降钙素原对外科ICU全身炎症反应综合征患者病因诊断及预后的价值  

Value of serum procalcitonin determination for the etiological diagnosis and prognosis of systemic inflammatory response syndrome in surgical ICU

作　　者：陈笑[1] 宇世飞 李芳秋[1] 商秀娟[1] 刘倩[1] 胡毓安[1] 

机构地区：[1]南京大学医学院附属金陵医院(南京军区南京总医院)解放军临床检验医学研究所,南京医学硕士研究生210002

出　　处：《医学研究生学报》2016年第7期723-726,共4页Journal of Medical Postgraduates

基　　金：国家自然科学基金(81302536);南京军区医学科技创新重点课题(10Z027);江苏省科技支撑计划-社会发展项目(BE2009673)

摘　　要：目的全身炎症反应综合征（systemic inflammatory response syndrome,SIRS）可由感染和非感染因素引起,两者临床特征相似,但治疗和预后不同,需尽早区分。降钙素原（procalcitonin,PCT）在感染时快速大量合成,可作为早期快速诊断脓毒症的血清生物标志。文中回顾性分析血清PCT水平对外科ICU病房SIRS患者的病因诊断与预后价值。方法选择2014年6月1日至2015年6月1日期间南京军区南京总医院外科监护病房166例SIRS患者的数据进行分析,其中包括患者基本情况、原发疾病、实验室结果及临床转归。分析比较血培养结果、临床转归及血清PCT测定值。结果 166例SIRS患者中脓毒症131例,PCT中位数浓度为2.43（0.81-10.51）ng/m L,其中109例血清PCT阳性（≥0.47 ng/m L）,阳性率为83.2%;非感染性SIRS 35例,PCT中位数浓度为0.23（0.10-0.39）ng/m L,阳性率为17.14%。2组患者血清PCT及阳性率比较,差异有统计学意义（P〈0.05）。细菌和真菌所致脓毒症患者PCT阳性率分别为86.5%（83/96）和74.3%（26/35）,中位数浓度分别为4.28（1.05-14.59）和0.89（0.37-1.59）ng/m L,细菌感染组显著高于真菌感染组（P〈0.05）。脓毒症死亡和存活患者血清PCT阳性率分别为94.4%（34/36）和78.9%（75/95）,中位数浓度分别为12.89（4.76-47.73）和1.41（0.54-4.00）ng/m L,两者阳性率及血清PCT水平比较差异均有统计学意义（P〈0.05）。结论血清PCT水平可成为区分脓毒症和非感染SIRS的重要依据。细菌感染脓毒症患者血清PCT水平明显高于真菌感染组;脓毒症死亡组患者血清PCT水平显著高于存活患者。血清PCT测定有助于SIRS病因诊断和预后。Objective The systemic inflammatory response syndrome（SIRS） can be caused by infection and non-infection factors,which have similar clinical features but differ in treatment and prognosis.Rapid synthesis of procalcitonin（PCT） during infection can be used as a biomarker for the early diagnosis of sepsis.The present study aims to assess the value of the serum PCT level in the etiological diagnosis and prognosis of SIRS in the surgical ICU.Methods We retrospectively analyzed the data on 166 cases of SIRS from the surgical ICU in Jinling Hospital between June 2014 and June2015.The data obtained were associated with the patients＇ demographics,primary diseases,laboratory results,and clinical outcomes.We analyzed the serum PCT values,blood culture results,and clinical outcomes.Results Totally,131 of the patients were diagnosed with sepsis,with a median value of serum PCT of 2.43（0.81-10.51） ng/mL,of whom 109 were PCT-positive（≥0.47 ng/mL）,with a positive rate of 83.2%.Among the 35 non-infection SIRS patients,the mean level of serum PCT was 0.23（0.1-0.39）ng/mL,with a positive rate of 17.14%（6/35）.There were statistically significant differences between the two groups in both the serum PCT level and positive rate（P0.05）.The PCT-positive rate was significantly higher in the bacteria-infected than in the fungi-infected group（86.5% [83/96] vs 74.3% [26/35 ],P0.05）,with a median value of 4.28（1.05-14.59） ng/mL and 0.89（0.37-1.59） ng/mL,respectively,so was it in the survivors than in the non-survivors（94.4% [34/36]vs 78.9% [75/95],P〈0.05）,with a median value of 12.89（4.76-47.73） ng/mL and 1.41（0.54-4.00） ng/mL,respectively.Conclusion The serum PCT level might be used to distinguish between sepsis and non-infection SIRS,significantly higher in bacteria-infected and survival groups than in fungi-infected and non-survival groups.Serum PCT determination contributes to the etiological diagnosis and prognosis of SIRS.

关 键 词：降钙素原 脓毒症 诊断 预后 

分 类 号：R459.7[医药卫生—急诊医学]