血清降钙素原、白细胞介素6和C反应蛋白在脓毒血症和全身炎症反应综合征鉴别诊断中的意义  

Clinical significance of serum procalcitonin,interleukin-6 and C-reactive protein in differential diagnosis of sepsis and systemic inflammatory response syndrome

作　　者：杨琴[1] 曹军皓[1] 丁进亚[1] 洪纯[1] 周杉[1] 孙丽[1] 

机构地区：[1]解放军广州军区武汉总医院检验科,湖北武汉430070

出　　处：《临床军医杂志》2013年第7期675-677,共3页Clinical Journal of Medical Officers

摘　　要：目的探讨血清降钙素原(PCT)、白细胞介素6(IL-6)和C反应蛋白(CRP)在全身炎症反应综合征(SIRS)和脓毒血症鉴别诊断中的临床意义。方法本研究以重症监护病房(ICU)患者为研究对象,共72例,其中脓毒血症30例,SIRS 42例,动态监测其血清PCT、IL-6和CRP水平变化情况。结果脓毒血症患者血清CRP、PCT和IL-6的水平与SIRS患者相比均有统计学差异。患者在进入ICU后的最初24h内PCT水平<2μg/L,可排除脓毒血症(阴性预期值97%)。反之,PCT水平>10μg/L,很可能为细菌感染引起的脓毒血症(阳性预期值91%)。诊断正确率(DOR)提示:PCT能更准确地鉴别诊断SIRS与脓毒血症。结论在脓毒血症和SIRS鉴别诊断时PCT优于CRP和IL-6。Objective To investigate the clinical significance of serum procalcitonin （PCT） , intedeukin-6 （ IL-6 ）, and C-reactive protein （CRP） levels in differentiation between sepsis and systemic inflammatory response syndrome （SIRS）. Methods The changes in serum PCT, IL-6 and CRP levels were dynamically measured in 72 ICU patients, including 30 ones with sepsis and 42 ones with SIRS. Results The levels of PCT, IL-6 and CRP were significantly higher in patients with sepsis than in the ones with SIRS. With PCT level 〈 2μg/L in the first 24 hours after admission to ICU, sepsis was virtually excluded （ negative predictive value 97 % ）. With PCT level 〉 10 μg/L, sepsis with bacterial infection was very likely （positive predictive value 91% ）. PCT was the best at discriminating between sepsis and SIRS with the highest DOR （ diagnostic odds ratios）. Conclusion It is showed that PCT acts as a more useful marker than IL-6 or CRP in differentiating sepsis from SIRS.

关 键 词：脓毒血症 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]