血清降钙素原及白细胞介素-6对合并急性呼吸窘迫综合征的多器官功能不全患者的临床诊断价值  

Assessment of the application of procalcitonin and interleukin -6 to diagnose acute respiratory distress syndrome in patients with multiple organ dysfunction syndrome

作　　者：惠亮亮[1] 章向成[1] 安旭生[1] 李金芳[1] 臧奎[1] 尚福泰[1] 郑崇明[2] 张国新[3] 

机构地区：[1]南京医科大学附属淮安市第一人民医院ICU,江苏淮安223300 [2]南京医科大学第一附属医院ICU,江苏南京210029 [3]南京医科大学第一附属医院消化内科

出　　处：《徐州医学院学报》2016年第5期296-300,共5页Acta Academiae Medicinae Xuzhou

基　　金：国家自然科学基金（81270476）

摘　　要：目的研究监测血清降钙素原（PCT）及白细胞介素-6（IL-6）对合并急性呼吸窘迫综合征（ARDS）的多器官功能不全（MODS）患者的临床意义及指导价值。方法选取MODS合并ARDS的患者（MODS＋ARDS组）24例，非MODS的ARDS患者（ARDS组）18例及非ARDS的MODS患者（对照组）55例。检测患者入院后7、14、21、28天的血清PCT、IL-6和C反应蛋白（CRP）水平、白细胞（WBC）计数及氧合指数（PaO2／FiO2），比较PCT、IL-6及CRP在各组的敏感度及特异度，比较3组患者出院时的相关指标，使用ROC曲线分析PCT、CRP、WBC计数及IL-6对MODS合并ARDS诊断的敏感度。结果MODS＋ARDS组及ARDS组与同期对照组相比PCT和IL-6水平升高，差异有统计学意义（P〈0．05或P〈0．01）。MODS＋ARDS组中患者PCT的水平随ARDS严重程度升高而升高（P〈0．01）。MODS＋ARDS组及ARDS组与同期对照组相比PCT、IL-6的敏感度增强，差异有统计学意义（P〈0．05）。PCT及IL-6联合预测MODS合并ARDS的ROC曲线下面积达0．911。结论血清PCT和IL-6对MODS合并ARDS患者的诊断具有重要价值，并且血清PCT水平与ARDS严重程度有关。联合监测PCT及IL-6的动态变化有助于早期发现MODS患者ARDS的发生，改善预后。Objective To assess the application of serum procalcitonin （PCT） and interleukin 6 （IL -6） to treat acute respiratory distress syndrome （ARDS） in patients with multiple organ dysfunction syndrome （MODS）. Methods In the current study, 24 MODS patients with ARDS （Group MODS ＋ ARDS）, 18 ARDS patients without MODS （Group ARDS）, and 55 MODS patients without ARDS （Group control） were selected. Then, their levels of serum PCT, IL- 6, C -reactive protein （CRP）, as well as white blood cell （WBC） counts and oxygenation index （PaOJFiO2 ） were detected 7, 14, 21 and 28 days after admission. The sensitivity and specificity of PCT, IL- 6 and CRP as well as related indexes before discharge were compared. The ROC curve was plotted to analyze the sensitivity of PCT, CRP, WBC counts, and IL - 6 in MODS patients with ARDS. Results Compared with the control, Groups MODS ＋ ARDS and ARDS produced remarkably increased levels of PCT and IL - 6 （ P 〈 0.05 or P 〈 0.01 ）. The level of PCT in Group MODS ＋ ARDS was enhanced along with the elevated severity of ARDS （P 〈 0.01 ）. Compared with the control, Groups MODS ＋ ARDS and ARDS presented enhanced sensitivity of PCT and IL - 6 （ P 〈 0.05 ）. The area under the ROC curve was 0. 911 when a combination of PCT and IL -6 was used to predict MODS patients with ARDS. Conclusion Serum PCT and IL - 6 are essential to diagnose MODS patients with ARDS, and the level of PCT was related with the severity of MODS pa- tients with ARDS. Monitoring the dynamic changes of PCT and IL - 6 is helpful for early diagnosis of ARDS in patients with MODS and improving prognosis.

关 键 词：降钙素原 白细胞介素-6 急性呼吸窘迫综合征 多器官功能不全 

分 类 号：R459.7[医药卫生—急诊医学]