血清降钙素原和C反应蛋白在脓毒性休克患者中的变化及对预后的评估

目的探讨血清降钙素原(PCT)和C反应蛋白(CRP)在脓毒性休克患者中的变化及临床意义。方法选取2013年1月—2015年6月某医院重症监护病房(ICU)严重感染患者,按感染程度分为脓毒性休克组(66例)根据1个月生存情况分为存活组(50例)和死亡组(16例)]和重症脓毒症组(62例),对照组为同期住院非脓毒性休克患者60例,分别比较分析各组患者治疗前和治疗后不同时间血清PCT、CRP及WBC水平。结果脓毒性休克组治疗前,治疗1、3、7 d后血清PCT、CRP及WBC水平均高于对照组;重症脓毒症组治疗1、3、7 d后血清PCT和CRP水平均高于对照组;死亡组治疗1、3、7 d后血清PCT水平均高于存活组,治疗3、7 d后血清CRP水平均高于存活组(均P0.05)。ROC曲线显示,PCT、CRP和WBC的曲线下面积(AUC)及95%CI分别为:0.786(0.703~0.864)、0.754(0.691~0.827)和0.603(0.542~0.679)。Spearman相关分析显示,脓毒性休克患者治疗前、治疗7 d后血清PCT与CRP呈正相关(r=0.596,P=0.004)和(r=0.523,P=0.012)],治疗7 d后血清PCT与WBC呈正相关(r=0.604,P=0.001)。结论 PCT可作为脓毒性休克患者早期诊断的指标,动态联合观察PCT和CRP水平对评估患者病情严重程度及判断患者预后具有重要意义。

Change and prognosis evaluation of serum procalcitonin and C reactive protein in patients with septic shock

ObjectiveTo evaluate the change and clinical significance of serum procalcitonin（PCT）and C reactive protein（CRP）in patients with septic shock. MethodsPatients with severe infection in the intensive care unit (ICU) of a hospital between January 2013 and June 2015 were selected. According to the extent of infection, patients were divided into septic shock group (n=66, subdivided into survival group ［n=50］ and death group［n=16］ according to 1 month survival) and severe sepsis group (n=62), control group were patients without septic shock during the same hospitalization period, serum PCT, CRP, and WBC levels in each group at different times before and after treatment were compared. ResultsIn septic shock group, serum PCT，CRP and WBC levels before treatment, after 1, 3, and 7 days of treatment were all significantly higher than control group; in severe septic shock group, serum PCT and CRP levels after 1, 3, and 7 days of treatment were all significantly higher than control group; in death group, serum PCT levels after 1, 3, and 7 days of treatment were all significantly higher than survival group, CRP levels after 3 and 7 days of treatment were both significantly higher than survival group（all P<0.05）. Receiver operating characteristic (ROC) curves showed that area under the curve （AUC） and 95%CI of PCT，CRP, and WBC were 0.786（0.703-0.864），0.754（0.691-0.827），and 0.603（0.542-0.679） respectively. Spearman correlation analysis showed that serum PCT and CRP in patients with septic shock before treatment，after 7 days of treatment were positively correlated（［r=0.596，P=0.004］, ［r=0.523，P=0.012］, respectively）, and after 7 days of treatment, serum PCT was positively correlated with WBC（r=0.604，P=0.001）. ConclusionPCT can be used as a indicator in early diagnosis of patients with septic shock，and dynamic observation of PCT and CRP has important significance in evaluating patients’severity and prognosis.