Procalcitonin as a diagnostic marker and IL-6 as a prognostic marker for sepsis

The diagnosis and prognosis of sepsis after antimicrobial therapy among systemic inflammatory response syndrome (SIRS) patients were evaluated with the biomarkers procalcitonin (PCT), interleukin-6 (IL-6), C-reactive protein (CRP), erythrocyte sedimentation rate, and white blood cell counts.     

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.     

Lipopolysaccharide-binding protein in critically ill neonates and children with suspected infection: comparison with procalcitonin,interleukin-6, and C-reactive protein

Objective To evaluate markers of infection in critically ill neonates and children, comparing lipopolysaccharide-binding protein (LBP) with procalcitonin (PCT), interleukin-6 (IL-6), and C-reactive protein (CRP).Design and setting Prospective, observational study in the level III multidisciplinary neonatal and pediatric intensive care unit.Patients Sixty patients with systemic inflammatory response syndrome (SIRS) and suspected infection classified into two groups: SIRS/sepsis (n=33) and SIRS/no sepsis (n=27). We included 29 neonates aged less than 48 h (neonates <48 h), 12 neonates older than 48 h (neonates >48 h), and 19 children. Median disease severity was high in neonates aged under 48 h and moderate in neonates aged over 48 h and children.Interventions Serum LBP, PCT, IL-6, and CRP were measured on two consecutive days. Area under the receiver operating characteristic (ROC) curve (AUC), sensitivity, specificity, and predictive values were evaluated.Results Serum LBP was higher in patients with SIRS/sepsis than in patients with SIRS/no sepsis. AUC for LBP on the first day of suspected infection was 0.89 in the younger neonates, 0.93 in the older neonates, and 0.91 in children.Conclusions In critically ill neonates aged under 48 h LBP on the first day of suspected infection is a better marker of sepsis than IL-6 and PCT, and is similar to CRP. In critically ill neonates aged over 48 h and children LBP is a better marker than IL-6 and CRP, and is similar to PCT.     

Lipopolysaccharide binding protein in acute pancreatitis

OBJECTIVE: To assess the expression of plasma lipopolysaccharide binding protein (LBP) concentrations and its relationship to markers of the systemic inflammatory response syndrome during acute pancreatitis. DESIGN: A prospective study. SETTING: General surgical units of university teaching hospitals in the Belfast area. PATIENTS: The study included 18 patients admitted with established diagnosis of acute pancreatitis on the basis of elevated serum amylase or by contrast radiology. Patients were retrospectively stratified using the Modified Glasgow Criteria into severe (n = 7) and mild (n = 11) disease. INTERVENTIONS AND MEASUREMENTS: Blood samples were obtained at admission (day 1) and for a further 3 days for the measurement of LBP, C-reactive protein (CRP), tumor necrosis factor, and interleukin (IL)-6. Acute Physiology and Chronic Health Evaluation (APACHE) II scores were calculated on day 1 and day 2. MAIN RESULTS: LBP and CRP concentrations were significantly increased from healthy control values in acute pancreatitis patients at presentation. In the mild group LBP, CRP and IL-6 concentrations remained relatively constant throughout the study period. By comparison, severe acute pancreatitis was associated with significantly higher LBP concentrations and a marked systemic inflammatory response as evidenced by increased CRP, IL-6, and APACHE II scores. The rise in LBP occurred after the observed increase of these markers. Significant correlations were found among CRP and LBP, IL-6 and LBP, and IL-6 and APACHE II scores. There were no fatalities in the mild group, whereas four of the seven patients with severe disease died. CONCLUSIONS: LBP was significantly raised in patients with severe acute pancreatitis but would seem to be of limited use in predicting disease severity. This acute phase protein may have a role in the progression of systemic complications associated with acute pancreatitis.     

