血presepsin对脓毒症诊断及病情判断的临床价值

目的探讨血可溶性白细胞分化抗原14亚型(sCD14-ST,presepsin)水平对脓毒症的诊断和病情判断的意义。方法对脓毒症患者72例、非感染全身炎症反应综合征(SIRS)患者23例、体检健康者20例,进行前瞻性研究。分别检测其入院时血presepsin、血清降钙素原(PCT)、C-反应蛋白(CRP)、乳酸(lactate)水平,WBC计数等,根据患者入院24 h内最差临床指标计算急性生理和慢性健康状况评分Ⅱ(APACHEⅡ),比较各组上述指标的差异。绘制ROC曲线并计算曲线下面积,比较各指标对脓毒症诊断的价值。根据患者病原体培养结果,对脓毒症患者分组,进行临床资料比较。根据疾病严重程度分组,比较各临床指标对脓毒症疾病严重程度的判断价值。结果脓毒症患者presepsin、PCT、CRP、WBC均明显高于健康人对照组及非感染SIRS组(P0.05)。presepsin的ROC曲线下面积(AUCROC)为0.975,以407 pg/mL为临界值,诊断脓毒症的敏感性为98.6%,特异性为90.7%。PCT、CRP、WBC的AUCROC分别为0.881、0.875和0.799。脓毒症革兰阳性菌感染组、革兰阴性菌感染组、细菌合并真菌感染组、真菌感染组的presepsin、PCT、CRP、WBC差异均无统计学意义(P0.05)。脓毒症组、严重脓毒症组和脓毒性休克组presepsin水平逐渐升高,各组间比较有统计学意义(P0.05)。结论 presepsin可作为脓毒症早期诊断的标志物之一,对脓毒症病情严重程度的判断有重要价值。     

降钙素原对老年患者脓毒症的诊断价值

区分感染与非感染因素引起的全身性炎症反应综合征( SIRS)、脓毒症及脓毒性休克对早期诊断、判断患者预后及提高患者生存率非常重要。脓毒症与非感染性SIRS的临床表现相似,但治疗与预后不同。目前常用的脓毒症临床和实验室诊断指标特异性有限,降钙素原( PCT)作为一种全身细菌感染的新指标,与其他临床传统炎症指标相比,显示出较高的特异性与敏感性。本实验的目的是了解PCT对脓毒症的早期诊断价值。表1　两组患者体温、PCT评分及细胞学分析比较( x±s)组别例数(例) PCT评分(分)白细胞(×1 0 9/ L)中性粒细胞分类体温(℃)脓毒症组　　…     

血清降钙素原在早期诊断脓毒症中的临床研究

目的 观察危重病人在脓毒症及全身性炎症反应综合征(SIRS)时血清降钙素原(PCT)水平的变化及临床意义。方法 38例入选患者分为脓毒症组和SIRS组,分别采用BRAHMS快速半定量法(PCT-Q)和免疫比浊法测定血清PCT、C-反应蛋白(CRP)浓度,同时比较两组间最高体温(BT)、白细胞计数(WBC计数)及中性粒细胞分类,评价PCT、CRP、WBC计数及中性粒细胞分类、BT在SIRS患者中对脓毒症的诊断价值。结果 RCT在脓毒症组较SIRS组显著升高(x±s分别是2.72±1.07分和1.55±0.76分,P=0.001),两组间CRP、WBC计数及中性粒细胞分类、BT比较无差异,对脓毒症的诊断价值由高到低分别为PCT、CRP、BT、中性粒细胞分类和白细胞计数(AUC分别是0.80、0.64、0.64、0.61、0.43)。结论 PCT可以作为早期诊断脓毒症的可靠指标,其他传统炎症指标在区分感染性与非感染性SIRS中的意义有限。     

