【摘要】 目的:探讨血清降钙素原水平对急诊严重脓毒症患者早期诊断和病情评估的临床意义。方法:60例患者分为脓毒症组20例,严重脓毒症组40例。在24 h内检测2组患者血清白细胞计数、C反应蛋白和降钙素原水平,计算急性生理与慢性健康状况评分Ⅱ(APACHEⅡ),并绘制受试者工作特征曲线(ROC曲线)。另外,根据28 d后的生存结局,将严重脓毒症组分为存活组18例,死亡组22例。采用多因素logistic回归分析筛选其预测死亡的独立危险因素。结果:严重脓毒症组同脓毒症组相比,降钙素原(17.02±2.09)vs(1.85±0.31)ng/mL,白细胞计数(17.96±9.45)vs(11.11±4.95)×109/L,APACHEⅡ评分(25.63±6.56)vs(15.00±6.58),均有统计学差异(均P<0.05);ROC曲线分析显示,降钙素原的曲线下面积(AUC)为0.889,与APACHEⅡ评分的曲线下面积(0.866)相当,其截断值为10.12 ng/mL,敏感性为87.5%,特异性为81.2%。严重脓毒症死亡组同存活组相比,仅APACHEⅡ评分(29.25±6.02 vs 22.00±6.00,P<0.05)存在统计学差异,多因素logistic回归分析发现,APACHEⅡ评分(OR=1.227,95%CI 1.034~1.456,P=0.019)是预测死亡的独立危险因素。结论:降钙素原有助于早期诊断严重脓毒症并评估病情的严重程度,但初始降钙素原水平不能预测严重脓毒症患者的预后。更多还原

【Abstract】 Objective: To explore the clinical significance of procalcitonin in early diagnosis of severe sepsis and assessment of disease condition. Methods: Sixty patients were divided into sepsis group( 20 cases) and severe sepsis group( 40cases). White blood cell count,serum C-reactive protein and procalcitonin were detected within 24 hours. Acute physiology and chronic health evaluation Ⅱ( APACHE Ⅱ) was graded and the receiver operating characteristic curve( ROC) were plotted. In addition,the severe sepsis group was divided into surviving group( 18 cases) and death group( 22 cases) according to the 28 days’ survival outcome. The independent risk factors of predicting death were screened out by using multivariate logistic regression analysis. Results: There were significant differences in serum levels of procalcitonin [( 17. 02 ±2. 09) vs( 1. 85 ± 0. 31) ng /mL],white blood cell count [( 17. 96 ± 9. 45) vs( 11. 11 ± 4. 95) × 109/L] and APACHE Ⅱ( 25. 63 ± 6. 56 vs 15. 00 ± 6. 58) between severe sepsis group and sepsis group( P < 0. 05). ROC curve analysis showed the area under the curve of procalcitonin( AUC) was 0. 889,and equivalent to APACHE Ⅱ AUC( 0. 866),and its cutoff value was 10. 12 ng /mL,the sensitivity was 87. 5% and specificity was 81. 2%. When severe sepsis death group compared with survival group,only APACHE Ⅱ score( 29. 25 ± 6. 02 vs 22. 00 ± 6. 00) showed significantly difference( P < 0. 05). Multivariate logistic regression analysis showed that APACHE Ⅱ( OR = 1. 227,95% CI 1. 034 ~ 1. 456,P = 0. 019) was the independent risk factor for predicting death. Conclusions: Procalcitonin helps to early diagnosis of severe sepsis and assessment of disease condition,but the initial level of procalcitonin can’t predict the prognosis of patients with severe sepsis.更多还原