血清降钙素原和白细胞介素6检测在感染和非感染性全身性炎症反应鉴别诊断中的作用

目的　评价降钙素原 (PCT)和白细胞介素 6 (IL 6)对感染和非感染引起的全身炎症反应综合征 (SIRS)的鉴别作用。方法　共有 2 0例感染性全身性SIRS及 31例非感染性SIRS患者入选。患者临床出现炎症表现 2 4h内测定血清PCT、IL 6和C反应蛋白 (CRP)水平。同时记录白细胞计数 ,中性粒细胞比例 ,中性粒细胞绝对计数和最高体温。结果　全身性感染患者血清PCT3 6(1 8,2 7 5)μg/L]、IL 6 (81 0ng/L± 51 6ng/L)、CRP(1 80g/L± 1 0 8g/L)水平及最高体温 (38 6± 1 2℃ )明显高于SIRS患者 0 5(0 2 ,1 8) μg/L ,2 35ng/L± 1 77ng/L ,1 0 9g/L± 70g/L ,37 9± 0 9℃ ]。所有炎症指标中 ,IL 6和PCT的敏感性 (≥ 80 % )和特异性 (>70 % )最高。由IL 6和PCT构成的感染评分对全身性感染的辨别力最佳 (受试者工作特征曲线下面积为 0 92 3)。结论　与传统炎症指标相比 ,IL 6和PCT有助于鉴别全身性感染和SIRS。

Serum procalcitonin and interleukin-6 help differentiate between severe sepsis and systemic inflammatory response syndrome of non-infectious origin

OBJECTIVE: To evaluate the efficacy of serun procalcitonin (PCT) and interleukin (IL)-6 in differentiating between severe sepsis and systemic inflammatory response (SIRS) of non-infectious origin. METHOD: The serum PCT, IL-6, C-reactive protein (CRP), white blod cell count, percentage of neutrophils, and absolute neutrophil count were determined, and maximal body temperature was recorded among 21 patients was 3.6 (1.8, 27.5) micro g/L, significantly higher than that in SIRS patients (1.3 micro g/L +/- 1.6 micro g/L, P < 0.05). The IL-6 in sepsis patients was 810 ng/L +/- 516 ng/L, significantly higher than that in SIRS patients (235 ng/L +/- 177 ng/L, P < 0.01). However, the differences of CRP, WBC count, percentage of neutrophil, and absolute neutrophil count between the severe sepsis patients and SIRS patients were not statistically significant. PCT and IL-6 showed sensitivity equal or over 80% and specificity equal to or over 70%. The infection score based on PCT and IL-6 showed the best discriminative power to differentiate between severe sepsis and SIRS with the artea under the receiver operating characteristic curve of 0.923. CONCLUSION: In comparison with the conventional inflammatory markers, PCT and IL-6 are more reliable indicators to differentiate between sepsis and SIRS.