C反应蛋白、降钙素原、中性粒细胞表面CD35和CD64诊断脓毒症的临床价值

目的比较C反应蛋白、降钙素原、中性粒细胞表面CD35和CD64诊断脓毒症的临床价值。方法选取2015年2月到2015年9月于首都医科大学附属北京友谊医院内科住院患者中脓毒症、非感染性全身炎症反应(SIRS)患者及同期随机选择体检中心体检者。抽取患者入院第一天血作为标本,通过流式细胞术测定中性粒细胞表面CD35和CD64;散射比浊法测定C反应蛋白(CRP);免疫色谱检测法测定血清中的降钙素原(PCT)浓度。利用SPSS 22.0统计软件对上述资料进行单因素和多因素分析。结果共入组61例研究对象,其中健康对照组17例,SIRS组15例和脓毒症组29例,CRP、PCT和CD35在SIRS组和脓毒症组差异未达到统计学意义(P=0.193,0.921和0.198);而CD64在SIRS组和脓毒症组差异达到统计学意义(P=0.000);ROC曲线显示CRP、PCT、CD35和CD64曲线下面积分别为0.601,0.509,0.620和0.901。根据ROC曲线计算的CD64区别全身炎症反应综合征(SIRS)组与脓毒症组的诊断界值为130MFI,敏感度为75.9%,特异度93.3%。结论相比于CRP、PCT和CD35,CD64能很好地区分SIRS患者和脓毒症患者。     

脓毒症患者血清急性时相蛋白的变化及其与APACHEⅡ评分和预后的关系

目的探讨脓毒症患者血清急性时相蛋白含量的变化及其与APACHEⅡ评分和预后的关系。方法应用免疫散射比浊法测定入住ICU病房的81例危重病患者第1天血清急性时相蛋白的含量,包括CRP、CER、HPT、AAG、PAB、TRF及ALB。依据SIRS发生与否分为SIRS组和无SIRS组进行分析。另对70例SIRS患者依据感染发生与否分为SIRS感染组(即脓毒症组)和SIRS无感染组进行分析。结果SIRS组患者CRP、AAG的含量明显高于无SIRS组(P<0.01);PAB、TRF的含量明显低于无SIRS组(P<0.01或P<0.05)。脓毒症组患者CRP水平明显高于SIRS无感染组(P<0.01)。危重病患者7项急性时相蛋白中只有CRP水平与APACHEⅡ评分存在相关性(r=0.253,P<0.05)。经Logistic回归分析结果显示,只有CRP水平与预后明显相关。结论CRP的检测在脓毒症的诊断及疾病严重程度与预后的评估中具有可靠的应用价值。     

高迁移率蛋白-1在全身炎症反应综合征患者中的价值分析

目的 观察全身炎症反应综合征(SIRS)患者血清高迁移率蛋白-1(HMGB1)在疾病不同程度分组中的差别及与感染存在的相关性.方法 符合SIRS诊断标准的病人60例,入院后做可疑感染分泌物和排泄物等细菌培养,同时肘静脉穿刺取血进行HMGB1测定和APACHE-Ⅱ评分.根据疾病严重程度分为三组:轻度SIRS组,重度SIRS组和休克组,再根据细菌培养结果分为脓毒症组和非脓毒症组,并设对照组.结果 轻度SIRS组,重度SIRS组,休克组HMGB1含量与对照组之间的差异具有统计学意义(P<0.01);重度SIRS组和休克组HMGB1含量与轻度SIRS组之间的差异具有统计学意义(P<0.01);而重度SIRS组和休克组之间的差异无统计学意义(P>0.05).APACHE-Ⅱ评分在三组之间的差异均具有统计学意义(P<0.01).脓毒症组和非脓毒症组抵抗素含量之间的差异具有统计学意义(P<0.01),两组与对照组之间的差异均具有统计学意义(P<0.01).结论 HMGB1可作为判断SIRS患者疾病的严重程度和预后指标,也可作为区分脓毒症和非脓毒症SIRS的参考指标.     

