mL,敏感性和特异性分别为94.1%、82.3%.结论 血清PCT在CAP患儿中的鉴别诊断价值优于CRP和 ESR,可为临床医师早期诊断及合理使用抗菌药物提供可靠依据.     

血清HDL-C联合PCT、CRP、IL-6检测在评估腹腔感染患者严重程度中的价值

目的探讨高密度脂蛋白胆固醇(HDL-C)联合降钙素原(PCT)、C-反应蛋白(CRP)、白细胞介素-6(IL-6)检测在评估腹腔感染患者严重程度中的价值。方法选取华中科技大学同济医学院附属同济医院2018年1月至2019年7月收治的116例腹腔疾病患者为研究对象,依据感染程度不同分为复杂腹腔感染组45例,单纯腹腔感染组37例,以及无感染的对照组34例。分别检测3组患者在治疗前及治疗后血清中HDL-C、PCT、CRP、IL-6和白细胞(WBC)水平,统计患者序贯脏器衰竭评分(SOFA评分),分析其与感染程度的相关性。结果治疗前,复杂腹腔感染组中患者血清HDL-C显著低于单纯腹腔感染组及对照组(P0.05),PCT、CRP、IL-6和WBC显著高于单纯腹腔感染组及对照组(P0.05)。受试者工作特征曲线(ROC曲线)分析结果显示,HDL-C、PCT、CRP、IL-6、WBC联合检测的曲线下面积为0.972,均高于PCT(0.961)、HDL-C(0.877)、IL-6(0.766)、WBC(0.686)和CRP(0.661)单独检测。治疗后,复杂腹腔感染组及单纯腹腔感染组中患者血清HDL-C上升,PCT、CRP、IL-6和WBC下降,与治疗前比较,差异均有统计学意义(P0.05)。复杂腹腔感染组中死亡患者血清HDL-C低于好转出院患者(P0.05),SOFA评分明显高于好转出院患者(P0.05),而PCT、CRP、IL-6和WBC差异无统计学意义(P0.05)。结论临床检测腹腔感染患者血清中HDL-C、PCT、CRP、IL-6及WBC水平对评估患者感染的严重程度及治疗效果有一定的指导作用,治疗过程中患者血清HDL-C持续性处于较低水平可能提示预后不良。     

Circulating levels of copeptin, a novel biomarker, in lower respiratory tract infections

BACKGROUND: Vasopressin has haemodynamic as well as osmoregulatory effects, and reflects the individual stress response. Copeptin is co-synthesized with vasopressin, directly mirroring vasopressin levels, but is more stable in plasma and serum. Both levels are increased in patients with septic shock. Lower respiratory tract infections (LRTI) are a precursor of sepsis. Thus, we investigated circulating levels and the prognostic use of copeptin for the severity and outcome in patients with LRTI. MATERIALS AND METHODS: Five hundred and forty-five consecutive patients with LRTI and 50 healthy controls were evaluated. Serum copeptin levels were measured with a new chemiluminescent sandwich immunoassay. RESULTS: Of the 545 patients, 373 had community-acquired pneumonia (CAP), 60 acute exacerbations of chronic obstructive pulmonary disease (COPD), 59 acute bronchitis, 13 exacerbations of asthma and 40 other final diagnoses. Copeptin levels were significantly higher in patients with LRTI as compared to controls (P < 0.001) with highest levels in patients with CAP. Copeptin levels increased with increasing severity of CAP, as classified by the pneumonia severity index (PSI) (P < 0.001). In patients who died, copeptin levels on admission were significantly higher as compared to levels in survivors [70.0 (28.8-149.0) vs. 24.3 (10.8-43.8) pmol L(-1), P < 0.001]. The area under the receiver operating curve (AUC) for survival was 0.75 for copeptin, which was significantly higher as compared to C-reactive protein (AUC 0.61, P = 0.01), leukocyte count (AUC 0.59, P = 0.01) and similar to procalcitonin (AUC 0.68, P = 0.21). CONCLUSIONS: Copeptin levels are increased with increasing severity of LRTI namely in patients with CAP and unfavourable outcome. Copeptin levels, as a novel biomarker, might be a useful tool in the risk stratification of patients with LRTI.     

