降钙素原和常用炎症指标在严重脓毒症中表达及临床意义

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1、降钙素原和常用炎症指标在严重脓毒症中表达及临床意义Clinicalsignificanceofprocalcitoninandcommoninflammatorymarkersinpatientswithseveresepsis【Abstract】Objective  Tostudythediagnosticvalueofprocalcitonin(PCT)andcommoninflammatorymarkersinpatientswithseveresepsis.MethodsPatientswereobservedcontinuouslyinaperspectivestudywithd

2、iagnostictests.AccordingtothedefinitionofACCP/SCCMConsensusConference,patientswereclassifiedinto2groups,includingsepsisgroupandseveresepsisgroup.IndexesofinflammationandconcentrationofPCT，Creactiveprotein(CRP)andwhitebloodcells(WBC)weredeterminedat24hours,andtheircorrelationwasanalyzed.Resultsoneh

3、undredandninepatientswereenrolled,including52insepsisgroup,59inseveresepsisgroup.PCT，CRPandwbclevelsweresignificantlyhigherinseveresepsisgroup,PCTconcentrationswerepositivelycorrelatedwiththeCRPandwbclevels.Spearman′scorrelationcoefficientwas0.260（P=0.006）and0.443(P＝0.000).Inthediagnosisofseverese

4、psis,PCTyieldedthesignificantlyhighestdiscriminativevalue,withanAUCof0.872(CI,0.795 to0.928),followedbyWBC(0.747;CI,0.654 to0.825;P=0.026),andCRP(0.736;CI,0.643 to0.816;P=0.009).Atacutoffof0.9 ng/ml,PCTyieldedasensitivityof73.7%andaspecificityof84.6%todifferentiatepatientswithseveresepsisfromnon-s

5、everesepsis.MedianPCTconcentrationsonadmission(ng/ml,range)were0.34（0.16to0.73）forsepsis;2.79（0.58to5.38）forseveresepsis(P< 0.001).Conclusion  PCTcombiningwiththetraditionalinflammatorymarkersishelpfulforthediagnosisofseveresepsis，PCTyieldedthesignificantlyhighestdiscriminativevalue.     【Keywords

6、】severesepsis;procalcitonin;Creactiveprotein;whitebloodcells摘要：目的对降钙素原和临床常用指标(C反应蛋白,白细胞计数)进行联合检测，评价它们在严重脓毒症中的诊断价值。方法 ：采用前瞻性、临床病例观察及诊断试验研究。根据美国胸科医师协会/危重病医学会(ACCP/SCCM)共识会议，严格将入选病例分为非严重脓毒症组、严重脓毒症组。测定24小时内的炎症指标、降钙素原浓度并进行统计分析。结果109例患者入选，其中脓毒症组52例，严重脓毒症组59例。三项炎症指标在严重脓毒症组的表达都有显著升高，与脓毒症组比较差异均有统计学意义。相关分析

7、表明，PCT的表达与CRP和WBC的表达呈正相关，Spearman相关系数分别为0.260（P=0.006），0.443(P＝0.000)。受试者工作特征曲线(ROC曲线)分析发现，PCT的曲线下面积0.872(0.795，0.928),WBC为0.747（0.654 ，0.825；P=0.026)，CRP为0.736（0.643 ，0.816；P=0.009)。PCT与CRP及WBC的曲线下面积比较，差别均有统计学意义