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降钙素原对脓毒症早期预测及病情评估的价值

发布时间:2019-01-12 08:03
【摘要】:目的:探讨血清降钙素原浓度水平对脓毒症患者早期预测及病情严重程度的评估价值。方法:回顾性分析皖南医学院弋矶山医院2012年8月至2013年2月接受PCT、CRP、血常规检测的患者共计1650例,参照全身炎症反应综合征及脓毒症诊断标准及排除标准,筛选出243例纳入本研究。依照分级标准分为全身炎症反应综合征组(SIRS组),早期脓毒症组(ES组),严重脓毒症组(SS组)和脓毒症休克组(SSH组)。比较全身炎症反应综合征和脓毒症各组PCT、WBC和CRP水平,分析其相关性,并绘制受试者工作特征曲线,计算曲线下面积,评价PCT、WBC和CRP对脓毒症的诊断价值。结果:(1)各组患者一般资料比较:纳入各组患者性别比、年龄、致病因素比较差异无统计学意义(P0.05)。SS组与SSH组APACHEⅡ评分高于SIRS组(P0.05)。(2)SIRS组与脓毒症组的WBC、CRP、PCT的中位数和四分位数分别为:8.40(4.60,13.10);69.22(29.02,127.87);0.05(0.05,0.96)。脓毒症组患者WBC、CRP、PCT水平均高于SIRS组(P0.05);(3)Spearman相关分析显示,CRP和PCT与SIRS组和各型脓毒症均呈正相关,rs值分别为0.390、0.488,与WBC无相关性。(4)CRP在早期诊断脓毒症价值优于PCT和WBC,其曲线下面积分别为0.678,0.659,0.576。(5)PCT预测严重脓毒症(SS组和SSH组)的价值优于CRP,其曲线下面积分别为0.830,0.729。PCT和CRP在诊断预测严重脓毒症时,阈值分别定为3.845ng/mL和108.500mg/L时。PCT和CRP联合诊断严重脓毒症时,其诊断灵敏度为88.24%,高于单独使用PCT(72.50%)和CRP(62.70%)。结论:1.血清PCT与CRP浓度水平可作为脓毒症诊断指标,并与各型脓毒症病情呈正相关,CRP在早期诊断脓毒症的价值优于血清PCT;2.血清PCT预测脓毒症严重程度的价值优于CRP,具有较高的灵敏度和特异度;3.血清PCT联合CRP可作为脓毒症病情诊断和评估指标,阈值分别定为3.845ng/mL和108.500mg/L时,其诊断灵敏度增高,可作为临床医师评估脓毒症病情严重程度的依据之一。
[Abstract]:Objective: to evaluate the value of serum procalcitonin concentration in early prediction and severity of sepsis. Methods: a total of 1650 patients who received PCT,CRP, blood routine examination from August 2012 to February 2013 were analyzed retrospectively. The diagnostic criteria and exclusion criteria for systemic inflammatory response syndrome and sepsis were reviewed. 243 cases were selected for inclusion in this study. According to the grading criteria, they were divided into three groups: systemic inflammatory response syndrome (SIRS), early sepsis (ES), severe sepsis (SS) and septic shock (SSH). To compare the levels of PCT,WBC and CRP in each group of systemic inflammatory response syndrome and sepsis, analyze the correlation, draw the operating characteristic curve, calculate the area under the curve, and evaluate the value of PCT,WBC and CRP in the diagnosis of sepsis. Results: (1) comparison of general data of patients in each group: sex ratio, age, There was no significant difference in the pathogenic factors (P0.05 between). SS group and SSH group APACHE 鈪,

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