引用本文:卢秋维,廖美娟,林雪珍.多种炎性因子在脓毒血症中的诊断和预后价值比较[J].中国临床新医学,2019,12(4):402-406.
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多种炎性因子在脓毒血症中的诊断和预后价值比较
卢秋维,廖美娟,林雪珍
530021 南宁,广西壮族自治区人民医院检验科
摘要:
[摘要] 目的 探讨多种炎性因子在脓毒血症中的诊断和预后评估价值。方法 回顾性分析235例脓毒血症患者和251例非脓毒症患者的白细胞计数(WBC)、中性粒细胞比率(NEU%)、C反应蛋白(CRP)水平、降钙素原(PCT)水平、脑钠肽(BNP)水平和急性生理学与慢性健康状况评分系统Ⅱ(APACHEⅡ)评分,采用ROC曲线、方差分析、Jonckheere-Terpstra检验、U检验进行分析。结果 ROC曲线分析结果显示,PCT、CRP和BNP诊断脓毒血症的的AUC分别为0.792、0.638、0.626,其诊断脓毒血症的灵敏度和特异度分别为82.90%和52.30%、80.50%和31.20%、86.60%和35.20%;方差分析显示PCT、CRP、BNP和APACHEⅡ评分水平在感染性休克组、严重脓毒血症组、一般脓毒血症组与非脓毒血症组之间的差异有统计学意义(P<0.01);Jonckheere-Terpstra Test分析显示PCT、CRP和BNP在四组间有量效关系,PCT的J-T值最大,为9.658,CRP和BNP分别为3.734、3.328,提示PCT评估感染严重程度的能力最强。脓毒血症死亡组和存活组对比分析结果显示,年龄和APACHEⅡ评分在两组间差异有统计学意义(P<0.05),但性别、WBC、NEU%、CRP、PCT和BNP水平在两组间差异无统计学意义(P>0.05)。结论 PCT、CRP和BNP水平有助于早期脓毒血症诊断并对其严重程度进行评价,其中PCT的诊断和疾病分程价值最优,年龄和APACHEⅡ评分是脓毒血症患者发生死亡的影响因素。
关键词:  炎性因子  C反应蛋白  降钙素原  脑钠肽  脓毒血症
DOI:10.3969/j.issn.1674-3806.2019.04.12
分类号:R 446
基金项目:广西卫健委科研课题(编号:Z2013382)
Comparison of diagnosis and prognostication values of multiple inflammatory factors in patients with sepsis
LU Qiu-wei, LIAO Mei-juan, LIN Xue-zhen, et al.
Department of Laboratory Medicine, the People′s Hospital of Guangxi Zhuang Autonomous Region, Nanning 530021, China
Abstract:
[Abstract] Objective To explore the diagnosis and prognostication values of multiple inflammatory factors in patients with sepsis. Methods The white blood cell count(WBC), percentage of neutrophills(NEU%) and the levels of blood C-reactive protein(CRP), serum procalcitonin(PCT) and serum brain natriuretic peptide(BNP), and the APACHEⅡ scores in 235 septic patients and 251 non-septic patients were analyzed by the receiver operating characteristic(ROC), ANOVA, Jonckheere-Terpstra Test and U-test. Results The ROC curve displayed that the AUC for PCT, CRP, and BNP was 0.792, 0.638, and 0.626, respectively. The sensitivity and specificity of these parameters were 82.90% and 52.30%(PCT), 80.50% and 31.20%(CRP), 86.60% and 35.20%(BNP), respectively. The results of ANOVA analysis showed that there were significant differences in PCT, CRP, BNP and APACHEⅡ among the infectious shock group, severe sepsis group, general sepsis group and non-sepsis group(P<0.01). Furthermore, the results of Jonckheere-Terpstra Test indicated that there were dose-effect relationships between PCT, CRP and BNP, with PCT having the most maximum J-T valuet(9.658), followed by CRP(3.734) and BNP(3.328), which suggested that PCT was the most valuable index in predicting the severity of infections. Compared the death and survival groups of sepsis, the results showed that there were signifcant differences in age and APACHEⅡ socres(P<0.05), but there were no significant differences in gender, WBC, NEU%, CRP, PCT, and BNP between the two groups(P>0.05). Conclusion The levels of PCT, CRP and BNP are useful for the early diagnosis and evaluation of the severity of sepsis among which the value of PCT diagnosis and disease classification is optimal. Age and APACHEⅡ scores is the influencing factors for death.
Key words:  Inflammatory factors  C-reactive protein  Procalcitonin  Brain natriuretic peptide  Sepsis