降钙素原在全身炎症反应综合征鉴别诊断和监测中的作用  

Role of Procalcitonin in the Differentiation and Surveillance of Systemic Inflammatory Response Syndrome

作　　者：刘晓利[1] 杜斌 潘家绮[1] 许莹[1] 华宝来[1] 

机构地区：[1]中国医学科学院中国协和医科大学北京协和医院血液内科,北京100730 [2]Department of Intensive Care Medicine, PUMC Hospital, CAMS and PUMC, Beijing

出　　处：《中国医学科学院学报》2005年第1期48-52,共5页Acta Academiae Medicinae Sinicae

摘　　要：目的评价在出现全身炎症反应综合征(SIRS)表现早期,降钙素原(PCT)、白细胞介素-6(IL-6)以及传统指标对于感染性和非感染性病因的鉴别作用,及其与病情严重程度的相关性。方法采用前瞻性研究,共有30例非感染性SIRS和27例感染性SIRS患者入选,在出现临床表现24h内测定血清PCT、IL-6和C反应蛋白(CRP)水平,同时记录最高体温、白细胞计数、中性粒细胞比例及绝对计数等,做急性生理和慢性健康评分(APACHEⅡ)及全身性感染相关器官衰竭评分(SOFA)。结果感染性SIRS患者与非感染性SIRS患者相比,血清PCT(5.54[1.20,32.74]μg/Lvs0.77[0.22,3.90]μg/L,P=0.001)、IL-6(163.66[33.60,505.26]ng/Lvs37.72[22.52,110.78]ng/L,P=0.004)、CRP([15.28±8.41]g/Lvs[9.51±7.65]g/L,P=0.010)和中性粒细胞比例(0.91±0.04vs0.88±0.04,P=0.010)水平显著升高。受试者工作特征曲线表明,PCT和IL-6的鉴别力最佳。血清PCT和IL-6水平与患者的APACHEⅡ评分及SOFA评分显著相关,血清PCT水平和住院日呈正相关。结论与传统炎症指标相比,PCT和IL-6有助于鉴别感染性和非感染性SIRS,并且和病情严重程度有一定相关性。Objective To evaluate the discrimination of serum procalcitonin(PCT)and interleukin-6(IL-6)between patients with sepsis and non-infectious inflammatory response syndrome(SIRS)and the prediction power of clinical outcome. Methods A perspective study was performed in 27 patients with sepsis and 30 patients with non-infectious SIRS. The serum concentrations of PCT, IL-6, C-reactive protein(CRP), white blood cell count, percentage of neutrophil, absolute neutrophil count, and maximal body temperature were obtained less than 24 hours after clinical onset of sepsis or SIRS. Results The serum levels of PCT and IL-6 and percentage of neutrophil were significantly higher in patients with sepsis than in those with non-infectious SIRS(PCT:5.54[1.20, 32.74]μg/L vs 0.77[0.22, 3.90]μg/L, P = 0.001; IL-6:163.66[33.60, 505.26]ng/L vs 37.72[22.52, 110.78]ng/L, P = 0.004; CRP[15.28 ± 8.41]g/L vs[9.51 ± 7.65]g/L, P = 0.010; and percentage of neutrophil:0.91 ± 0.04 vs 0.88 ± 0.04, P = 0.010). Receiver operating characteristic curve showed that the power of PCT and IL-6 were the best of all above. There was significant correlation between serum PCT or IL-6 and the acute physiology and chronic health evaluation(APACHE Ⅱ)or sepsis-related organ failure assessment(SOFA)scores, so was between serum PCT and the intensive care unit(ICU)length of stay. Conclusions PCT and IL-6 are more reliable indicators to differentiate sepsis and non-infectious SIRS than the conven-tional inflammatory markers, and correlate with the disease severity. PCT levels are significantly corre-lated with ICU length of stay.

关 键 词：全身性感染 全身炎症反应综合征 降钙素原 白细胞介素-6 C反应蛋白 

分 类 号：R631[医药卫生—外科学]