全身炎症反应综合征患者血浆E-选择素变化及意义

目的观察全身炎症反应综合征(SIRS)患者血浆中可溶性E-选择素(sE-selectin)在疾病不同程度分组中的差别及与感染存在的相关性.方法符合SIBS诊断标准的病人60例,入院后做可疑感染分泌物、排泄物等细菌培养,同时肘静脉穿刺取血进行可溶性E-选择素定量测定和APACHE-Ⅱ评分.根据疾病严重程度分为三组轻度SIRS组、重度SIRS组和休克组.再根据细菌培养结果分为脓毒症组和非脓毒症组.并设对照组.结果轻度SIRS组、重度SIRS组、休克组可溶性E-选择素含量与对照组比较有显著差异(P＜0.01);重度SIRS组和休克组可溶性E-选择素含量与轻度SIRS组比较有显著差异(P＜0.01);而重度SIRS组和休克组无明显差异(P＞0.05).APACHE-Ⅱ评分在三组的组间比较中均有显著差异.脓毒症组和非脓毒症组可溶性E-选择素含量比较有显著性差异(P＜0.01),两组与对照组比较均有显著差异(P＜0.01).结论可溶性E-选择素可作为判断SIRS患者疾病的严重程度和预后指标,也可作为区分脓毒症和非脓毒症SIRS的参考指标.     

可溶性髓细胞触发受体-1在脓毒症诊断及病情判断的价值

目的 通过检测人血浆可溶性髓细胞触发受体-1(sTREM-1)水平,研究sTREM-1对脓毒症的诊断价值和在评估脓毒症严重程度及预后的意义.方法 将2010-05～2011-01收治的64例系统性炎症反应综合征(SIRS)患者,根据脓毒症诊断标准分为脓毒症组43例(脓毒症17例、严重脓毒症14例和脓毒性休克12例)、SIRS组(非感染)21例,根据28 d预后将脓毒症组分为存活组29例和死亡组14例.收集所有患者第1天的血浆,追踪留取脓毒症患者第1、4、7天的血浆,并记录对应时间的心率、白细胞计数、C反应蛋白(CRP)等临床数据.结果.患者入ICU第1天脓毒症组sTREM-1高于SIRS组[(147.28±58.32 pg/mL]比(81.61±24.57 pg/mL,P<0.05)];sTREM-1的受试者特征操作曲线下面积高于降钙素原(PCT)、CRP、IPS评分;sTREM-1水平变化与APACHEⅡ评分变化呈正相关(rs=0.446,P=0.000).sTREM-1水平在存活组则呈逐渐下降趋势,在死亡组随时间推移无明显变化趋势,死亡组sTREM-1于病程第4天起高于存活组同期对应指标(P＜0.05).结论.检测血浆sTREM-1可作为脓毒症早期诊断的指标,在诊断上具有良好的敏感性和特异性,诊断价值优于PCT、CRP及IPS评分等指标;动态监测检测血浆sTREM-1能反映疾病的严重程度及预后.     

血浆降钙素原在脓毒症早期的诊断价值

目的 评价血浆降钙素原(PCT)在脓毒症早期的诊断价值.方法 分别对24例脓毒症及27例非脓毒症全身炎症反应综合征( SIRS)患者的PCT动态监测,比较两组PCT水平.结果 入院8小时内两组患者PCT水平无显著性差异(P＞0.05),24小时后,脓毒症组PCT水平明显高于非脓毒症SIRS组(P＜0.05).以PCT值2μg/L为临界值,诊断早期脓毒症的敏感性为75％,特异性为85.2％,准确性为80.4％.结论 PCT可以作为脓毒症早期诊断的指标之一,具有良好的敏感性、特异性及准确性.     

血小板计数及动态变化在创伤患者SIRS中的意义

目的:研究血小板在危重创伤患者全身炎症反应监测中的意义,为全身炎症反应综合征(SIRS)提供敏感而简易的临床检测方法。方法:对入住ICU的创伤患者326例,按有无发生SIRS分为非SIRS组(n=159)和SIRS组(n=167);SIRS组病例按临床结局分为死亡组(n=45)和存活组(n=122)。入院后当天和第3天、5天、7天、10天进行血小板计数、急性生理学和慢性健康状况评分(APACHEⅡ)、肿瘤坏死因子(TNF-α)检测。结果:创伤后当天非SIRS组和SIRS组血小板计数均低于正常范围,但差异无显著性;治疗后第5天、7天、10天非SIRS组呈上升趋势,而SIRS组呈下降趋势(P<0.01)。死亡组和存活组病例中:APACHEⅡ评分创伤当天显著升高,但差异无显著性,治疗第5天、7天、10天时存活组呈下降趋势,死亡组呈上升趋势(P<0.01);血小板计数在入院时均下降,治疗3天后均上升致正常范围,但在第5天、7天、10天存活组血小板计数呈上升趋势,而死亡组呈下降趋势(P<0.01);入院时两组患者血中TNF-α的浓度差异无显著性,治疗5d、7d、10d后存活组显著下降,而死亡组仍维持在高水平(P<0.0...     