Systemic inflammatory response syndrome and surgical stress in thoracic surgery

PURPOSE: To evaluate the clinical usefulness of postoperative systemic inflammatory response syndrome (SIRS) as an index of surgical stress in patients undergoing thoracic surgery. METHODS: Forty-five consecutive patients who underwent thoracic surgery with thoracotomy were enrolled. The SIRS criteria were examined daily during the first 7 postoperative days. The serum interleukin-6 (IL-6) level, operation time, intraoperative blood loss, amount of thoracic drainage, and C-reactive protein levels were also measured. RESULTS: Sixteen cases were categorized into the SIRS group, whereas 29 cases were categorized into the non-SIRS group. Among the patients who underwent thoracic surgery, the physiological responses of the patients to the surgery, such as serum IL-6 levels and C-reactive protein levels, were significantly higher in the SIRS group than in the non-SIRS group (P = .002 and .024, respectively). The serum IL-6 level on the first postoperative day was an independent factor associated with SIRS (95% CI 1.002-1.041; P = .030). Furthermore, there was a correlation between the number of SIRS days and the duration of the postoperative hospital stay (r = 0.379, P = .012). CONCLUSIONS: Our results demonstrated that SIRS reflected the degree of surgical stress, especially thoracotomic procedures, through the IL-6 levels, and affected the postoperative hospital stay. Systemic inflammatory response syndrome can be useful for the postoperative management of patients undergoing thoracic surgery.     

Discrimination of sepsis and systemic inflammatory response syndrome by determination of circulating plasma concentrations of procalcitonin, protein complement 3a, and interleukin-6

OBJECTIVE: To evaluate whether plasma concentrations of procalcitonin (PCT), interleukin-6 (IL-6), protein complement 3a (C3a), leukocyte elastase (elastase), and the C-reactive protein (CRP) determined directly after the clinical onset of sepsis or systemic inflammatory response syndrome (SIRS) discriminate between patients suffering from sepsis or SIRS and predict the outcome of these patients. DESIGN: Prospective study. SETTING: Medical intensive care unit at a university hospital. PATIENTS: Twenty-two patients with sepsis and 11 patients with SIRS. MEASUREMENTS AND MAIN RESULTS: The plasma concentrations of PCT, C3a, and IL-6 obtained < or =8 hrs after clinical onset of sepsis or SIRS but not those of elastase or CRP were significantly higher in septic patients (PCT: median, 16.8 ng/mL, range, 0.9-351.2 ng/mL, p = .003; C3a: median, 807 ng/mL, range, 422-4788 ng/mL, p < .001; IL-6: median, 382 pg/mL, range, 5-1004 pg/mL, p = .009, all Mann-Whitney rank sum test) compared with patients suffering from SIRS (PCT: median, 3.0 ng/mL, range, 0.7-29.5 ng/mL; C3a: median, 409 ng/mL, range, 279566 ng/mL; IL-6: median, 98 pg/mL, range, 23-586 pg/mL). The power of PCT, C3a, and IL-6 to discriminate between septic and SIRS patients was determined in a receiver operating characteristic analysis. C3a was the best variable to differentiate between both populations with a maximal sensitivity of 86% and a specificity of 80%. An even better discrimination (i.e., a maximal sensitivity of 91% and a specificity of 80%) was achieved when PCT and C3a were combined in a "sepsis score." C3a concentrations also helped to predict the outcome of patients. Based on the sepsis score, a logistic regression model was developed that allows a convenient and reliable determination of the probability of an individual patient to suffer from sepsis or SIRS. CONCLUSIONS: Our data show that the determination of PCT, IL-6, and C3a is more reliable to differentiate between septic and SIRS patients than the variables CRP and elastase, routinely used at the intensive care unit. The determination of PCT and C3a plasma concentrations appears to be helpful for an early assessment of septic and SIRS patients in intensive care.     

