降钙素原监测在经皮肾镜术后尿源性脓毒症诊治中的意义  

Significance of procalcitonin monitoring in diagnosis and treatment of urine derived sepsis after percutaneous nephrolithotomy

作　　者：洪涛[1] 张显军[1] 王晨[1] 俞洪元[1] 柯莽[1] 朱翮嘉[1] 

机构地区：[1]浙江省台州医院泌尿外科,浙江临海317000

出　　处：《中华医院感染学杂志》2015年第4期744-746,共3页Chinese Journal of Nosocomiology

基　　金：浙江省教育厅基金资助项目(Y201328629)

摘　　要：目的了解降钙素原(PCT)监测在经皮肾镜术后尿源性脓毒症诊治中的意义,为临床治疗尿源性脓毒症提供参考依据。方法选取2013年1月-2014年10月经皮肾镜术后尿源性脓毒症患者50例,其中,脓毒症组30例、严重脓毒症组16例、脓毒症性休克组4例,治疗前后检测3组患者的血清PCT、C-反应蛋白(CRP)水平,行受试者工作特征曲线(ROC曲线)分析,评价PCT、CRP对尿源性脓毒症的诊断价值。结果 3组患者治疗前血清PCT水平比较,差异均有统计学意义(P<0.05),治疗后血清PCT水平均低于治疗前,差异有统计学意义(P<0.05),3组患者治疗前血清CPR水平比较,差异有统计学意义(P<0.05),脓毒症组治疗后的血清水平低于治疗前,差异有统计学意义(P<0.05);血清PCT诊断尿源性脓毒症的曲线下面积0.816±0.081、诊断临界值为1.2ng/ml、特异度83.6%、敏感度88.4%、诊断准确率83.6%,血清CRP诊断尿源性脓毒症的曲线下面积0.739±0.055、诊断临界值为40.2μg/ml、特异度71.5%、敏感度81.7%、诊断准确率72.3%。结论动态监测患者PCT对早期诊断尿脓毒症的发生以及判断尿脓毒症病程进展更准确,在评估抗感染治疗疗效方面更准确,值得临床重视和推广。OBJECTIVE To learn the significance of procalcitonin（PCT）monitoring in diagnosis and treatment of urine derived sepsis after percutaneous nephrolithotomy,so as to provide reference for clinical treatment of urine derived sepsis.METHODS Totally 50 cases with urine derived sepsis after percutaneous nephrolithotomy during Jan.2013 to Oct.2014 were selected,including 30 cases in the sepsis group,16 cases in the severe sepsis group,4cases in the septic shock group.Before and after treatment,the serum PCT and CRP levels of all cases were detected in the three groups.Through analysis of performance curve（ROC curve）of the cases,PCT and CRP values for the diagnosis of urine derived sepsis were analyzed and evaluated.RESULTS Before the treatment,the differences in serum PCT levels among the sepsis group,the severe sepsis group and the septic shock group were significant（P〈0.05）.After treatment,serum PCT levels of the three groups were lower than before treatment,the differences were significant（P〈0.05）.Before the treatment,the differences in serum CRP levels amog the three groups were significant（P〈0.05）.After treatment,the serum CRP level of the sepsis group was lower than before treatment,the difference was significant（P〈0.05）.For serum PCT in the diagnosis of urine derived sepsis,the area under ROC curve was 0.816±0.081,the diagnostic critical value was 1.2ng/ml,the specific degree was 83.6%,the sensitivity was 88.4%,and the diagnostic accuracy rate was 83.6%.For serum CRP in the diagnosis of urine derived sepsis,the area under ROC curve was 0.739±0.055,the diagnostic critical value was 40.2μg/ml,the specific degree was 71.5%,the sensitivity was 81.7%,and the diagnostic accuracy was72.3%.CONCLUSIONDynamic monitoring of patient PCT is more accurate in early diagnosis of urine derived sepsis and determine progression of urine derived sepsis,is more accurate in assessment anti-infection treatment curative,worth clinical recognition and promotion.

关 键 词：经皮肾镜术 降钙素原 尿源性脓毒症 C-反应蛋白 诊断指标 

分 类 号：R446[医药卫生—诊断学]