降钙素原对脓毒症的早期诊断价值

目的　评价血清降钙素原 (PCT)在脓毒症 (Sepsis)病人早期诊断和治疗中的意义。方法　对重症监护病房 (ICU )内 160例危重病人进行前瞻性研究 ,按照全身炎症反应综合症 (SIRS)的定义 (ACCP/SCCM ) ,将病人分为四组 :对照组2 0例、SIRS组 5 0例、血培养阴性脓毒症组 46例、血培养阳性脓毒症组 44例。在入院第 1天记录每例病人的急性生理与慢性健康评分 (APACHE Ⅱscore)、临床和生理指标及血清PCT和C 反应蛋白 (CRP)浓度。结果　血清PCT浓度在脓毒症组与非脓毒症组之间存在显著性差异 (P <0 .0 0 0 1) ,在血培养阳性脓毒症组与血培养阴性脓毒症组之间亦存在显著性差异 (P <0 .0 5 )。而在对照组与SIRS组之间无显著性差异 (P >0 .5 )。血清PCT >2 .0ng/ml即可诊断脓毒症 ,其灵敏度和特异性分别为 93 .3 %和 10 0 % ,血清PCT >10ng/ml即可诊断菌血症 ,其灵敏度和特异性分别为 88.9%和85 .6%。结论　PCT是诊断脓毒症的一个新的主要指标之一。对ICU危重病人常规检测PCT有助于脓毒症的早期诊断和合理治疗。     

Clinical laboratory differentiation of infectious versus non-infectious systemic inflammatory response syndrome

OBJECTIVE: To evaluate the accuracy of C-reactive protein (CRP), procalcitonin (PCT), neopterin, and endotoxin in the differential diagnosis of sepsis and non-infectious systemic inflammatory response syndrome (SIRS). METHODS: A Medline database and references from identified articles were used to perform a literature search relating to the differential diagnosis of sepsis versus non-infectious SIRS. RESULTS: CRP, PCT, and neopterin are released both in sepsis and in non-infectious inflammatory disease. CRP and PCT are equally effective, although not perfect, in differentiating between sepsis and non-infectious SIRS. However, CRP and PCT have different kinetics and profiles. The kinetics of CRP is slower than that of PCT, and CRP levels may not further increase during more severe stages of sepsis. On the contrary, PCT rises in proportion to the severity of sepsis and reaches its highest levels in septic shock. PCT tends to be higher in nonsurvivor than in survivor. Therefore, PCT demonstrated a closer correlation with the severity of sepsis and outcome than CRP. Unlike CRP and PCT, neopterin is increased in viral infection as well as bacterial infection, and neopterin is also a useful indicator of sepsis. Endotoxemia was detected in no more than half of patients with Gram-negative bacteremia, and Gram-negative bacteremia was detected in half of patients with endotoxemia. CONCLUSIONS: The diagnostic capacity of PCT is superior to that of CRP due to the close correlation between PCT levels and the severity of sepsis and outcome. Neopterin is very useful in the diagnosis of viral infection. The endotoxin assay in combination with CRP, PCT, or neopterin may help as a diagnostic marker for Gram-negative bacterial infection.     