全身炎性反应综合征患者血清C反应蛋白、白细胞介素6和D-二聚体的变化

目的探讨神经科并发全身炎性反应综合征(SIRS)的危重症患者血清C-反应蛋白(CRP)、白细胞介素-6(IL-6)和D-二聚体(D-Di)水平变化及其与多器官功能障碍综合征(MODS)和病死率的关系。方法将120例神经科危重症患者根据是否并发SIRS分为SIRS组(48例)和非SIRS组(72例),分别于发病24 h内及3 d、7 d晨起空腹抽取静脉血5 mL,测定血清CRP、IL-6、D-Di水平,并观察两组患者的MODS发生率和病死率。结果发病24 h内、3 d、7 d不同时间血清CRP,非SIRS组内比较差异无统计学意义(P0.05),但SIRS组内比较差异有统计学意义(P0.05);各时间点SIRS组血清CRP水平明显高于非SIRS组(P0.01)。SIRS组发病24 h内、3 d、7 d时血清IL-6明显高于非SIRS组(P0.05)。非SIRS组发病24 h内、3 d、7 d不同时间D-Di水平比较差异无统计学意义(P0.05),SIRS组内比较差异有统计学意义(P0.05);各时间点SIRS组D-Di水平明显高于非SIRS组(P0.01)。SIRS组MODS发生率明显高于非SIRS组(χ2=5.042,P0.05),SIRS组病死率明显高于非SIRS组(χ2=7.879,P0.05)。结论血清CRP、IL-6及D-Di可作为预测MODS的早期指标。     

严重创伤患者早期胰岛素强化治疗对血清炎症介质水平的影响

目的研究严重创伤患者施行胰岛素强化治疗对体内肿瘤坏死因子-α(TNF-α)和白细胞介素-6(IL-6)等早期炎症介质的影响。方法40例发生应激性高血糖(血糖超过9.0mmol/L)的严重创伤患者〔创伤严重度评分(ISS)≥20分〕配对后随机分为胰岛素强化治疗组和常规治疗组,采用酶联免疫吸附法(ELISA)连续检测72h内血清TNF-α与IL-6水平,并监测C反应蛋白(CRP)变化以评估炎症强度。结果胰岛素强化治疗显著降低了创伤后血清TNF-α、IL-6和CRP水平,与常规治疗组比较差异有显著性(P<0.05或P<0.01)。结论胰岛素强化治疗可拮抗创伤后机体呈现的高炎状态,抗炎效应可能是除降血糖、促合成代谢作用之外胰岛素强化治疗又一改善创伤患者预后的重要机制。     

Comparison of usefulness of plasma procalcitonin and C-reactive protein measurements for estimation of severity in adults with community-acquired pneumonia

Although procalcitonin (PCT) measurement has been performed in patients with infectious diseases, there are few reports on its usefulness in community-acquired pneumonia (CAP) associated with systemic inflammatory response syndrome (SIRS). We investigated 88 patients who visited the internal medicine departments of Nagasaki University Hospital, Nagasaki, Japan, and its 11 affiliated hospitals in Japan because of CAP with or without SIRS. Of the 88 patients, 15 (17.0%), 43 (48.9%), and 30 (34.1%) were judged to have severe, moderate, and mild CAP, respectively. Although 87 patients (98.9%) had C-reactive protein (CRP) levels exceeding 0.3 mg/dL, only 30 patients (34.1%) had PCT levels more than 0.5 ng/mL. In addition, 93.3% (28/30) of patients with mild CAP had negative PCT, and 48.3% (28/58) of patients positive for PCT had moderate or severe CAP. Our findings suggest that PCT level might be more useful for estimating CAP severity than CRP level at the 1st visit.     

Systemic inflammatory response syndrome without systemic inflammation in acutely ill patients admitted to hospital in a medical emergency

Criteria of the systemic inflammatory response syndrome (SIRS) are known to include patients without systemic inflammation. Our aim was to explore additional markers of inflammation that would distinguish SIRS patients with systemic inflammation from patients without inflammation. The study included 100 acutely ill patients with SIRS. Peripheral blood neutrophil and monocyte CD11b expression, serum interleukin-6, interleukin-1beta, tumour necrosis factor-alpha and C-reactive protein were determined, and severity of inflammation was evaluated by systemic inflammation composite score based on CD11b expression, C-reactive protein and cytokine levels. Levels of CD11b expression, C-reactive protein and interleukin-6 were higher in sepsis patients than in SIRS patients who met two criteria (SIRS2 group) or three criteria of SIRS (SIRS3 group). The systemic inflammation composite score of SIRS2 patients (median 1.5; range 0-8, n=56) was lower than that of SIRS3 patients (3.5; range 0-9, n=14, P=0.013) and that of sepsis patients (5.0; range 3-10, n=19, P<0.001). The systemic inflammation composite score was 0 in 13/94 patients. In 81 patients in whom systemic inflammation composite scores exceeded 1, interleukin-6 was increased in 64 (79.0%), C-reactive protein in 59 (72.8%) and CD11b in 50 (61.7%). None of these markers, when used alone, identified all patients but at least one marker was positive in each patient. Quantifying phagocyte CD11b expression and serum interleukin-6 and C-reactive protein concurrently provides a means to discriminate SIRS patients with systemic inflammation from patients without systemic inflammation.     

