【摘要】：目的:探討血清降鈣素原濃度水平對膿毒癥患者早期預(yù)測及病情嚴(yán)重程度的評估價值。方法:回顧性分析皖南醫(yī)學(xué)院弋磯山醫(yī)院2012年8月至2013年2月接受PCT、CRP、血常規(guī)檢測的患者共計1650例,參照全身炎癥反應(yīng)綜合征及膿毒癥診斷標(biāo)準(zhǔn)及排除標(biāo)準(zhǔn),篩選出243例納入本研究。依照分級標(biāo)準(zhǔn)分為全身炎癥反應(yīng)綜合征組(SIRS組),早期膿毒癥組(ES組),嚴(yán)重膿毒癥組(SS組)和膿毒癥休克組(SSH組)。比較全身炎癥反應(yīng)綜合征和膿毒癥各組PCT、WBC和CRP水平,分析其相關(guān)性,并繪制受試者工作特征曲線,計算曲線下面積,評價PCT、WBC和CRP對膿毒癥的診斷價值。結(jié)果:(1)各組患者一般資料比較:納入各組患者性別比、年齡、致病因素比較差異無統(tǒng)計學(xué)意義(P0.05)。SS組與SSH組APACHEⅡ評分高于SIRS組(P0.05)。(2)SIRS組與膿毒癥組的WBC、CRP、PCT的中位數(shù)和四分位數(shù)分別為:8.40(4.60,13.10);69.22(29.02,127.87);0.05(0.05,0.96)。膿毒癥組患者WBC、CRP、PCT水平均高于SIRS組(P0.05);(3)Spearman相關(guān)分析顯示,CRP和PCT與SIRS組和各型膿毒癥均呈正相關(guān),rs值分別為0.390、0.488,與WBC無相關(guān)性。(4)CRP在早期診斷膿毒癥價值優(yōu)于PCT和WBC,其曲線下面積分別為0.678,0.659,0.576。(5)PCT預(yù)測嚴(yán)重膿毒癥(SS組和SSH組)的價值優(yōu)于CRP,其曲線下面積分別為0.830,0.729。PCT和CRP在診斷預(yù)測嚴(yán)重膿毒癥時,閾值分別定為3.845ng/mL和108.500mg/L時。PCT和CRP聯(lián)合診斷嚴(yán)重膿毒癥時,其診斷靈敏度為88.24%,高于單獨使用PCT(72.50%)和CRP(62.70%)。結(jié)論:1.血清PCT與CRP濃度水平可作為膿毒癥診斷指標(biāo),并與各型膿毒癥病情呈正相關(guān),CRP在早期診斷膿毒癥的價值優(yōu)于血清PCT;2.血清PCT預(yù)測膿毒癥嚴(yán)重程度的價值優(yōu)于CRP,具有較高的靈敏度和特異度;3.血清PCT聯(lián)合CRP可作為膿毒癥病情診斷和評估指標(biāo),閾值分別定為3.845ng/mL和108.500mg/L時,其診斷靈敏度增高,可作為臨床醫(yī)師評估膿毒癥病情嚴(yán)重程度的依據(jù)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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