血清降钙素原和常用炎症指标结合SOFA评分对脓毒症早期诊断和预后价值的评价

目的 结合感染相关器官功能衰竭评分(SOFA)评价血清降钙素原(PCT)和临床常用炎症指标对脓毒症的早期诊断和预后价值.方法 采用前瞻性、临床病例观察及诊断试验研究.根据美国胸科医师协会/危重病医学会(ACCP/SCCM)共识会议,严格将入选病例分为全身炎症反应综合征(SIRS)组、脓毒症组、严重脓毒症组、脓毒性休克组、非SIRS对照组.测定24 h内的炎症指标、SOFA评分及PCT浓度并进行相关分析.结果 208例患者入选,其中对照组59例,SIRS组57例,脓毒症组52例,严重脓毒症组28例,脓毒性休克组12例.血清PCT浓度与脓毒症严重程度呈正相关,Spearman相关系数为0.909(P=0.000).根据受试者工作特征曲线(ROC曲线)分析,PCT的ROC曲线下面积(AUC)为0.936±0.020,SOFA评分的AUC为0.973±0.011(P均=0.000).判断最佳诊断界值PCT为＞0.375 μg/L,SOFA评分为＞3.5分,其约登(Youden)指数分别为0.808和0.801.二分类Logistic回归分析显示,在排除了年龄、CRP混杂因素后PCT和SOFA评分与脓毒症发病明显相关,相对危险度(OR值)分别为84.794和10.761(P均=0.000),并且可以预测脓毒症的发病概率.SOFA评分是脓毒症疾病预后的最显著因子,OR值为2.084(P=0.000 2).结论 传统炎症指标和C-反应蛋白(CRP)是鉴别SIRS和非SIRS的有用指标,但不是早期诊断脓毒症的可靠指标.PCT是早期诊断脓毒症并能与SIRS鉴别的特异性较高的炎症指标;结合SOFA评分和PCT可以预测脓度症的发病概率;根据PCT值的变化,再结合SOFA评分可以客观判断脓毒症病情的严重性.SOFA评分与脓毒症预后明显相关.     

Prognostic and diagnostic value of eosinopenia,C-reactive protein,procalcitonin, and circulating cell-free DNA in critically ill patients admitted with suspicion of sepsis

Introduction

The aims of this study were to assess the reliability of circulating cell-free DNA (cf-DNA) concentrations, compared with C-reactive protein (CRP), procalcitonin (PCT) and eosinophil count, in the diagnosis of infections in patients with systemic inflammatory response syndrome (SIRS) and their prognostic values in a cohort of critically ill patients.

Methods

We conducted a prospective cohort study in a medical-surgical intensive care unit of a university hospital. Eosinophil count and concentrations of cf-DNA, CRP, and PCT were measured in patients who fulfilled SIRS criteria at admission to the intensive care unit (ICU) and a second determination 24 hours later. DNA levels were determined by a PCR method using primers for the human beta-haemoglobin gene.

Results

One hundred and sixty consecutive patients were included: 43 SIRS without sepsis and 117 with sepsis. Levels of CRP and PCT, but not cf-DNA or eosinophil count, were significantly higher in patients with sepsis than in SIRS-no sepsis group on days 1 and 2. PCT on day 1 achieves the best area under the curve (AUC) for sepsis diagnosis (0.87; 95% confidence interval = 0.81-0.94). Levels of cf-DNA do not predict outcome and the accuracy of these biomarkers for mortality prediction was lower than that shown by APACHE II score. PCT decreases significantly from day 1 to day 2 in survivors in the entire cohort and in patients with sepsis without significant changes in the other biomarkers.

Conclusions

Our data do not support the clinical utility of cf-DNA measurement in critical care patients with SIRS. PCT is of value especially for infection identification in patients with SIRS at admission to the ICU.     

Soluble triggering receptor expressed on myeloid cells 1 and the diagnosis of sepsis

Purpose

Early diagnosis and assessment of the systemic inflammatory response to infection are difficult with usual markers (fever, leukocytosis, C-reactive protein [CRP]). Triggering receptor expressed on myeloid cells-1 (TREM-1) expression on phagocytes is up-regulated by microbial products. We studied the ability of soluble TREM-1 (sTREM-1) to identify patients with sepsis.

Materials and Methods

Plasma samples were obtained on intensive care unit admission from patients with systemic inflammatory response syndrome for sTREM-1 measurement.