The monoethylglycinexylidide (MEGX) test as a marker of hepatic dysfunction in septic patients with pneumonia.

The aim of this study was to monitor hepatic function in patients with pneumonia meeting the sepsis criteria of the American College of Chest Physicians/Society of Critical Care Medicine (ACCP/SCCM) and to determine if hepatic dysfunction is related to the systemic inflammatory response. Twenty patients were recruited. The monoethylglycinexylidide (MEGX) test was carried out on days 1-10 after admittance to the intensive care unit. Blood samples for determination of serum concentrations of hyaluronic acid, C-reactive protein (CRP), interleukin (IL)-6, IL-8, IL-10 and conventional liver function tests (aspartate aminotransferase, alanine aminotransferase, bilirubin, albumin) were also drawn. Patients were classified into two groups according to illness severity estimated by the simplified acute physiology score (SAPS II) on the day of admission. Patients in group I (n=10) had a SAPS II probability of mortality >3% while those in group II (n=10) had a SAPS II < 3%. The MEGX level over the first five days was significantly lower in group I than in group II (p<0.0001). Significant inverse correlations during the first 5 days were observed between the MEGX 30 min test results and IL-6, CRP and SAPS II and more modest correlations with hyaluronic acid (p=0.0025) and IL-10 (p=0.021). The conventional liver function tests did not differ between the two groups and were mostly within the respective reference ranges. We conclude that the MEGX test is a sensitive marker of liver dysfunction early in sepsis and that low MEGX values are associated with an enhanced inflammatory response.     

急腹症并发多器官功能障碍综合征细胞因子及炎症介质与肽类激素的变化

目的：探讨细胞因子及其他炎症介质与肽类激素在急腹症所致多器官功能障碍综合征（MODS）中的作用。方法：动态观察19例MODS患者血浆肿瘤坏死因子-α（TNF-α），白介素-6（IL-6），血栓素B2（TXB2），6-酮-前列腺素F1α（6-keto-PGF1α），内毒素，内皮素-1（ET-1），降钙素基因相关肽（CGRP），P物质（SP）及血清脂质过氧化物（LPO）和一氧化氮9NO）水平。结果；MODS患者的TNF-α主IL-6均显著增高；入院当天未治疗者IL-6高于经布什镜逆行胆管引流（ERBD）或激素等处理者，重症胆管炎高于重症胰腺炎，并发中毒性休克者高达24000ng/L。早期MODS患者的TNF-α和IL-6均显著高于全身炎症反应综合征（SIRS）者；MODS者的内毒素及LPO均显著程式高；MODS急症住院者NO升高，某些重症胰腺炎，肝癌及高龄肝脓肿长期发热者NO降低；TXB2和6-keto-PGF1α先升后降；ET-1和CGRP早期明显增高；SP于入院当天达峰值。结论；急腹症患者IKL-6持续高于300ng/L，提示MODS时IL-6和TNF-α可区别全身炎症反应程度；NO存在升高和降低两种情况；ET-1，CGRP，TXB2，6-keto-PGF1α，内毒素和LPO增高并促进MODS的形成与发展。     

Decreased plasma concentrations of apolipoprotein M in sepsis and systemic inflammatory response syndromes

