血清PCT及D-D检测在急诊脓毒症患者病情以及预后的评估中的价值  

Value of serum PCT and D-D in the assessment of the condition and prognosis of patients with acute sepsis

作　　者：李爱光[1] 周康[1] 孙孟良 田国欣 马红军[1] 王雪[2] LI Ai-guang;ZHOU Kang;SUN Meng-liang;TIAN Guo-xin;MA Hong-jun;WANG Xue(Intensive Care Unit,Xi’an Aerospace General Hospital,Xi’an,Shaanxi　710100,China)

机构地区：[1]西安航天总医院重症医学科,陕西西安710100 [2]西安交通大学第一附属医院重症医学科,陕西西安710061

出　　处：《临床肺科杂志》2018年第5期828-831,共4页Journal of Clinical Pulmonary Medicine

摘　　要：目的探讨早期检测血清降钙素原(PCT)、D-二聚体(D-D)对于急诊脓毒症患者病情评估及预后预测中的临床价值。方法选取2013年8月至2016年8月我院诊治的急诊脓毒症患者80例进行研究,根据病情分为脓毒症组37例、严重脓毒症组30例、感染性休克组13例,根据治疗结局分为存活组54例、死亡组26例,检测并对比各组患者血清PCT、D-D水平,并采用受试者工作曲线分析血清PCT、D-D预测患者预后的临床价值。结果脓毒症组、严重脓毒症组、感染性休克组三组患者的血清PCT[(3.54±1.26)ng/m L、(10.93±2.89)ng/m L、(17.62±3.08)ng/m L]、D-D[(1.59±0.63)mg/L、(3.32±1.20)mg/L、(5.03±1.85)mg/L]、WBC[(13.58±2.77)10~9/L、(17.19±3.02)10~9/L、(21.63±5.94)10~9/L]、APACHEⅡ评分[(11.63±4.15)分、(15.26±5.58)分、(20.41±6.33)分]、死亡率(5.41%、43.33%、84.62%)均逐渐升高,组间比较差异均具有统计学意义(F=48.853,F=33.627,F=29.084,χ~2=30.082,P<0.05),感染性休克组患者的中性粒细胞(94.58±9.77)%,比例高于脓毒症组(83.52±8.610)%、严重脓毒症组(85.00±9.14)%(t=4.410,t=3.309,P<0.05);入院24h内,死亡组脓毒症患者的血清PCT(12.69±2.98)ng/m L、D-D(4.39±1.69)mg/L,均高于存活组(6.63±2.52)ng/m L、(2.03±1.17)mg/L,差异具有统计学意义(t=9.487,t=7.278,P<0.05);当血清PCT值为7.86ng/m L时,PCT预测脓毒症患者死亡的灵敏度为82.90%、特异度为78.42%,曲线下面积AUC值为0.847;当血清D-D值为2.63 mg/L时,D-D预测脓毒症患者死亡的灵敏度为76.51%、特异度为70.84%,曲线下面积AUC值为0.797。结论早期检测血清PCT、D-D对于急诊脓毒症患者病情评估及预后预测、指导治疗、具有重要的临床意义。Objective To investigate the clinical value of early detection of serum calcitonin(PCT)and D-Dimmer(D-D)in patients with emergency sepsis and prognosis prediction.Methods From August 2013 to August 2016,80 patients with sepsis were divided into the sepsis group(37 cases),the severe sepsis group(30 cases)and the septic shock group(13 cases).According to the outcome of treatment,they were also divided into the survival group(54 cases)and the death group(26 cases).The levels of serum PCT and D-D were detected,and the clinical value of serum PCT and D-D in predicting prognosis was analyzed by receiver operating curve.Results The levels of serum PCT were[(3.54±1.26)ng/mL,(10.93±2.89)ng/mL,(17.62±3.08)ng/mL],the levels of D-D were[(1.59±0.63)mg/L,(3.32±1.20)mg/L,(5.03±1.85)mg/L],the levels of WBC were[(13.58±2.77)10 9/L,(17.19±3.02)10 9/L,(21.63±5.94)10 9/L],the score of APACHEⅡwas[(11.63±4.15),(15.26±5.58),(20.41±6.33)],and the mortality was(5.41%,43.33%,84.62%)respectively in the sepsis group,the severe sepsis group and the septic shock group(F=48.853,F=33.627,F=29.084,χ2=30.082,P<0.05).The percentage of neutrophils in the septic shock group(94.58±9.77)%was higher than that in the sepsis group(83.52±8.610)%,and the severe sepsis group(85.00±9.14)%(t=4.410,t=3.309,P<0.05).The level of serum PCT was(12.69±2.98)ng/mL and D-D was(4.39±1.69)mg/L in the death group,which were higher than those in the survival group(6.63±2.52)ng/mL,(2.03±1.17)Mg/L(t=9.487,t=7.278,P<0.05).When the serum PCT value was 7.86 ng/mL,the sensitivity of PCT predicting death in sepsis was 82.90%,the specificity was 78.42%,and the area under the curve AUC was 0.847.When the serum D-D value was 2.63 mg/L,the sensitivity of D-D predicting death in sepsis was 76.51%,the specificity was 70.84%,and the area under the curve was 0.797.Conclusion The early detection of serum PCT and D-D in patients with acute sepsis disease has important clinical significance on its assessment and prognosis.

关 键 词：早期 降钙素原 D-二聚体 脓毒症 预后 

分 类 号：R459.7[医药卫生—急诊医学]