肝素结合蛋白和降钙素原及C反应蛋白在脓毒症早期诊断中的价值比较  

Comparison of the clinical value of plasma heparin-binding protein, procalcitonin and C-reactive protein in the early diagnosis of sepsis

作　　者：钱定良[1] 闫绍荣 潘晓荷 

机构地区：[1]温州医科大学附属第三医院检验科,瑞安市325200 [2]温州市中心医院检验科

出　　处：《中华检验医学杂志》2017年第6期451-455,共5页Chinese Journal of Laboratory Medicine

摘　　要：目的探讨肝素结合蛋白（HBP）在脓毒症诊断及分级中的临床应用价值。方法采取回顾性研究方法，选取2014年8月至2016年11月在温州医科大学附属第三医院和温州市中心医院ICU就诊的脓毒症患者31例、严重脓毒症患者16例、脓毒性休克患者12例及局部感染非脓毒症患者37例，测定各组患者HBP、降钙素原（PCT）及C反应蛋白（CRP）水平，利用非参数检验分析比较各组间检测指标的差异；通过ROC曲线分析各检测指标对脓毒症的检测效能；Spearman相关检验分析HBP、PCT及CRP与多项临床及实验室指标的相关性。结果HBP在严重脓毒症[（100.65±58.82）ng/ml与（31.86±36.87）ng/ml，Z＝-3.856，P〈0.05；（100.65±58.82）ng/ml与（24.96±17.49）ng/ml，Z＝-3.556，P〈0.05]及脓毒性休克[（148.28±99.73）ng/ml与（31.86±36.87）ng/ml，Z＝-4.432，P〈0.05；（148.28±99.73）ng/ml与（24.96±17.49）ng/ml，Z＝-4.157，P〈0.05]患者中升高，CRP[（154.64±62.90）mg/L与（92.56±67.49）mg/L，Z＝-2.749，P〈0.05；（154.64±62.90）mg/L与（79.21±51.80）mg/L，Z＝-3.218，P〈0.05]及PCT[（32.86±39.93）ng/ml与（2.70±6.24）ng/ml，Z＝-3.395，P〈0.05；（32.86±39.93）ng/ml与（4.21±14.94）ng/ml，Z＝-4.092，P〈0.05]仅在脓毒性休克患者中升高，与对照和脓毒症组相比，差异有统计学意义；HBP的ROC曲线下面积最大（AUC＝0.687）且具临床诊断意义（P〈0.05），最佳诊断界值（18.58 ng/ml）时具有较优检测敏感度（0.729）；HBP（APTT：r＝0.244，P＝0.016；PT：r＝0.351，P〈0.001；INR：r＝0.314，P＝0.002；D二聚体：r＝0.334，P＝0.001；血乳酸：r＝0.394，P〈0.001）、CRP（APTT：r＝0.271，P＝0.008；PT：r＝0.348，P＝0.001；INR：r＝0.264，P＝0.009；D二聚体：r＝0.257，P＝0.012；血乳酸：r＝0.329，P＝0.001）及PCT（APTT：r＝0.375，P〈0.001；PT：r＝0.523，P〈0.001；INR：r＝0.535，P〈0.001；D二聚体�Objective To assess the clinical utility of measurement of plasma heparin-binding protein （HBP） in diagnosis and prognosis of sepsis. Methods This is a retrospective study on the performance of plasma heparin-binding protein, procaleitonin and C-reaction protein in the early diagnosis of sepsis. Thirty-one patients with sepsis, 16 patients with severe sepsis, 12 patients with septic shock and 37 control patients without confirmed sepsis, all admitted to the Intensive Care Units （ ICU ） of the Third Hospital Affiliated to Wenzhou Medical University and Wenzhou Central Hospital from August 2014 to November 2016, were enrolled in the study. The plasma level of HBP, procalcitonin （PCT） and C-reactive protein （CRP） were measured, and the detailed clinical data were retrieved from the patient chart records for all patients described above. Comparison of each laboratory and clinical parameters between groups was earried out by Non-parameter Test. The efficiency of each parameter was calculated by receiver operating charaeteristies eurves（ ROC ） analysis. The eorrelation between HBP, PCT or CRP and clinieal or other laboratory parameters was explored using Spearman correlation analysis. Results HBP was significantly elevated in patients with severe sepsis [ （100. 65 ±58.82）ng/ml and （31.86 ± 36. 87 ）ng/ml, Z = -3. 856, P 〈 0. 05 ; （ 100. 65 ±58.82 ） ng/ml and （24. 96 ± 17.49 ） ng/ml ,Z = - 3. 556,P 〈 0. 05 ] and in patients with septie shock[ （ 148.28 ± 99.73 ） ng/ml and （ 31.86 ± 36. 87 ） ng/ml, Z = - 4. 432, P 〈 0. 05 ; （ 148.28 ± 99.73 ） ng/ml and（24. 96 ± 17.49） ng/ml, Z = - 4. 157, P 〈 0. 05 ], respeetively, while CRP [ （ 154. 64 ± 62. 90） mg/L and （92.56 ± 67.49） rag/L, Z = - 2. 749, P 〈 0. 05 ; （ 154.64 ± 62. 90） mg/L and （79. 21 ± 51.80） mg/L,Z = - 3. 218, P 〈 0. 05 ] and PCT [ （ 32.86 ± 39. 93 ） ng/ml and （ 2. 70 ± 6.24 ） ng/ml, Z = -3.395,P〈0.05;（32.86 ±39.93）ng/ml and（4.21 ± 14. 94）ng/ml,Z= - 4. 09

关 键 词：血蛋白质类 载体蛋白质类 抗微生物阳离子肽类 脓毒症 C反应蛋白质 降钙素 

分 类 号：R459.7[医药卫生—急诊医学]