ABSTRACT: INTRODUCTION: Apolipoprotein M (apoM) is present in 5% of high-density lipoprotein (HDL) particles in plasma. It is a carrier of sphingosine-1-phosphate (S1P), which is important for vascular barrier protection. The aim was to determine the plasma concentrations of apoM during sepsis and systemic inflammatory response syndrome (SIRS) and correlate them to levels of apolipoprotein A-I (apoA1), apolipoprotein B (apoB), HDL-, and low-density lipoprotein (LDL)-cholesterol. METHODS: Plasma samples from patients with (1), severe sepsis with shock (n = 26); (2), severe sepsis without shock (n = 44); (3), sepsis (n = 100); (4), infections without SIRS (n = 43); and (5) SIRS without infection (n = 20) were analyzed. The concentrations of apoM, apoA1, and apoB were measured with enzyme-linked immunosorbent assays (ELISAs). Total, HDL-, and LDL-cholesterol concentrations were measured with a commercial HDL/LDL cholesterol test. RESULTS: ApoM concentrations correlated negatively to acute-phase markers. Thus, apoM behaved as a negative acute-phase protein. Decreased values were observed in all patient groups (P < 0.0001), with the most drastic decreases observed in the severely sick patients. ApoM levels correlated strongly to those of apoA1, apoB, HDL, and LDL cholesterol. The HDL and LDL cholesterol levels were low in all patient groups, as compared with controls (P < 0.0001), in particular, HDL cholesterol. ApoA1 and apoB concentrations were low only in the more severely affected patients. CONCLUSIONS: During sepsis and SIRS, the plasma concentrations of apoM decrease dramatically, the degree of decrease reflecting the severity of the disease. As a carrier for barrier-protective S1P in HDL, the decrease in apoM could contribute to the increased vascular leakage observed in sepsis and SIRS.     

乌司他丁对全身炎症反应综合征的治疗作用

目的　探讨乌司他丁在阻断全身炎症反应综合征( SIRS)向多器官功能障碍综合征( MODS)发展中的作用及其机制。方法　60例符合SIRS诊断标准3项以上的患者随机分为试验组( n=3 0 )和对照组( n=3 0 ) ,并选取1 5名正常体检者作为正常组。试验组接受常规抗感染治疗,对照组在试验组用药基础上静脉注射乌司他丁1 0 0 k U,8h1次,连用5d。常规监测患者心率( HR)、呼吸频率( RR)、体温( T)、白细胞计数( WBC)、SIRS症状改善时间和病死率;并于治疗前和治疗后5d抽取静脉血检测血清白细胞介素6( IL 6)、IL 1 0、肿瘤坏死因子α( TNFα)、C反应蛋白( CRP)水平。正常组于体检时抽血检测的结果作为正常对照。结果　试验组T、RR、HR及WBC治疗后改善情况均明显优于对照组( P<0 .0 5或P<0 .0 1 )。SIRS患者入院时炎性细胞因子水平均明显高于正常组( P均<0 .0 1 ) ;两组患者治疗后5d的CRP、IL 6和TNFα水平均较治疗前明显下降( P<0 .0 5或P<0 .0 1 ) ,但试验组下降较对照组更为明显。试验组治疗后5d的IL 1 0较治疗前上升,治疗前后自身对照差异有显著性( P<0 .0 1 ) ;对照组治疗后5d的IL 1 0水平与治疗前比较差异无显著性( P>0 .0 5)。另外,试验组患者治疗后SIRS炎性指标超过3 d无明显改善者明显少于对照组( P<0 .0 1 ) ,转为     

ω-3鱼油脂肪乳对脑外伤后全身炎症反应综合征的影响

目的:探讨ω-3鱼油脂肪乳对脑外伤合并全身炎症反应综合征(SIRS)患者体内血C反应蛋白(CRP)及体液免疫的影响。方法:将2011年6月-2013年12月收治的脑外伤合并SIRS患者96例随机分为对照组和实验组各48例,分别给予常规静脉营养和联合ω-3鱼油脂肪乳治疗,比较两组静脉营养前1d,后第7 d的肿瘤坏死因子-α(TNF-α)、CRP、白介素-6(IL-6)的浓度。结果:治疗后两组血TNF-α、CRP、IL-6等水平均较治疗前明显降低(P0.05),但实验组第7 d时的观察指标均明显低于对照组(P0.05)。结论:ω-3鱼油脂肪乳可降低脑外伤合并SIRS患者体内TNF-α、CRP、IL-6浓度,具有抗炎和改善免疫功能的作用。     

