血浆Presepsin水平在脓毒症早期诊断中的价值研究  

Value of plasma Presepsin level in early diagnosis of sepsis

作　　者：周文杰[1] 张楠[2] 刘勤富 白吉佳 张珺[1] 王晓红[1] 杨晓军[1] 马希刚[1] 

机构地区：[1]宁夏医科大学总医院ICU科,宁夏银川750004 [2]宁夏医科大学总医院手术室,宁夏银川750004

出　　处：《中华医院感染学杂志》2017年第21期4846-4849,共4页Chinese Journal of Nosocomiology

基　　金：国家自然基金资助项目(81260853);宁夏医科大学校级科研基金资助项目(XM2016027)

摘　　要：目的探讨血浆可溶性白细胞分化抗原14亚型(Presepsin)水平对脓毒症早期诊断和病情评估的临床价值。方法采用前瞻性研究方法选取2016年9月-12月医院重症监护病房(ICU)住院治疗的80例危重病患者,依据脓毒症诊断标准分为脓毒症组40例、脓毒症休克组40例,选择同期20例健康体检者为对照组,入院时检测所有研究对象血浆Presepsin、降钙素原(PCT)、超敏C-反应蛋白(hs-CRP)水平,并进行急性生理学与慢性健康状况评分系统Ⅱ(APACHEⅡ)评分和序贯性器官功能衰竭(SOFA)评分,采用Pearson或Spearman相关分析法分析Presepsin与PCT、APACHEⅡ评分、SOFA评分的相关性;采用受试者工作特征曲线(ROC)评估Presepsin、PCT、hs-CRP对脓毒症的诊断价值。结果脓毒症休克组血浆Presepsin、PCT及hs-CRP水平均明显高于脓毒症组和健康对照组(P<0.01);脓毒症休克组APACHEⅡ评分和SOFA评分高于脓毒症组(P<0.01);Pearson相关分析结果显示,Presepsin与PCT呈显著正相关(r=0.517,P<0.01);Spearman相关分析结果显示,Presepsin与APACHEⅡ评分、SOFA评分呈显著正相关(r=0.554,r=0.605,P<0.01);ROC曲线分析显示:Presepsin、PCT、hs-CRP诊断脓毒症时的ROC曲线下面积(AUC)分别为(0.917,P<0.001;0.691,P<0.001;0.625,P>0.05)。结论血浆Presepsin水平可作为脓毒症患者早期诊断及评估病情严重程度和预后的有效指标。OBJECTIVE To explore the clinical value of plasma soluble leukocyte differentiation antigen 14 subtype（Presepsin）level in early diagnosis of sepsis and evaluation of illness condition.METHODS A total of 80 critically ill patients who were hospitalized for treatment in intensive care unit（ICU）from Sep 2016 to Dec 2016 were enrolled in the study by means of prospective study and were divided into the sepsis group with 40 cases and the septic shock group with 40 cases according to the criteria for diagnosis of sepsis,meanwhile,20 healthy people who received physical examination were set as the control group.The levels of plasma Presepsin,procalcitonin（PCT）and high-sensitivity C-reactive protein（hs-CRP）of all the enrolled patients were detected at the admission to the hospital,the acute physiology and chronic health evaluationⅡ（APACHEⅡ）score and the sequential organ failure assessment（SOFA）score were recorded,the correlation between the Presepsin and the PCT,APACHEⅡscore and SOFA score was observed by means of Pearson or Spearman correlative analysis method,and the value of the Presepsin,PCT and hs-CRP in diagnosis of sepsis was evaluated with the use of receiver operating characteristic（ROC）curve.RESULTS The levels of plasma Presepsin,PCT and hs-CRP of the septic shock group were higher than those of the sepsis group and the control group（P〈0.01）.The APACHEⅡ score and SOFA score of the septic shock group were significantly higher than those of the sepsis group（P〈0.01）.The Pearson correlation analysis indicated that the Presepsin was positively correlated with the PCT（r=0.517,P〈0.01）;the Spearman correlation analysis showed that the Presepsin was positively correlated with the APACHEⅡ score and SOFA score（r=0.554,r=0.605,P〈0.01）.The ROC curve analysis indicated that the area under ROC curve of the Presepsin,PCT and hs-CRP for diagnosis of sepsis were respectively 0.917,P〈0.001;0.691,P〈0.001;0.625,P〉0.05.CONCLUSIONThe plasma Presepsin level can be use

关 键 词：可溶性白细胞分化抗原14亚型 降钙素原 急性生理学与慢性健康状况评分系统Ⅱ 脓毒症 

分 类 号：R515.3[医药卫生—内科学]