血清降钙素原对脓毒症早期诊断价值及预后意义

目的 探讨血清降钙素原(PCT)对脓毒症早期诊断价值及预后意义.方法 将2008年12月至2009年4月收治的67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50例、SIRS组(非细菌性)17例,同时收集非SIRS患者23例作为对照组,根据28 d预后将脓毒症组分为生存组和死亡组两个亚组.于入院第1天、第4天晨时取血,动态观察PCT、C反应蛋白(CRP)、红细胞沉降率(ESR)、白细胞(WBC)、中性粒细胞百分率(N)等炎性指标变化,同时记录当日最高体温.结果 脓毒症组患者入院第1天血清PeT高于SIRS组及对照组[6.68μg/L(1.16~12.46μg/L)比0.22μg/L(0.05～0.54μg/L)比0.05 μg/L(0.05~0.27 μg/L),P<0.05];死亡组15例患者血清PCT高于生存组35例患者[11.89μg/L(10.00~28.67μg/L)比2.44μg/L(1.11~10.00μg/L),P<0.05];脓毒症组患者血清PCT与急性生理和慢性健康状况(APACHE)Ⅱ评分呈正相关(r=0.511,P=0.000);PCT的受试者特征操作曲线下面积高于CRP、WBC、N、ESR;生存组血清PCT呈下降趋势直至正常,死亡组无明显下降趋势.结论 血清PCT是脓毒症早期诊断的一个较好指标,其灵敏度和特异度高于其他炎性指标,与疾病严重程度相关,能够反映疾病预后.

The early diagnostic value and prognostic significance of serum procalcitonin in patients with sepsis

Objective To investigate the early diagnostic value and prognostic significance of serum procalcitonin (PCT) in patients with sepsis. Methods Ninety cases between December 2008 and April 2009 were collected. According to the 1991 ACCP/SCCM and 2001 SCCM/ESICM/ACCP/ATS/SIS sepsis diagnosis criteria,they were divided into sepsis group (50 cases), nonbacterial systemic inflammation syndrome group (SIRS group, 17 cases) and control group (23 cases). Sepsis group was divided into two subgroups (survival group and death group) according to 28-day prognosis Dynamic changes of serum PCT, C-reactive protein (CRP), erythrocyte sedimentation rate (ESR), white blood cell (WBC), and neutrophil count percentage (N) on the 1st, 4th day after admission was monitored,meanwhile, the maximal body temperature was recorded. Results The serum PCT level of sepsis group on the 1st day was higher than that in SIRS group and control group,and the difference was statistically significant [6.68 μg/L(1.16-12.46 μg/L) vs 0.22 μg/L(0.05-0.54 μg/L) vs 0.05 μg/L(0.05-0.27 μg/L), P < 0.05]. The serum PCT level of death group was higher than that in survival group,and the difference was statistically significant[11.89μg/L (10.00-28.67 μg/L) vs 2.44 μg/L(1.11-10.00 μg/L),P<0.05]. In sepsis group,serum PCT was positively correlated with APACHE Ⅱ score(r = 0.511, P = 0.000). The area under the ROC curve of PCT was bigger than that of CRP,WBC,N and ESR. The serum PCT level of survival group gradually decreased to normal level after the therapy,but the serum PCT level of death group didn't decrease significantly. Conclusions Serum PCT is a better biomarker in the early diagnosis of sepsis,and its sensitivity and specificity is superior to other inflammation parameters. It positively correlates with the severity of sepsis and can predict the prognosis.