血清降钙素原在急诊脓毒症早期诊断中的意义

目的探讨降钙素原(PCT)对急诊脓毒症的早期诊断价值。方法 2010年10月—2011年4月将收住急诊抢救室的74例患者按诊断标准分为严重脓毒症(SS)组25例、脓毒症(sepsis)组25例、全身炎性反应综合征(SIRS)组11例、非全身炎性反应综合征(Non-S1RS)组13例,分别检测PCT、C反应蛋白(CRP)和白细胞(WBC)计数,并记录急性生理学和慢性健康状况评分Ⅱ(APACHEⅡ)。结果 SS组血清PCT、WBC、CRP水平及APACHEⅡ评分明显升高,其次为sepsis组,SIRS组和Non-SIRS组较低,各组间差异均有统计学意义(P<0.05)。以PCT≥0.5ng/ml为临界点,诊断脓毒症的敏感性为82.0%,特异性91.7%,均高于CRP、WBC计数。PCT的ROC曲线下面积大于CRP与WBC,血清PCT与CRP、APACHEⅡ评分呈明显正相关(r=0.724,r=0.475,P<0.01),CRP与APACHEⅡ评分呈正相关(r=0.389,P=0.001)。结论 PCT对急诊脓毒症具有较高的早期诊断价值。PCT与脓毒症患者的严重程度相关,是评估感染严重程度的较好参数。

Clinical value of procalcitonin test for early diagnosis of sepsis in the emergency department

Objective To investigate the diagnostic value of procalcitonin（PCT） as an early indicator for sepsis in emergency department.Methods From Oct 2010 to Apr 2011.according to the definition of sepsis defined by ACCP/SCCM Consensus Conference,74 emergency patients were divided into four groups：severe sepsis（SS） group（n = 25）,sepsis group（n =25）,SIRS group（n =11）,non systemic inflammatory response syndrome（Non-SIRS） group（n = 13）.The serum level of PCT,C reactive protein（CRP）,white blood cell（WBC） count of each patient were measured,and the acute physiology and chronic health evaluation score II（APACHE II） were calculated.Results Serum level of PCT,WBC,CRP and APACHE II in the SS group was significantly elevated,followed by sepsis group,SIRS group and Non-SIRS group（P〈0.05 ）.There were significant differences among the groups.Receiver operating characteristic curve（ROC curve） were drawn and areas under these curves were calculated.For the assessment of sepsis,at a cutoff level of PCT≥0.5 ng/ml,the sensitivity was 82.0%,the specificity was 91.7%,higher than the levels of CRP and WBC count.Serum level of PCT has a positive relationship with CRP,APACHEⅡscore（r = 0.724,r = 0.475,P〈0.01 ）,CRP has positive relationship with APACHEⅡscore（r =0.389,P =0.001）.Conclusion PCT was a prospective marker of bacterial infection,and substantially useful to early diagnosis of sepsis in the ED setting.PCT could be a better marker for assessing sepsis of critically ill patients.