sCD14-ST在脓毒血症早期诊断中的应用  

sCD14-ST in the early diagnosis of sepsis

作　　者：廖娟[1] 林礼兴[1] 李扬宇[1] 秦雪君[1] 周子鑫[1] 陈蓉艳[1] 宋艳芳[1] 林青[1] 

机构地区：[1]福建中医药大学附属人民医院检验科,福建福州350004

出　　处：《检验医学》2016年第7期562-566,共5页Laboratory Medicine

基　　金：福建中医药大学校管科技类课题(XB2011011)

摘　　要：目的探讨可溶性白细胞分化抗原14亚型(s CD14-ST)在脓毒血症早期诊断中的临床应用价值。方法采用前瞻性研究,选取2012年3月至2014年8月疑似脓毒血症患者共50例,正常对照者30名。根据美国胸内科医师学会和危症监护医学学会(ACCP/SCCM)共识会议及临床相关表现将入选患者分为脓毒血症组、细菌感染性全身炎症反应综合征(SIRS)组、局部细菌感染组。收集50例患者入院治疗前、使用抗菌药物24 h、使用抗菌药物72 h及30名正常对照者的血浆和/或血清,检测其s CD14-ST、降钙素原(PCT)及C反应蛋白(CRP)水平。采用受试者工作特征(ROC)曲线研究s CD14-ST在脓毒血症早期诊断中的应用价值。结果入院治疗前,3个病例组血s CD14-ST、PCT和CRP水平均显著高于正常对照组(P<0.05),其中s CD14-ST水平在3个病例组之间差异有统计学意义(P<0.05),而脓毒血症组PCT和CRP水平与细菌感染性SIRS组比较,差异无统计学意义(P>0.05)。对脓毒血症组治疗前后的s CD14-ST、PCT和CRP的动态变化进行分析,s CD14-ST在入院治疗前、使用抗菌药物24 h和使用抗菌药物72 h 3个时间点的水平差异有统计学意义(P<0.05)。s CD14-ST、PCT和CRP的ROC曲线下面积分别为0.956、0.939和0.848。结论 s CD14-ST与PCT和CRP相比,在诊断脓毒血症中具有明显优势,可为诊断早期脓毒血症提供重要的临床依据。Objective To investigate the significance of soluble CD14-subtype（s CD14-ST）in the early diagnosis of sepsis. Methods Prospective study was used. A total of 30 healthy controls and 50 patients with suspected sepsis were enrolled from March 2012 to August 2014. According to the guidelines of American College of Chest Physicians/Society of Critical Care Medicine（ACCP/SCCM）,the 50 patients were classified into sepsis group,bacterial infection of systemic inflammatory response syndrome（SIRS）group and local bacterial infection group. Plasma and/or serum were/was collected at the first medical evaluation before any medical treatment and after the use of antibiotics for 24 h and 72 h. The levels of s CD14-ST,procalcitonin（PCT）and C-reactive protein（CRP）were determined. Receiver operating characteristic（ROC）curve was used to evaluate the role of s CD14-ST in the early diagnosis of sepsis. Results s CD14-ST,PCT and CRP levels were higher in 3 patient groups than in control group at the first medical evaluation before any medical treatment（P〈0.05）. There was statistical significance for s CD14-ST level among the 3 patient groups（P〈0.05）. There was no statistical significance for PCT and CRP levels between bacterial infection of SIRS and sepsis groups（P〉0.05）. The dynamic changes of s CD14-ST,PCT and CRP levels in sepsis group before and after treatment were analyzed. s CD14-ST level had statistical significance at the first medical evaluation before any medical treatment and after the use of antibiotics for 24 h and 72 h（P〈0.05）. The areas under ROC curves were 0.956 for s CD14-ST,0.939 for PCT and 0.848 for CRP, respectively. Conclusions s CD14-ST is better than PCT and CRP in the diagnosis of sepsis,which can provide a reference for the early diagnosis of sepsis.

关 键 词：可溶性白细胞分化抗原14亚型 降钙素原 C反应蛋白 脓毒血症 

分 类 号：R446.62[医药卫生—诊断学]