【摘要】：目的:本研究通過對膿毒癥患者血清降鈣素原(PCT)、C反應(yīng)蛋白(CRP)指標(biāo)的檢測,可以為臨床進(jìn)行早期準(zhǔn)確診斷,盡早進(jìn)行有效合理治療,取得良好的預(yù)后提供有利的指導(dǎo)依據(jù)。方法:隨機(jī)選取2013年1月1日-2015年12月31日入住江蘇大學(xué)附屬醫(yī)院ICU的重癥患者302例納入本研究,按照膿毒癥診斷標(biāo)準(zhǔn)將302例患者分為三組:膿毒癥組、膿毒性休克組與非膿毒癥組。其中膿毒癥組102例,男56例,女46例,年齡39-68歲;膿毒性休克組87例,男47例,女40例,年齡42-75歲;非膿毒癥組113例為對照組,其中男50例,女63例,年齡40-74歲。全部患者的血清中PCT的檢測用酶聯(lián)熒光分析法測定,CRP采用熒光免疫定量法檢測,最終檢測指標(biāo)在各組間進(jìn)行對比,分析組間差別,并對PCT、CRP指標(biāo)繪制受試者工作特征曲線(ROC曲線),比較各檢測炎癥指標(biāo)對診斷膿毒癥的敏感度、特異度、陽性預(yù)測值、陰性預(yù)測值、準(zhǔn)確率等指標(biāo)。采用統(tǒng)計專業(yè)軟件對最終數(shù)據(jù)進(jìn)行統(tǒng)計分析,P0.05為有統(tǒng)計學(xué)意義。結(jié)果:1、比較膿毒性休克組、膿毒癥組與對照組患者的年齡、性別、APACHEⅡ分、ICU住院時間(天)等指標(biāo)上均無顯著性差距(P0.05),在ISS評分、住院死亡率[n(%)]上有明顯差異(P0.05)。2、膿毒癥患者血清PCT水平達(dá)(6.03±3.98 ug/L),高于對照組患者水平(1.68±0.93 ug/L),膿毒性休克組患者的PCT水平(14.03±9.61 ug/L)較膿毒癥組高,均具有明顯差異(P0.05);膿毒癥患者血清中CRP的水平達(dá)(34.91±15.71mg/L),高于對照組患者水平(12.41±7.98 mg/L),膿毒性休克組患者的CRP水平(148.29±32.04 mg/L)較膿毒癥組高,均具有明顯差異(P0.05)。3、膿毒性休克組、膿毒癥組和對照組患者血清PCT檢測陽性率分別為93.1%、80.4%、29.2%,3組比較差異有統(tǒng)計學(xué)意義(X2=104.335;P0.05);膿毒性休克組、膿毒癥組和對照組患者血清CRP檢測陽性率分別為90.8%、79.4%、25.7%,3組比較差異有統(tǒng)計學(xué)意義(X2=107.702;P0.05)。4、PCT、CRP聯(lián)合檢測診斷膿毒癥的敏感度、特異度、陽性預(yù)測值、陰性預(yù)測值、準(zhǔn)確率(84.7%、87.6%、92.0%、77.3%、85.8%)均明顯高于PCT單獨(dú)檢測(75.7%、77.0%、84.7%、65.4%、76.2%),同樣高于CRP單獨(dú)檢測(77.8%、74.3%、83.5%、66.7%、76.5%),具有明顯差異(P0.05)。PCT、CRP聯(lián)合檢測ROC曲線下面積為0.922,曲線下面積的95%置信區(qū)間為(0.872,0.971);PCT水平ROC曲線下面積為0.850,曲線下面積的95%置信區(qū)間為(0.777,0.923);CRP水平的檢測水準(zhǔn)描記出的ROC相應(yīng)曲線下規(guī)模為0.814,曲線下具體取值的95%置信區(qū)間為(0.730,0.898)。結(jié)論:1、血清PCT、CRP水平可用來評估膿毒癥患者的病情嚴(yán)重程度,其水平越高,病情越嚴(yán)重。2、血清PCT、CRP聯(lián)合檢測較PCT或CRP單獨(dú)檢測敏感度及特異度大大提高,提示通過對PCT、CRP水平的聯(lián)合檢測可提高膿毒癥早期診斷的準(zhǔn)確率。
[Abstract]:Objective: to detect the serum calcitonin proto (PCT) C-reactive protein (PCT) (CRP) in patients with sepsis, and to provide a good basis for early diagnosis, effective and reasonable treatment and good prognosis. Methods: 302 severe patients admitted to the affiliated Hospital of Jiangsu University from January 1, 2013 to December 31, 2015 were randomly selected and divided into three groups according to the diagnostic criteria of sepsis: sepsis group. Septic shock group and non sepsis group. There were 102 cases of sepsis group (56 males, 46 females, aged 39-68), 87 septic shock patients (47 males, 40 females, aged 42 to 75 years) and 113 non-septic patients (50 males and 63 females, aged 40-74 years). The detection of PCT in serum of all the patients was detected by enzyme linked fluorescence assay (Elisa) and fluorescence immunoassay (FIA). The final detection indexes were compared among the groups and the differences between the groups were analyzed. The sensitivity, specificity, positive predictive value, negative predictive value, accuracy and so on of the inflammatory indexes for the diagnosis of sepsis were compared by drawing the ROC curve of the PCT,CRP index, and comparing the sensitivity, the specificity, the positive predictive value, the negative predictive value and the accuracy rate of each inflammatory index in the diagnosis of sepsis. Statistical analysis of the final data using statistical professional software is statistically significant. Results there was no significant difference in age, sex Apache 鈪，

本文編號：2201631