炎性指标对住院严重感染患者病情的评估效果研究  

Effects of inflammatory indexes on evaluation of illness condition of hospitalized patients with severe infection

作　　者：谈晨[1] 陈炜[1] 张雷[1] 杨挺[1] 黄铭[1] TAN Chen;CHEN Wei;ZHANG Lei;YANG Ting;HUANG Ming(Third People＇s Hospital of Wuxi,Wuxi,Jiangsu 214000,China)

机构地区：[1]无锡市第三人民医院ICU,江苏无锡214000

出　　处：《中华医院感染学杂志》2018年第22期3378-3380,3384,共4页Chinese Journal of Nosocomiology

基　　金：江苏省医学会/康缘药业临床医学科研专项基金资助项目(2015JZKY7)

摘　　要：目的探究前降钙素(PCT)、C-反应蛋白(CRP)、白细胞计数等炎性指标对于加强医疗科(ICU)脓毒症患者感染严重程度以及预后效果的诊断评估价值。方法选取2016年1月-2017年1月转入ICU进行治疗的174例患者为研究对象,根据脓毒症诊断标准将患者分为非脓毒症组和脓毒症组,其中非脓毒症组96例,脓毒症组78例。转入ICU第一天时检测患者PCT、CRP、外周血白细胞计数(WBC)、白细胞介素-6(IL-6)、乳酸浓度(Lac)等炎性指标水平,记录患者急性生理与慢性健康评分Ⅱ(APACHEⅡ)以及序贯器官衰竭评分(SOFA)。结果转入ICU时脓毒症组患者PCT、CRP、WBC、IL-6、Lac水平均显著高于非脓毒症组患者,差异具有统计学意义(P<0.05)。脓毒症根据严重程度分组比较发现,一般脓毒症组、严重脓毒症组以及MODS组间PCT、CRP、WBC、APACHEⅡ以及SOFA比较差异均具有统计学意义(P<0.05)。ROC曲线显示PCT、Lac、APACHEⅡ评分以及SOFA评分与感染严重程度呈正相关关系,且PCT对于早期诊断脓毒症的特异度最高,优于其他指标。结论炎性指标与感染患者病情严重程度存在明显的相关性,其中PCT对于由感染引起的全身炎症反应综合征具有良好的诊断预测价值,其浓度越高提示患者感染程度越重,临床可对其进行观察以控制患者病情。OBJECTIVE To explore the effects of the inflammatory indexes such as procalcitonin（PCT）,C-reactive protein（CRP）and white blood cell（WBC）counts on evaluation of severity of sepsis in intensive care unit（ICU）patients and prediction of treatment outcomes.METHODS A total of 174 patients who were transfer to ICU for treatment from Jan 2016 to Jan 2017 were recruited as the stud objects and divided into the non-sepsis group with 96 cases and the sepsis group with 78 cases according to the criteria for diagnosis of sepsis.The levels of PCT,CRP,peripheral blood WBC counts,interleukin-6（IL-6）and lactic acid（Lac）of the patients were detected on the first day of transfer to ICU.The Acute Physiology and Chronic Health Evaluation（APCHE）II score and Sequential Organ Failure Assessment（SOFA）score of the patients were recorded.RESULTS The levels of PCT,CRP,WBC,IL-6 and Lac of the sepsis group were significantly higher than those of the non-sepsis group（P〈0.05）.According to the severity of sepsis,there were significant differences in the PCT,CRP,WBC,APCHEⅡscore and SOFA score among the general sepsis group,the severe sepsis group and the MODS group（P〈0.05）.The ROC curve indicated that the severity of infection was positively correlated with the PCT,Lac,APCHEⅡscore and SOFA score,and the specificity of the PCT was the highest in the early diagnosis of sepsis,higher than that of other indexes.CONCLUSION The severity of infection shows significant association with the inflammatory indexes,the serum PCT shows favorable value in diagnosis and prediction of systemic inflammatory response syndrome induced by the infection,the higher the level of the serum PCT is,the severer the infection;it is necessary for the hospital to control the illness condition based on the serum PCT level.

关 键 词：前降钙素 C-反应蛋白 炎性指标 脓毒症 

分 类 号：R631[医药卫生—外科学]