严重多发伤患者降钙素原对感染并发症的预测和辅助诊断价值  

Procalcitonin: a new parameter for the prediction and assisting diagnosis of infection complications in severe multiple trauma patients

作　　者：耿波[1] 徐祥[1] 梁华平[1] 罗艳[1] 

机构地区：[1]第三军医大学附属大坪医院野战外科研究所第一研究室,重庆400042

出　　处：《第三军医大学学报》2003年第15期1391-1393,共3页Journal of Third Military Medical University

摘　　要：目的　研究多发伤患者血浆降钙素原 (PCT)对伤后感染并发症的辅助和鉴别诊断价值。方法　应用双抗夹心免疫发光法测定 3 4例ISS≥ 16分的多发伤患者伤后血浆PCT含量 ,同时用ELISA法测定血浆TNF α、IL 6和C反应蛋白(CRP)含量 ,并与 11例健康对照比较 ,应用ROC曲线进行统计学处理。结果　伤后早期未并发感染的多发伤患者PCT、TNF α、IL 6、CRP出现不同水平升高 ;在伤后早期未并发感染患者感染前血浆TNF α和CRP与非感染组相比无显著差异 ,待并发感染后则明显升高 ,而血浆PCT和IL 6在整个观察期间感染组均明显高于非感染组 ;对感染并发症的辅助诊断价值 ,PCT的灵敏度最高 ,有较高的特异性、阳性预测值和阴性预测值。结论　对多发伤伤后感染并发症的辅助诊断 ,这些指标均有一定的临床价值 ,其中PCT是最好的伤后感染并发症的预测和辅助诊断指标。Objective To study the changes in tumor necrosis alpha(TNF α), interleukin 6(IL 6), procalcitonin(PCT) and C reactive protein (CRP) levels and their values in the prediction and assisting diagnosis of infection complications in severe multiple trauma patients. Methods TNF α, IL 6 and CRP were measured by enzyme linked immunosorbant assay(ELISA) and PCT was determined by immunoluminometric assay(ILMA) in serial samples of plasma from 34 patients with severe multiple trauma(ISS≥16) and compared with those of 11 normal control volunteers. Patients were divided into 2 groups(infection and non infection groups). The differences of the above parameters between groups were compared. In addition, all data were managed by receiver operating characteristic(ROC), and sensitivity, specificity, negative and positive predictive values for the diagnosis of infection complications were calculated. Results Plasma levels of TNF α, IL 6, PCT and CRP in multiple trauma patients without infection complications were increased differently in the early posttrauma period. TNF α and CRP levels in the early posttrauma period before infection were not significantly different from those in patients without infection complications, but they increased significantly following infection. However, during the whole observing period, plasma levels of PCT and IL 6 in the patients with infection complications were higher than those in patients without. The value of those parameters in assisting diagnosis of infection was evaluated. PCT was of the highest specificity and higher negative and positive predictive values. Conclusion All the parameters are of clinical value in infection diagnosis after severe multiple trauma. PCT is the best index for the prediction and assisting diagnosis of infection after multiple trauma.

关 键 词：多发伤 细胞因子 PCT 感染诊断 

分 类 号：R446.62[医药卫生—诊断学] R641[医药卫生—临床医学]