脓毒症患者肿瘤坏死因子样凋亡微弱诱导剂的表达及意义

目的探讨脓毒症患者肿瘤坏死因子样凋亡微弱诱导剂（tumor necrosis factor-like weak inducer of apoptosis,TWEAK）的表达及其临床意义。方法全身炎症反应综合征（systemic inflammatory response syndrome,SIRS）患者112例,其中脓毒症患者75例为感染性SIRS组,非感染性SIRS患者37例为非感染性SIRS组。感染性SIRS组又分为脓毒症组22例、严重脓毒症组32例和脓毒性休克组21例,检测各组血清TWEAK、肿瘤坏死因子-α（tumor necrosis factor-α,TNF-α）、白细胞介素-6（interleukin-6,IL-6）及C反应蛋白（C-reactive protein,CRP）水平。结果感染性SIRS组血清TWEAK与TNF-α水平明显高于非感染性SIRS组（P〈0.05）,IL-6、CRP水平与非感染性SIRS组比较差异无统计学意义（P〉0.05）;4组血清TWEAK、TNF-α水平两两比较差异有统计学意义（P〈0.05）,且随脓毒症程度加重,血清TWEAK、TNF-α水平逐渐升高;4组血清CRP、IL-6水平两两比较差异均无统计学意义（P〉0.05）;血清TWEAK水平在细菌、真菌及混合细菌真菌感染中差异无统计学意义（P〉0.05）。结论血清TWEAK水平与感染病原菌无关,脓毒症患者TWEAK含量明显升高,可作为脓毒症患者的重要检测指标。     

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.     

Circulating complement (C3 and C4) for differentiation of SIRS from sepsis

The systemic inflammatory response of the body to invading microorganisms, called sepsis, leads to profound activation of the complement (C3 and C4) system. The present study was conducted to compare the use of serum C3 and C4 levels with C-reactive protein (CRP) and thrombocyte and leukocyte counts in differentiating patients with systemic inflammatory response syndrome (SIRS) from those with sepsis. Over a 6-mo period, all patients with SIRS or sepsis who stayed in the intensive care unit for > 24 h were enrolled in the study. At admission, each patient’s clinical status was recorded, and blood was taken for laboratory analysis (complete blood count, CRP, C3, and C4). A total of 58 patients with SIRS and 41 patients with sepsis were admitted to the study. The mean±SD thrombocyte count was found to be significantly lower in septic patients (179,975±95,615) than in those with SIRS (243,165±123,706) (P=.005); no difference in plasma concentrations of CRP and levels of C3 and C4 was noted between groups. The thrombocyte count was determined to be the most reliable parameter for differentiating between SIRS and sepsis (highest area under the curve=0.656).     

多发伤并发全身炎症反应综合征临床危险因素分析

目的探讨多发伤并发全身炎症反应综合征（SIRS）临床危险因素,为早期预防治疗全身炎症反应综合征提供依据。方法2009年2月至2013年2月急诊就诊多发伤患者289例,合并全身炎症反应综合征为观察组,未合并炎性反应综合征为对照组。病例的评估采用急性生理学和慢性健康状况Ⅱ（APACHEⅡ）评分和损伤严重度评分（ISS）。CD4^＋,CD8^＋水平测量采用流式细胞仪。胰岛素（Insulin,INS）水平测量采用化学发光法。C-反应蛋白（Creactive protein,CRP）测量采用免疫比浊法。肿瘤坏死因子α（tumor necrosis factor-α,TNF-α）、白细胞介素10（intefleukin-10,IL-10）、白细胞介素-6（interleukin-6,IL-6）的测定采用酶联免疫吸附双抗体夹心法。结果DIC、ISS、APACHEⅡ评分两组间差异有统计学意义（Х^2=5．67,t=-2．63、2．51,P〈0．05）;IL-6、IL-10、INS两组间差异有统计学意义（t=2．34、2．18、2．08,P〈0．05）;ISS、APACHEⅡ、DIC、IL-6、IL-10、INS是多发伤并发全身炎症反应综合征的危险因素,其中IL-10的OR值最大,其次为DIC。结论ISS、APACHEⅡ、DIC、IL-6、IL-10、INS是多发伤并发全身炎症反应综合征的危险因素,治疗多发伤时应注意这6种影响因素的变化。     

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...