降钙素原在典型病原菌及非典型病原菌致社区获得性肺炎的鉴别诊断研究

目的：通过测定典型病原菌及非典型病原菌致社区获得性肺炎（CAP）患者的血清降钙素原（PCT）水平,探讨其鉴别诊断的价值。方法回顾性分析222例CAP患者,根据病原菌的不同,分为典型病原菌组（139例）及非典型病原菌组（83例）两组,比较两组患者的PCT、CRP 及WBC,并绘制PCT和CRP的ROC曲线,根据曲线下面积评价其对上述两组病原菌所致CAP的鉴别诊断价值。结果典型病原菌组患者PCT水平为0.31 ng/ml（四分位数间距：0.10 ng/ml,2.58 ng/ml）,明显高于非典型病原菌组0.17 ng/ml（四分位数间距：0.08 ng/ml,0.66 ng/ml）（P＜0.05）;且两组患者PCT的阳性率比较有统计学意义（0.96比0.67）（P＜0.05）。绘制PCT鉴别CAP病原菌的ROC曲线,曲线下面积（AUC）为0.783,在临界值为0.95 ng/ml时,其敏感度为0.932,特异度为0.894。结论血清PCT测定有助于CAP病原菌的鉴别诊断,可作为初始选择抗生素治疗的依据。     

B-type natriuretic peptide in predicting the severity of community-acquired pneumonia

BACKGROUND: Although pneumonia severity index(PSI) is widely used to evaluate the severity of community-acquired pneumonia(CAP), the calculation of PSI is very complicated. The present study aimed to evaluate the role of B-type natriuretic peptide(BNP) in predicting the severity of CAP.METHODS: For 202 patients with CAP admitted to the emergency department, BNP levels, cardiac load indexes, inf lammatory indexes including C-reactive protein(CRP), white blood cell count(WBC), and PSI were detected. The correlation between the indexes and PSI was investigated. BNP levels for survivor and non-survivor groups were compared, and a receiver operating characteristic(ROC) curve analysis was performed on the BNP levels versus PSI.RESULTS: The BNP levels increased with CAP severity(r=0.782, P0.001). The BNP levels of the high-risk group(PSI classes IV and V) were signifi cantly higher than those of the low-risk group(PSI classes I–III)(P0.001). The BNP levels were signifi cantly higher in the non-survivor group than in the survivor group(P0.001). In addition, there were positive correlations between BNP levels and PSI scores(r=0.782, P0.001). The BNP level was highly accurate in predicting the severity of CAP(AUC=0.952). The optimal cut-off point of BNP level for distinguishing high-risk patients from low-risk ones was 125.0 pg/m L, with a sensitivity of 0.891 and a specifi city of 0.946. Moreover, BNP level was accurate in predicting mortality(AUC=0.823). Its optimal cut-off point for predicting death was 299.0 pg/m L, with a sensitivity of 0.675 and a specifi city of 0.816. Its negative predictive cut-off value was 0.926, and the positive predictive cut-off value was 0.426.CONCLUSION: BNP level is positively correlated with the severity of CAP, and may be used as a biomarker for evaluating the severity of CAP.     

