血清C-反应蛋白与降钙素原水平对细菌性脓毒症的诊断价值  

Diagnostic and prognostic values of serum procalcitonin and C-reactive protein in patients of bacterial sepsis

作　　者：黄新文[1] 王晋鹏[1] 李海林[1] 

机构地区：[1]浙江省立同德医院急诊科,杭州310012

出　　处：《中华医学杂志》2014年第27期2106-2109,共4页National Medical Journal of China

摘　　要：目的 探讨血清C-反应蛋白（CRP）与降钙素原（PCT）水平对细菌性脓毒症的诊断价值.方法 在2012年7月至2013年5月入住浙江省立同德医院急诊科的危重患者120例,其中脓毒症患者63例（脓毒症组）,局部感染患者57例（局部感染组）,另选同期30例健康者作为对照组.脓毒症患者根据预后情况分为生存组和死亡组,并根据细菌培养结果分为G＋菌组和G-菌组,分析各组的血清PCT和CRP水平.结果 脓毒症组血清PCT和CRP水平以及APACHEⅡ评分和SOFA评分均显著地大于局部感染组和对照组[（11.1 ±3.3） μg/L比（0.3±0.2） μg/L比（0.1±0.0）μg/L;（76.3 ±21.0）mg/L比（17.0±6.4） mg/L比（3.0±1.0） mg/L,（P＜0.05）];局部感染组血清PCT和CRP水平以及APACHEⅡ评分和SOFA评分均显著地大于对照组（P＜0.05）;血清PCT诊断细菌性脓毒症的敏感性、特异性、阳性预测值和阴性预测值均明显大于血清CRP（P ＜0.05）;生存组在第1、5、10、15天的血清PCT和CRP值均显著地小于死亡组（P＜0.05）,生存组血清PCT、CRP值有显著的时间效应（P＜0.05）,但死亡组血清PCT、CRP值无显著的时间效应（P＞0.05）.当PCT≥10.0 μg/L时,G-菌组的例数显著多于G＋菌组（P＜0.05）.结论 血清PCT和CRP是诊断细菌性脓毒症和评估预后的可靠指标,在局部感染中也有一定的参考价值,且血清PCT敏感性和特异性高于血清CRP.Objective To explore the diagnostic and prognostic values of serum procalcitonin （PCT） and C-reactive protein （CRP） in patients of bacterial sepsis.Methods From July 2012 to May 2013,a total of 120 critically ill patients at our intensive care unit （ICU） were recruited.They included septic （sepsis group,n =63） local infection （local infection group,n =57） and healthy people （control group,n =30）.The serum levels of PCT and CRP were measured.Septic patients were divided into survival and death groups according to the prognosis.They were also divided into gram-positive and gram-negative bacteria groups according to the results of bacterial cultivation.Results The serum levels of PCT and CRP,as well as acute physiology and chronic health evaluation Ⅱ （APACHE Ⅱ） scores and sepsis related organ failure assessment （SOFA） scores in the sepsis group were significantly higher than those in the local infection and control groups （P ＜ 0.05）.And those in the local infection group were higher than those in the control group （P ＜ 0.05）.The sensitivity,specificity,positive predictive value and negative predictive value for serum PCT in diagnosing bacterial sepsis were significantly larger than those for serum CRP （P ＜0.05）.The serum levels of PCT and CRP in survival group were less than those in death group at Day 1,5,10 and 15 （P ＜0.05）.Moreover,there were significant time effects on the serum levels of PCT and CRP in the survival group （P＜0.05）,but not in the death group （P＞0.05）.When PCT was ≥10.0 μg/L,the patients of gram-negative bacteria were more than those of gram-positive bacteria （P ＜ 0.05）.Conclusion The serum levels of PCT and CRP are reliable in the diagnostic and prognostic evaluations of bacterial sepsis.Both also have certain reference value for local infection.Moreover the sensitivity and specificity of serum PCT were better those of serum CRP.

关 键 词：脓毒症 细菌感染 C反应蛋白质 降钙素 

分 类 号：R459.7[医药卫生—急诊医学]