降钙素原对危重症患者合并脓毒症早期诊断及预后预测的意义  

Significance of procalcitonin in early diagnosis and prognosis of critically ill patients with sepsis

作　　者：麻微微[1] 蒋永泼 MA Weiwei;JIANG Yongpo(Department of Clinical Laboratory, Taizhou Hospital in Zhejiang Province, Linhai 317000, China;Intensive Care Unit, Taizhou Hospital in Zhejiang Province, Linhai 317000, China)

机构地区：[1]浙江省台州医院检验科,浙江临海317000 [2]浙江省台州医院重症监护室,浙江临海317000

出　　处：《中国现代医生》2019年第7期133-136,共4页China Modern Doctor

基　　金：浙江省医药卫生科技计划(2017KY706)

摘　　要：目的探讨降钙素原(PCT)在危重症患者合并脓毒症早期诊断及预后预测的意义。方法选取2017年2月～2018年2月我院重症监护病房(ICU)收治的82例全身炎症反应综合征(SIRS)患者为研究对象,根据脓毒症的诊断标准分为脓毒症组(n=42)和非脓毒症组(n=40),在入院第1、3、5天分别检测患者PCT水平、白细胞(WBC)计数、C反应蛋白(CRP)水平以及慢性健康状况Ⅱ(APACHEⅡ)评分。以脓毒症患者来评价患者预后,存活32例(存活组)和死亡10例(死亡组),比较两组患者PCT水平、WBC计数、CRP水平、APACHEⅡ评分,通过受试者工作特征曲线(ROC)来评价差异指标对预后的预测价值。结果入院第1、3、5天时,脓毒症组PCT水平和APACHEⅡ评分均高于非脓毒症组,差异有统计学意义(P<0.05);脓毒症组WBC计数和CRP水平与非脓毒症组比较无显著差异(P>0.05)。脓毒症中死亡组PCT水平和APACHEⅡ评分均高于存活组,差异有统计学意义(P<0.05);死亡组WBC计数和CRP水平与存活组比较无显著性差异(P>0.05)。PCT水平用于预测患者预后的AUC、敏感性、特异性均高于APACHEⅡ评分。结论 PCT可用于危重症合并脓毒症患者的早期诊断和预后判断,准确性高,值得临床推广应用。Objective To investigate the significance of procalcitonin (PCT) in early diagnosis and prognosis of critically ill patients with sepsis. Methods 82 patients with systemic inflammatory response syndrome(SIRS) admitted in the intensive care unit (ICU) of our hospital from February 2017 to February 2018 were selected as subjects. According to the diagnostic criteria for sepsis, they were divided into the sepsis group (n=42) and the non-sepsis group(n=40). The PCT level, white blood cell (WBC) count, C-reactive protein and chronic health status Ⅱ(APACHE Ⅱ) score were measured at 1, 3, and 5 days after admission. Patients with sepsis were evaluated for prognosis, and 32 patients survived(survival group), and 10 patients died(death group). The PCT level, WBC count, CRP level, and APACHE Ⅱ score were compared between the two groups. The receiver operating characteristic curve (ROC) was used to evaluate the predictive value of differential indicators for prognosis. Results On the 1st, 3rd, and 5th day after admission, the PCT level and APACHE Ⅱ score of sepsis group were higher than those of non-sepsis group. The difference was statistically significant(P<0.05). There was no significant difference in WBC count and CRP level between non-septic group and sepsis group(P>0.05). The PCT level and APACHE Ⅱ score of dead patients were higher than those of survivors, and the difference was statistically significant(P<0.05). There was no significant difference in WBC count and CRP level between dead patients and survivors(P>0.05). The AUC, sensitivity, and specificity of PCT levels for predicting patient outcome were higher than that of APACHE Ⅱ scores. Conclusion PCT can be used for early diagnosis and prognosis of critically ill patients with sepsis, with high accuracy and is worthy of clinical application.

关 键 词：PCT APACHEⅡ评分 脓毒症 早期诊断 预后 

分 类 号：R459.7[医药卫生—急诊医学]