血清VEGF、pro-ADM水平与老年呼吸机相关性肺炎病情严重程度及预后的关系

目的研究血清血管内皮生长因子(VEGF)、前肾上腺髓质素(pro-ADM)水平对老年呼吸机相关性肺炎(VAP)病情严重程度与预后的关系。方法选择本院2015年7月至2018年7月住院患者中机械通气的时间>2天的410例患者资料,有76例为VAP。按患者病情的严重程度分成低危组(26例)、中危组(30例)及高危组(20例),根据患者的临床结局分成存活组(57例)和死亡组(19例),采取ELISA方法测定各组血清VEGF及pro-ADM的水平,对各组的VEGF和pro-ADM水平差异以及两者之间的相关性进行比较,并评价血清VEGF、pro-ADM水平对VAP病情严重程度与预后的关系。结果VAP组的血清VEGF含量、pro-ADM较非VAP组显著升高(P<0.05);3组间血清的VEGF、pro-ADM水平比较结果:低危组<中危组<高危组,差异有统计学意义(P<0.05)。相关分析示:在VAP组中,患者的血清VEGF含量与pro-ADM含量呈正相关(r=0.864,P=0.000)。ROC曲线的分析显示:血清VEGF曲线下面积(ACU):0.804(95%CI:0.752~0.856),最佳工作点:130.8 pg/mL,此时则判定VAP患者的预后不良特异性为62.90%及敏感度为73.70%;pro-ADM ACU:0.748(95%CI:0.693~0.804),最佳工作点:3.12 nmol/L,此时则判定VAP患者的预后不良特异性为93.70%及敏感度为86.80%。结论在老年呼吸机相关性肺炎患者中,血清VEGF含量与pro-ADM含量呈正相关,VEGF含量越高,pro-ADM含量越高,患者的病情越重,其预后越差,通过联合检测血清VEGF与pro-ADM含量可有效预测老年呼吸机相关肺炎患者病情的严重程度和临床预后,有较高的实用价值。     

Mortality prediction using serum biomarkers and various clinical risk scales in community-acquired pneumonia

We evaluated the predictive value of serum biomarkers and various clinical risk scales for the 28-day mortality of community-acquired pneumonia (CAP). Serum biomarkers including procalcitonin (PCT) and C-reactive protein (CRP) were evaluated in the emergency department. Scores for the pneumonia severity index (PSI); CURB65 (confusion, urea, respiration, blood pressure; age >65?years); Infectious Disease Society of America (IDSA) and American Thoracic Society (ATS) guidelines for severe CAP; Acute Physiology, Chronic Health Evaluation (APACHE) II; Sequential Organ Failure Assessment (SOFA); and quick SOFA (qSOFA) were calculated. Receiver-operating characteristic curves for 28-day mortality were calculated for each predictor using cut-off values, and we applied logistic regression models and area under the curve (AUC) analysis to compare the performance of predictors. Of the 125 enrolled patients, 13 died within 28?days. The AUCs of the PCT and CRP were 0.83 and 0.77, respectively. Using a PCT level >5.6?μg/L as the cut-off, the sensitivity and specificity for mortality were 76.9% and 90.2%, respectively. The three pneumonia severity scales showed an AUC of 0.86 (PSI), 0.87 (IDSA/ATS) and 0.77 (CURB65). The AUCs of the APACHE II, SOFA and qSOFA scores were 0.85, 0.83 and 0.81, respectively. The models combining CRP and/or PCT with PSI or the IDSA/ATS guidelines demonstrated superior performance to those of either PSI or the IDAS/ATS guidelines alone. In conclusion, serum PCT is a reliable single predictor for short-term mortality. Inclusion of CRP and/or PCT could significantly improve the performance of the PSI and IDAS/ATS guidelines.     

The study on pro-adrenomedullin as a new biomarker in sepsis prognosis and risk stratification

OBJECTIVE: To assess the clinical value of pro-adrenomedullin (pro-ADM) in the prognosis and risk stratification in sepsis. METHODS: Fifty-one critically ill patients admitted to the intensive care unit (ICU) were prospectively stratified into four groups according to internationally recognized criteria: systemic inflammatory response syndrome (SIRS, 25 cases), sepsis (12 cases), severe sepsis (9 cases) and septic shock (5 cases). The levels of plasma pro-ADM was determined in every patient using a new sandwich immunoassay, and compared with procalcitonin (PCT), C-reactive protein (CRP) and interleukin-6 (IL-6), and the acute physiology and chronic health evaluation II (APACHEII) score. RESULTS: (1) Median pro-ADM concentration was 0.34 mug/L for SIRS, 2.23 mug/L for sepsis, 4.57 mug/L for severe sepsis and 8.21 mug/L for septic shock. The plasma concentration of pro-ADM exhibited a gradual increase, and the median pro-ADM value was highest in the septic shock group (all P<0.05). (2) Compared with the other biomarkers, in the sepsis, severe sepsis and septic shock groups, the plasma concentration of pro-ADM and APACHEII score in the non-survivors was significantly higher than in the survivors (pro-ADM: 2.01 mug/L vs. 9.75 mug/L, APACHEII score: 23.44 scores vs. 38.21 scores, both P<0.05). (3) By the receiver operating characteristic (ROC) curve plot analysis of pro-ADM in sepsis, the area under the ROC curve for pro-ADM (0.87) in survivors was similar to the area under the ROC curve for PCT (0.81) and APACHEII score (0.81), and was significantly higher than the area under the ROC curve for CRP (0.53) and IL-6 (0.71). CONCLUSION: The measurement of pro-ADM is a new and useful marker in sepsis prognosis and risk strafification.     

