血清PCT、CRP及内毒素对G^-菌血流感染所致脓毒症病情的指导意义  

Significance of serum PCT,CRP and endotoxin on sepsis caused by G^-bacterial bloodstream infection

作　　者：段红茹 DUAN Hongru(Department of Laboratory,Baoding First Central Hospital,Baoding,071000,China)

机构地区：[1]保定市第一中心医院东院检验科,河北保定071000

出　　处：《临床血液学杂志（输血与检验）》2020年第4期545-549,共5页Journal of Clinical Hematology(Blood Transfusion & Laboratory Medicine)

摘　　要：目的:探讨血清降钙素原(PCT)、C反应蛋白(CRP)、内毒素对革兰氏阴性(G^-)菌血流感染所致脓毒症病情和预后的关系,为临床治疗提供指导。方法:纳入126例G^-菌血流感染所致脓毒症患者进行血清PCT、CRP、内毒素水平检测,分析不同感染程度(脓毒症、严重脓毒症、脓毒症休克)、急性生理学与慢性健康状况评分系统Ⅱ(APACHEⅡ)评分、序贯器官衰竭(SOFA)评分、预后(存活、死亡)患者血清PCT、CRP、内毒素水平差异。Pearson相关性分析血清PCT、CRP、内毒素与APACHEⅡ评分、SOFA评分之间的关联程度和方向。受试者工作特征曲线(ROC)分析PCT、CRP、内毒素鉴别G^-菌血流感染所致严重脓毒症/脓毒症休克的效能以及对患者预后的预测价值。结果:血清PCT、CRP、内毒素水平在不同感染程度、APACHEⅡ和SOFA评分患者中差异有统计学意义(P<0.05),死亡组患者血清PCT、CRP、内毒素水平高于存活组(P<0.05)。相关性分析结果显示,PCT与APACHEⅡ评分、SOFA评分呈高度正相关(r=0.661、0.682,P均<0.001),CRP、内毒素分别与APACHEⅡ评分、SOFA评分呈中低度正相关(r=0.375、0.413、0.312、0.391,P均<0.05)。ROC分析结果示PCT鉴别严重脓毒症/脓毒症休克,预测患者预后的曲线下面积分别达0.784(95%CI:0.639~0.928,P=0.002)、0.935(95%CI:0.880~0.991,P=0.000),高于CRP和内毒素。结论:血清PCT、CRP、内毒素水平与G^-菌血流感染所致脓毒症患者病情危重程度、预后均存在密切关系,PCT能更好的判断G^-菌血流感染所致脓毒症患者病情严重程度和不良预后。Objective:To explore the relationship between serum procalcitonin(PCT),C-reactive protein(CRP),endotoxin and disease condition and prognosis on sepsis patients caused by Gram-negative(G^-)bacterial bloodstream infection,and provide guidance for clinical treatment. Method:Serum PCT,CRP and endotoxin levels were measured in 126 patients with sepsis caused by G-bacterial bloodstream infection.The levels of PCT,CRP and endotoxin in patients with different infection degrees(sepsis,severe sepsis,septic shock),acute physiology and chronic health score II(APACHE II),sequential organ failure(SOFA)score and prognosis(survival,death)were compared.Pearson correlation analysis was used to analyze the correlation degree and direction between serum PCT,CRP,endotoxin and APACHE II score,SOFA score.Receiver operating characteristic curve(ROC)was used to analyze the efficacy of PCT,CRP and endotoxin in differentiating severe sepsis/sepsis shock caused by G-bacterial bloodstream infection and predicting the prognosis of patients. Result:The levels of serum PCT,CRP and endotoxin in patients with different infection degree,APACHE II and SOFA score were significantly different(P<0.05).The levels of serum PCT,CRP and endotoxin in the death group were higher than those in the survival group(P<0.05).The results of correlation analysis showed that PCT was positively correlated with APACHE II score and SOFA score(r=0.661,0.682,P<0.001).CRP and endotoxin were positively correlated with APACHE II score and SOFA score(r=0.375,0.413,0.312,0.391,P<0.05).ROC analysis showed that the area under curve of PCT was 0.784(95% CI:0.639-0.928,P=0.002)and 0.935(95% CI:0.880-0.991,P=0.000),respectively,which were higher than those of CRP and endotoxin.Conclusion:Serum PCT,CRP and endotoxin levels may be closely related to the severity and prognosis of sepsis patients caused by G-bacterial bloodstream infection.PCT can better judge the severity and adverse prognosis of sepsis patients caused by G-bacterial bloodstream infection.

关 键 词：降钙素原 C反应蛋白 内毒素 G^-感染 脓毒症 

分 类 号：R457.1[医药卫生—治疗学]