动态监测血清CRP和PCT水平对脓毒症患者预后判断的临床价值  

The Clinical Value of Dynamic Monitoring of Serum Procalcitonin and C-reactive Protein Levels for the Prognostic Evaluation of Sepsis

作　　者：左姝[1] 于凯江[2] 王洪亮[1] 郜杨[1] 刘海涛[2] 

机构地区：[1]哈尔滨医科大学附属第二医院重症医学科,黑龙江哈尔滨150086 [2]哈尔滨医科大学附属第三医院重症医学科,黑龙江哈尔滨150086

出　　处：《现代生物医学进展》2016年第24期4664-4667,共4页Progress in Modern Biomedicine

基　　金：国家自然科学基金项目(81571871)

摘　　要：目的:探讨动态监测血清C反应蛋白(CRP)和降钙素原(PCT)水平对脓毒症患者预后判断的临床应用价值。方法:选择我院重症监护病房2015年1月至2016年3月收治的116例脓毒症患者为研究对象,根据其28 d生存情况分为存活组和死亡组,比较两组患者入院第1、2、3、5、7 d的血清CRP、PCT水平的动态变化,入院第1 d白细胞、乳酸、APACHEⅡ评分和SOFA评分的差异,并分析血清CRP、PCT水平与APACHEⅡ评分和SOFA评分的相关性。结果:存活组和死亡组患者第1、2、3和5 d CRP水平无统计学差异,但死亡组患者第7 d CRP水平明显高于存活组,差异具有统计学意义(P<0.05);存活组和死亡组患者第1、2和3 d PCT水平无统计学差异,但死亡组患者第5、7 d PCT水平明显高于存活组,差异具有统计学意义(P<0.05);入院1 d,死亡组SOFA评分、APACHE II评分明显高于存活组,差异有统计学意义(P<0.05);入院第7 d,患者CRP水平与SOFA评分和APACHE II评分呈正相关(R分别为0.387和0.396,P均<0.01);入院第7 d,患者PCT水平与SOFA评分和APACHE II评分呈正相关(R分别为0.472和0.464,P均<0.01);CRP为10.0 mg/L时敏感性为79.2%,特异性为70.8%。PCT为2.0μg/L时敏感性为76.3%,特异性为69.4%。结论:CRP、PCT可以评价脓毒性患者的严重程度,并且动态观察其变化有助于预测脓毒症患者的预后。Objective： To investigate the clinical value of dynamic monitoring of serum procalcitonin（PCT） and c-reactive protein （CRP） levels for the prognostic evaluation of sepsis. Methods： A prospective study was performed on 116 cases of sepsis patients in the intensive care unit of our hospital. The patients were divided into the survival group and death group according to the 28 d survival. The serum CRP and PCT levels on the 1st, 2nd, 3rd, 5th, 7th day after admission were detected and compared. The CRP, PCT, WBC, LAC, APACHE II score and SOFA score on the 1st after admission were compared, and the correlation of serum CRP, PCT levels with APACHE II score and SOFA score were analyzed. Results： There was no significant difference of CRP on the 1st, 2nd, 3rd, 5th, day after admission between survival group and death group, but CRP of the death group on the 7th day after admission was higher than that of the survival group（P〈0.05）. PCT of the death group on the 5th, 7th day after admission were higher than those of the survival group（P〈0.05）. The APACHE II score and SOFA score of death group were significantly higher than those of the survival group（P〈0.05）. The CRP level of patients on the 7th day after admission was positively correlated with the APACHE II score and SOFA score （R were 0.396 and 0.387）. The PCT levels of patients on the 7th day after admission was positively correlated with the APACHE II score and SOFA score （R were 0.464 and 0.472）. The sensitivity was 79.2 % and specificity was 70.8 % when CRP was 10.0 mg/L. The sensitivity was 76.3 % and the specificity was 69.4 % when PCT was 2.0 μg/L. Conclusion： Peripheral blood CRP and PCT levels could be used for evaluating the severity of sepsis, which could predict the severity of illness.

关 键 词：C反应蛋白 降钙素原 脓毒症 

分 类 号：R631.2[医药卫生—外科学]