社区获得性肺炎病情严重度与降钙素原、C反应蛋白相关性的研究

目的探讨社区获得性肺炎(CAP)患者病情严重度与降钙素原(PCT)、C-反应蛋白(CPR)相关性。方法前瞻性收集2011年10月至2013年2月期间北京友谊医院感染内科、综合科、急诊病房住院的社区获得性肺炎且无肺部基础疾病患者共78例。在入院24小时、入院7天分别进行静脉血CRP和PCT水平检测,应用肺炎严重度指数(PSI)评分进行肺炎病情严重度评估。结果本组CAP患者中,入院第24小时和第7天PSI评分分别为(72.21±27.47)分和(64.58±36.4)分,CRP水平均在正常范围。入院24小时和第7天PCT值[(2.44±0.11)ng/ml和(1.83±0.90)ng/ml]均高于正常范围[(1.56±0.88)ng/ml]。入院24小时和第7天PCT与肺炎严重度指数(PSI)的相关系数r=0.539(P<0.01)和r=0.427(P<0.05),二者呈显著相关;CRP与PSI无相关性。结论 PCT水平与CAP患者的病情严重度存在相关性,CRP与病情严重程度无关。PCT对评估CAP患者的病情严重程度有一定价值。     

血清肾上腺髓质素前体在闭合性小肠破裂患者预后评估中的作用

目的 通过动态监测闭合性小肠破裂患者血清肾上腺髓质素前体(pro-adrenomedullin,pro-ADM)水平,探讨此类患者术前血清pro-ADM水平与术后继发腹腔感染之间的关系;以及术后血清pro-ADM水平对其术后腹腔感染严重程度的评估价值.方法 选取安徽医科大学第二附属医院急诊外科2014年6月至2015年5月收治的85例闭合性小肠破裂患者;并依据患者术后是否发生腹腔感染,分感染组及无感染组;感染组依据其感染严重程度分为SIRS,脓毒症,严重脓毒症,脓毒症休克四组.分别于患者入院时及患者术后第1、3、5天检测血清pro-ADM、白细胞介素-6(IL-6)、C-反应蛋白(CRP)水平并行急性生理学与慢性健康状况评分系统Ⅱ(APACHEⅡ)评分.比较患者入院时各组指标之间的差异性及相关性,并通过对各指标预测患者术后发生腹腔感染进行ROC曲线阈值分析,比较各指标对此类患者术后发生腹腔感染预测价值.并对术后血清pro-ADM水平及APACHEⅡ评分结果进行相关性分析,比较两者对患者术后腹腔感染严重程度的评估价值.结果 入院时及术后感染组血清pro-ADM (P=0.03,P＜0.01)、IL-6 (P =0.02,P＜0.01)水平及APACHEⅡ评分(均P＜0.01)显著高于无感染组(P＜0.05);感染组术后血清pro-ADM水平及APACHEⅡ评分随感染严重程度增加而升高(r=0.924),且各组之间差异具有统计学意义(P＜0.05),而各组IL-6及CRP水平差异无统计学意义.结论 (1)闭合性小肠破裂患者术前血清pro-ADM水平对预测患者术后继发腹腔感染有一定的预测价值.(2)患者术后血清pro-ADM水平对患者术后腹腔感染严重程度有一定的评估作用.