血清PCT、IL-6、NT-proBNP、CTnI和D-D测定水平在急诊脓毒症患者早期诊断中的临床研究  

The Clinical Study of Determining Serum Procalcitonin,Interleukin-6,N-terminal pro B-type Netriuretic Peptide,Cardiac Troponin I and D-dimer Levels in Early Diagnosis of Sepsis In Emergency Department

作　　者：赵若愚[1] 鲍逸民[1] 杨永青[2] 

机构地区：[1]南京医科大学附属苏州医院急诊科,江苏苏州215002 [2]南京医科大学附属苏州医院核医学科,江苏苏州215002

出　　处：《标记免疫分析与临床》2016年第6期613-616,共4页Labeled Immunoassays and Clinical Medicine

摘　　要：目的为了探讨急诊脓毒症患者早期诊断中测定血清降钙素原(procalcitonin,PCT)、白介素-6(interleukin-6,IL-6)、N端脑利钠肽前体(n-terminal pro B-type netriuretic peptide,NT-pro BNP)、肌钙蛋白I(cardiac troponin I,CTn I)和D-二聚体(Ddimer,D-D)水平的临床意义。方法采用化学发光免疫分析、超敏酶免疫分析和荧光免疫分析测定了急诊就诊患者439例,其中307例诊断为急诊脓毒症患者(包括236例严重脓毒症和71例脓毒症休克)和普通感染患者132例,以及86例正常对照组血清生物标志物(PCT、IL-6、NT-pro BNP、CTn I和D-D)水平,并进行了对比性分析。采用受试者工作特征曲线(receiver operating characteristic curve,ROC曲线)分析PCT、IL-6、NT-pro BNP、CTn I和D-D评估急诊脓毒症患者早期诊断的临床价值。结果 307例急诊脓毒症患者血清PCT、IL-6、NT-pro BNP、CTn I和D-D水平较之86例正常对照组明显增高(P分别为<0.001,<0.001,<0.01,<0.001和<0.001),并且随疾病严重程度而增高。132例普通感染患者血清PCT、NTpro BNP、CTn I和D-D水平正常(P均>0.05),仅血清IL-6水平轻度增高(P<0.05)。ROC曲线对急诊脓毒症早期诊断预测的价值评估表明:五种生物标志物均具有急诊脓毒症早期诊断的价值,以PCT为最佳,其后依次为IL-6、NT-pro BNP、CTn I和D-D。结论生物标志物(PCT、IL-6、NT-pro BNP、CTn I和D-D)是急诊脓毒症早期诊断和病情严重程度评估的有价值指标。Objective To explore early diagnostic value of Procalcitonin （PCT）, Interleukin-6 （IL-6）, N-terminal pro B-type Netriuretic Peptide （NT-proBNP）, Cardiac Troponin I （CTnI） and D-dimer （D-D） in sepsis in emergency department. Methods The serum biomarkers PCT, IL-6,NT-proBNP, CTnI and D-D were tested in 439 patients, 307 patients with emergency department sepsis （including 236 cases as severe sepsis and 71 cases as sepsis shock）; 132 patients had nonspecific infection and 83 healthy controls. Chemi-luminesence immunoassay, high sensitive enzyme immunoassay and flurorescence immunoassay were compared in the analysis. The receive operating characteristic （ROC） curve was plotted to analyze PCT, IL-6, NT-proBNP, CTnI and D-D. Results The serum levels of PCT, IL-6, NT-proBNP, CTnI and D-D in 307 patients with emergency department sepsis were significantly higher than those in 83 controls （P 〈 0.001 in each analysis）. The serum levels of PCT, NT- proBNP, CTnI and D- D in 132 patients with nonspecific infection were unchanged （all P 〉 0.05） ; IL- 6 level was slightly increased （P 〈0.05）. ROC curve analysis showed that five biomarkers all have early diagnosis value in emergency department sepsis; among which, PCT was the best, followed by IL-6, NT-proBNP, CTnI and D-D. Conclusion The biomarkers （PCT, IL-6, NT-proBNP, CTnI and D-D） were valuable indicators for early diagnosis and severity assessment in emergency department sepsis.

关 键 词：急诊脓毒症 严重脓毒症 脓毒症休克 生物标志物 早期诊断 有价值指标 

分 类 号：R459.7[医药卫生—急诊医学]