评估降钙素原和SOFA评分在细菌性脓毒症中的作用  

Effect evaluation of procalcitonin and SOFA score for patients in ICU with bacterial sepsis

作　　者：党晓燕[1] 秦勇[2] 王妮[1] 屈莉[1] 

机构地区：[1]西安交通大学第二附属医院急诊科,西安710004 [2]西安市中心医院普外二科

出　　处：《临床急诊杂志》2015年第5期351-354,共4页Journal of Clinical Emergency

摘　　要：目的:评估降钙素原(procalcitonin,PCT)与SOFA(sepsis-related organ failure assessment)评分在细菌性脓毒症中的作用。方法:回顾性分析细菌性脓毒症患者,抗生素使用前检测的PCT、超敏C反应蛋白(hypersensitive C-reactive protein,hs-CRP)、白细胞计数(WBC)水平及SOFA评分。比较存活组与死亡组PCT、hsCRP、WBC和SOFA评分的差异及相关性分析;比较不同浓度PCT时hs-CRP、WBC和SOFA评分;绘制受试者工作特征(ROC)曲线评估PCT、hs-CRP、WBC和SOFA评分对死亡及感染G-菌的预测意义。结果:与存活组比较,死亡组的PCT和SOFA评分均显著增高(P<0.05),且PCT与SOFA评分呈正相关(P<0.01)。ROC曲线证实PCT和SOFA评分对死亡有较高的预测价值。G-菌组PCT值显著高于G+菌组(P<0.05);而hs-CRP、WBC和SOFA评分在两组之间差异无统计学意义;PCT对G-菌的预测价值高。G-菌感染诊断的ROC曲线左上方最高点为2.05ng/ml,敏感度0.84,特异性0.67。结论:死亡组PCT和SOFA均明显增高且呈正相关,有较高的死亡预测价值。PCT对G-菌感染有预测价值,最佳截点为2.05ng/ml。Objective：To explore the role of procalcitonin （PCT） and sepsis-related organ failure assessment （SOFA） for patients in ICU with bacterial sepsis. Method：Patients in ICU with bacterial sepsis were retrospective- ly analyzed. PCT,hypersensitive C-reactive protein （hs-CRP） and white blood cell count （WBC） were detected be- fore the use of antibiotics. And SOFA score were assessed. The level of PCT,hs-CRP,WBC and SOFA score of the survival group and the death group were compared respectively and correlation analysis were carried out. The level of hs-CRP,WBC and SOFA score were compared when the concentrations of PCT were different. Drew the receiv- er-operating characteristic curve（ROC） to assess the predicted role of PCT, hs-CRP, WBC and SOFA score for death and G- bacteria infection. Result：Compared to the survival group, the level of PCT and SOFA score of the death group significantly in creased （P^0.05）. And PCT was positively related with SOFA score（P^0.01）. ROC curves proved PCT and SOFA score had higher predictive value for death. The level of PCT in the Gram-negative bacteria group were higher than that in the Gram-positive bacteria group（P〈0. 05）. There were not statistical differences of the level of hs-CRP, WBC and SOFA score between the two groups. ROC curve showed PCT had higher predictive value to Gram-negative bacteria infection. At the highest point of the upper left on the curve,the concentration of PCT was 2.05 ng/ml,the sensitivity was 0.84 %and the specificity was 0.67 %. Conclusion：The levels of PCT and SOFA score of the death groups were significantly higher than those of the survival group. PCT was positively related with SOFA score. PCT and SOFA score had higher predictive value for death. PCT had high- er predictive value to Gram-negative bacteria infection. The best cutoff point of PCT for patient with Gram-negative bacteria infection was 2.05 ng/ml.

关 键 词：脓毒症 降钙素原 SOFA评分 G+/G-菌 

分 类 号：R631[医药卫生—外科学]