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学科主题急诊医学
降钙素原对急诊脓毒症患者早期诊断的价值
其他题名Value of procalcitonin in the early diagnosis of sepsis in Department of Emergency
刘慧琳; 刘桂花; 马青变
关键词降钙素原 脓毒症 超敏C-反应蛋白 序贯器官衰竭评分 Procalcitonin Sepsis High sensitivity C-reactive protein Sequential organ failure assess
刊名中国危重病急救医学
2012
DOI10.3760/cma.j.issn.1003-0603.2012.05.011
24期:5页:298-301
收录类别中文核心期刊
文章类型Journal Article
摘要目的 探讨血清降钙素原(PCT)在脓毒症的早期诊断及危险分层的价值.方法 90例患者中有脓毒症42例、严重脓毒症48例,检测两组患者血清PCT水平及超敏C-反应蛋白(hs-CRP)、白细胞计数(WBC),中性粒细胞比例、乳酸水平;绘制受试者工作特征曲线(ROC曲线),评价PCT及相关炎症指标鉴别脓毒症高危患者的能力,并对PCT与序贯器官衰竭评分(SOFA)、WBC、乳酸、hs-CRP进行双变量相关性分析.结果 与脓毒症组比较,严重脓毒症组PCT浓度(μg/L)、hs-CRP(mg/L)、WBC(×109/L)、SOFA评分(分)均明显增高(PCT:7.228±2.153比0.172±0.165,hs-CRP:102.68±90.99比29.05±28.76,WBC:14.15±8.14比8.15±4.55,SOFA评分:9.87±2.47比3.09±1.55),差异均有统计学意义(均P<0.01);中性粒细胞、乳酸(mmol/L)略有升高(中性粒细胞:0.820±0.094比0.740±0.130,乳酸:1.47±0.99比1.18±0.60),但差异无统计学意义(均P>0.05).ROC曲线分析显示,PCT的曲线下面积(AUC)为0.808,高于WBC、中性粒细胞、乳酸和hs-CRP(AUC分别为0.124、0.042、0.551和0.262);且PCT为1.000μg/L时,敏感性为80.3%,特异性为72.2%,优于其他传统炎症指标.双变量相关性分析显示,PCT与SOFA评分和WBC均呈显著正相关(r1=0.418,P1=0.006;r2=0.251,P2=0.011),而与乳酸、hs-CRP均无明显相关性(r1=0.186,P1=0.155;r2=0.089,P2=0.133).结论 血清PCT对脓毒症患者早期诊断具有较好的敏感性和特异性,必要时可作为危重病患者的常规监测指标,且有助于临床医师对脓毒症严重程度的评估. Objective To investigate the value of procalcitonin (PCT) in the early diagnosis and risk stratification in sepsis.Methods Among 90 patients,42 patients suffered sepsis,and 48 patients with severe sepsis.Serum PCT levels,high sensitivity C-reactive protein (hs-CRP),white blood cell (WBC) count,the percentage of neutrophils and lactate levels in sepsis and severe sepsis patients were determined.Receive operating characteristic curve (ROC curve) was drawn to evaluate the ability of PCT and related inflammatory parameters in assessing risk factors in patients with sepsis,and to analyze correlation between PCT and sequential organ failure assess (SOFA) score,WBC,lactic acid,and hs-CRP.Results Compared with sepsis patients,among severe sepsis patients,the levels of PCT (μg/L),hs-CRP (mg/L),WBC ( × 109/L),and SOFA score were significantly higher (PCT:7.228 ±2.153 vs.0.172 ±0.165,hs-CRP:102.68 ±90.99 vs.29.05 ±28.76,WBC:14.15 ±8.14 vs.8.15 ±4.55,SOFA score:9.87 ± 2.47 vs.3.09 ± 1.55),with statistical significance (all P <0.01 ),and the levels of percentage of neutrophils and lactic acid (mmol/L) were slightly increased (percentage of neutrophils:0.820 ± 0.094 vs.0.740 ±0.130,lactic acid:1.47 ± 0.99 vs.1.18 ± 0.60),with no statistical significance (both P>0.05).Analysis of ROC curve displayed that area under the curve (AUC) of PCT was 0.808,which was higher than that of WBC,percentage of neutrophils,lactic acid and hs-CRP (AUC was 0.124,0.042,0.551 and 0.262,respectively),and when PCT was 1.000 μg/L,the sensitivity was 80.3%,specificity was 72.2%,and they were better than those of other traditional markers of inflammation.Bivariate correlation analysis showed that a positive correlation was found between PCT and SOFA score and WBC (r1=0.418,P1=0.006; r2=0.251,P2=0.011 ),and there was no correlation between PCT and lactic acid and hs-CRP (r1=0.186,P1=0.155; r2=0.089,P2=0.133).Conclusion Serum PCT is a reliable measure in emergency room for early diagnosis of sepsis with high sensitivity and specificity,it could be used as a routine monitoring index in critically ill patients to help assess disease severity in sepsis.
语种中文
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文献类型期刊论文
条目标识符http://ir.bjmu.edu.cn/handle/400002259/71412
专题北京大学第三临床医学院_急诊科
作者单位100191,北京大学第三医院急诊科
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刘慧琳,刘桂花,马青变. 降钙素原对急诊脓毒症患者早期诊断的价值[J]. 中国危重病急救医学,2012,24(5):298-301.
APA 刘慧琳,刘桂花,&马青变.(2012).降钙素原对急诊脓毒症患者早期诊断的价值.中国危重病急救医学,24(5),298-301.
MLA 刘慧琳,et al."降钙素原对急诊脓毒症患者早期诊断的价值".中国危重病急救医学 24.5(2012):298-301.
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