Results

Soluble TREM-1, CRP concentrations and erythrocyte sedimentation rate (ESR) were higher in the sepsis group (n = 52) than in the non-infectious systemic inflammatory response syndrome group (n = 43; P = .00, .02, and .001, respectively). Soluble TREM-1, CRP concentrations, white blood cell count and ESR were higher in the sepsis group than in the non SIRS group (n = 37; P = .04, .00, .01, and .00, respectively).In a receiver-operating characteristic curve analysis, ESR, CRP and sTREM-1 had an area under the curve larger than 0.65 (P = .00), in distinguishing between septic and non-infectious SIRS patients. CRP, ESR, sTREM-1 had a sensitivity of 60%, 70% and 70% and a specificity of 60%, 69% and, 60% respectively in diagnosing infection in SIRS.

Conclusion

C-reactive protein and ESR performed better than sTREM-1 and white blood cell count in diagnosing infection.     

可溶性髓样细胞触发受体-1对脓毒血症早期诊断价值

目的探讨可溶性髓样细胞触发受体-1(soluble triggering receptor expressed on myeloid cells-1,sTREM-1)对脓毒血症的早期诊断价值。方法 81例全身炎症反应综合征患者,根据脓毒血症诊断标准分为脓毒血症组35例与SIRS组46例,选择体检健康者30名为对照组,检测3组血清sTREM-1、降钙素原(procalcitonin,PCT)、C反应蛋白(C reactive protein,CRP)水平。结果脓毒血症组与SIRS组患者血清sTREM-1,PCT及CRP水平均高于对照组(P<0.05);脓毒血症组血清sTREM-1与PCT水平高于SIRS组(P<0.05),CRP水平与SIRS组比较差异无统计学意义(P>0.05)。结论血清sTREM-1是脓毒血症早期诊断的辅助指标,其灵敏度和特异性高于PCT和CRP。     

中性粒细胞CD64与C反应蛋白对烧伤脓毒症的诊断价值

目的探讨联合检测血清中性粒细胞CD64与c反应蛋白（CRP）对烧伤脓毒症患者的早期诊断价值。方法采用前瞻性研究,选择烧伤住院患者76例,依据烧伤脓毒症诊断标准分为脓毒症组27例,局部感染组31例,非细菌感染对照组18例,入院后24-48h内均以流式细胞术检测外周静脉血中性粒细胞CD64,蛋白分析仪检测CRP,五分类血液分析仪检测外周血白细胞计数（WBC）、中性粒细胞比率（N）,并进行微生物培养,脓毒症组经常规抗感染治疗7d和14d后复查各指标。结果脓毒症组CD64及CRP均高于局部感染组和对照组（P〈0．01）,局部感染组CD64和CRP均高于对照组（P〈0．01）,CD64与CRP呈正相关;脓毒症组治疗7d后CD64和CRP下降,但与治疗前相比差异无统计学意义;治疗14d后CD64和CRP下降明显,与治疗前相比差异有统计学意义,但仍然高于对照组（P〈0．01）。检测CD64联合CRP、CD64、CRP、WBC、N、ROC曲线下面积分别为0．952、0．923、0．904、0．756、0．728。结论中性粒细胞CD64对烧伤脓毒症有良好的早期诊断价值,其表达在革兰阳性菌和革兰阴性菌中无明显差异,联合检测CD64与CRP可以提高诊断率。     

Procalcitonin: a valuable indicator of infection in a medical ICU?

OBJECTIVE: To assess the use of procalcitonin (PCT) for the diagnosis of infection in a medical ICU. DESIGN: Prospective, observational study. PATIENTS: Seventy-seven infected patients and 24 patients with systemic inflammatory response syndrome (SIRS) due to other causes. Seventy-five patients could be classified into sepsis (n = 24), severe sepsis (n = 27) and septic shock (n = 24), and 20 SIRS patients remained free from infection during the study. Plasma PCT and C-reactive protein (CRP) levels were evaluated within 48 h of admission (day 0), at day 2 and day 4. RESULTS: As compared with SIRS, PCT and CRP levels at day 0 were higher in infected patients, regardless of the severity of sepsis (25.2 +/- 54.2 ng/ml vs 4.8 +/- 8.7 ng/ml; 159 +/- 92 mg/l vs 71 +/- 58 mg/l, respectively). At cut-off values of 2 ng/ml (PCT) and 100 mg/l (CRP), sensitivity and specificity were 65% and 70% (PCT), 74% and 74% (CRP). PCT and CRP levels were significantly more elevated in septic shock (38.5 +/- 59.1 ng/ml and 173 +/- 98 mg/l) than in SIRS (3.8 +/- 6.9 ng/ml and 70 +/- 48 mg/l), sepsis (1.3 +/- 2.7 ng/ml and 98 +/- 76 mg/l) and severe sepsis (9.1 +/- 18. 2 ng/ml and 145 +/- 70 mg/l) (all p = 0.005). CRP, but not PCT, levels were more elevated in severe sepsis than in SIRS (p<0.0001). Higher PCT levels in the patients with four dysfunctional organs and higher PCT and CRP levels in nonsurvivors may only reflect the marked inflammatory response to septic shock. CONCLUSION: In this study, PCT and CRP had poor sensitivity and specificity for the diagnosis of infection. PCT did not clearly discriminate SIRS from sepsis or severe sepsis.     

前降钙素检测在新生儿感染性疾病诊断中的临床应用探讨

目的探讨血清前降钙素(PCT)在新生儿感染性疾病的临床应用价值。方法新生儿败血症组60例,局部感染组56例,非感染组60例,入院时进行PCT、C反应蛋白(CRP)和外周血白细胞计数(WBC)检查,其中败血症组和局部感染组在抗感染治疗一周后复查PTC,并将结果进行分析。结果入院时败血症组的血PTC和CRP的平均值明显高于局部感染组和非感染组,差异均有统计学意义(P<0.01)。入院时局部感染组血PTC和CRP的平均值明显高于非感染组,差异有统计学意义(P<0.01)。败血症组外周血WBC与局部感染组和非感染组比较,差异无统计学意义(P>0.05)。局部感染组WBC和非感染组比较,差异无统计学意义(P>0.05)。PCT检测以2.5μg/L为临界点,对败血症的诊断敏感度是76.67%,特异度是80.17%;对所有感染的敏感度是54.31%,特异度是90.00%。CRP检测以8 mg/L为临界点,对败血症诊断的敏感度是55.00%,特异度是74.14%;对所有感染的敏感度是44.83%,特异度是81.67%。此外,败血症组和局部感染组在抗感染治疗一周后PTC都有明显下降,差异均有统计学意义(P<0.01)。结论与CRP比较,PTC诊断败血症和所有感染的敏感度和特异度均更高。PCT可作为新生儿细菌感染的检测指标,特别是对新生儿败血症的早期诊断、治疗、疗效评价和预后判定很有意义。     

Diagnostic accuracy of presepsin (soluble CD14 subtype) for prediction of bacteremia in patients with systemic inflammatory response syndrome in the Emergency Department

BackgroundBacteremia is indicative of severe bacterial infection with significant mortality. Its early diagnosis is extremely important for implementation of antimicrobial therapy but a diagnostic challenge. Although blood culture is the “gold standard” for diagnosis of bacteremia this method has limited usefulness for the early detection of blood-stream infection. In this study we assessed the presepsin as predictor of bacteremia in patients with systemic inflammatory response syndrome (SIRS) on admission to the Emergency Department and compare it with current available infection biomarkers.MethodsA total of 226 patients admitted to the Emergency Department with SIRS were included. In 37 patients blood culture had a positive result (bacteremic SIRS group) and 189 had a negative blood culture result (non-bacteremic SIRS group). Simultaneously with blood culture, presepsin, procalcitonin (PCT) and C-reactive protein (CRP) were measured. Receiver operating characteristic (ROC) curve analysis was performed for each biomarker as predictor of bacteremia.ResultsPresepsin values were significantly higher in bacteremic SIRS group when compared with non-bacteremic SIRS group. ROC curve analysis and area under curve (AUC) revealed a value of 0.750 for presepsin in differentiating SIRS patients with bacteremia from those without, similar than that for PCT (0.787) and higher than that for CRP (0.602). The best cut-off value for presepsin was 729 pg/mL, which was associated with a negative predictive value of 94.4%.ConclusionPresepsin may contribute to rule out the diagnosis of bacteremia in SIRS patients admitted to the Emergency Department.