摘要
目的探讨血清降钙素原（PCT）与c-反应蛋白（CRP）、白细胞计数（WBC）对全身炎症反应综合征（SIRS）病情评估和预后判断的价值。方法采用前瞻性病例对照方法，选择本院重症监护病房（ICU）2010年5月至2011年6月收治的SIRS患者72例，于患者入ICU1、3、5d分别测定外周静脉血PCT、CRP及WBC。按有无感染灶分为脓毒症组（49例）和非脓毒症组（23例），比较两组间各指标动态变化的差异，将有差异的指标与序贯器官衰竭评分（SOFA）进行相关性分析；随访28d临床结局，分为死亡组（19例）和存活组（53例），比较两组问各指标动态变化的差异；用受试者工作特征曲线（ROC曲线）下面积（AUC）分析相关指标预测28d生存情况的效能，用多因素logstic回归分析筛选其预测死亡的独立危险因素。结果脓毒症组人ICUl、3、5dPCT（μg／L）均明显高于非脓毒症组（1d：2．5±0．3比0．9±0．2，3d：1．9±03比0．6±0．2，5d：0．9±0．1比0．5±0．1，均P〈0．05），而CRP及WBC与非脓毒症组比较差异无统计学意义；脓毒症组随治疗时间延长PCT逐渐降低，各时间点比较差异有统计学意义（均P〈0．05），而在非脓毒症组PCT水平与治疗时间无关；PCT与SOFA评分存在显著正相关（r=O．979，P〈0．05）。死亡组患者人ICU1、3、5dPCT（μg/L）、CRP（mg／L）均明显高于存活组（PCT1d：2．0±0．8比0．8±0．3，3d：2．2±0．7比0．6±0.3，5d：2．4±1．0比0．4±0．1；CRP1d：422±45比411±44，3d：418±39比403±52，5d：392±38比382±46，均P〈0．05），而WBC与存活组比较差异无统计学意义；存活组随治疗时间延长PCT显著下降，各时间点比较差异有统计学意义（均P〈0．05），在死亡组与治疗时间无关，PCT持续在较高水平；而CRP、WBC随时间变化在两组间无明显差异。PCT和CRP预测患者28d生存的AUC分别为0．824和0．720（均P〈0．01）；多因素logistic回归分析显示，PCT〉2．23μg/L是预测预后的独立危险因素[优势比（OR值）=1．773，95％可信区间（95％CI）为（1．033，3．214），P=0．015]。结论SIRS患者血清PCT有助于早期鉴别脓毒症与非脓毒症，动态监测PCT可预警病情严重程度及预后，可能是预测28d生存情况的独立危险因素。
Objective To observe the dynamic changes in serum procalcitonin （PCT）, C-reactive protein （CRP）, and white blood cell （WBC） count in systemic inflammatory response syndrome （SIRS） and their implication in assessment of illness severity and prognosis. Methods A prospective case control study was conducted. Seventy-two patients with SIRS in Guangdong General Hospital were enrolled in intensive care unit （ICU） from May, 2010 to June, 2011. Parameters including PCT, CRP, and WBC count were determined on the 1st, Od, and 5th day after admission. The patients were divided into septic group （n=49） and non-septic group （non-infectious SIRS group, n =23） according to the presence or absence of infectious. Dynamic changes in all parameters were compared between the two groups and correlation analysis was carried out on the basis of differential indexes and sequential organ failure assessment （SOFA）. The clinical outcome within 28 days after admission to ICU was observed, and the patients were divided into death group （n=19） and survival group （n=53）. Dynamic changes in all parameters between the two groups were compared. Relevant parameters were analyzed with area under receiver operator characteristic curve （ ROC curve, AUC） to predict 28-day survival. Logistic regression analysis of the multiple factors was used to screen independent risk factors for predicting death. Results PCT level （μg/L） on 1st, 3rd, 5th day after admission were all significantly higher in septic group than those in non-septic group （ 1st day： 2.5±0.3 vs. 0.9±0.2, 3rd day： 1.9±0.3 vs. 0.6±0.2, 5th day： 0.9±0.1 vs. 0.5±0.1, all P〈0.05）, while there was no statistically significant difference in CRP and WBC between two groups. PCT level in septic group was gradually decreased with time, there were statistically significant differences between septic group and non-septic group at the different treatment time （all P〈O.05）, but there was no correlation between PCT and treatment duration in non-septic group. Positive statistical correlation was found between PCT and SOFA score （r=0.979, P〈O.05）. PCT （μg/L） and C RP levels （μg/L） on 1st, 3rd, 5th daywere significantly higher in death group than those of survival group （PCT on 1st day： 2.0±0.8 vs. 0.8±0.3, 3rd day： 2.2±0.7 vs. 0.6±0.3, 5th day： 2.4±1.0 vs. 0.4±0.1 ; CRP on 1st day： 422±45 vs. 411±44, 3rd day： 418 ±39 vs. 403 ±52, 5th day ： 392±38 vs. 382±46, all P〈0.05 ）, but WBC count showed no statistically significant difference between two groups. PCT level in survival group showed a significant lowering along with treatment duration, and statistical difference was seen by paired comparison between every two time-points （all P〈O.05）. There was no correlation between PCT level and treatment duration in death group, and it maintained a rather high level. No significant difference was seen in CRP and WBC between two groups with passage of time. AUC was 0.824 and 0.720, respectively, when patient＇s 28-day survival was predicted by PCT and CRP （both P〈0.01）. Logistic regression analysis of the multiple factors revealed that PCT 〉 2.23μg/L was independent risk factor predicting the prognosis [odds ratio （OR） was 1.773, 95% confidence interval （95%CI） 1.033 to 3.214, P=0.015]. Conclusions Serum PCT evaluation ,nay be helpful in differentiating sepsis and non-sepsis at early stage of disease, and also in predicting the severity of the illness and prognosis of SIRS. PCT may be one of the independent risk factors for 28-day survival.
出处
《中国危重病急救医学》
CAS
CSCD
北大核心
2012年第5期294-297,共4页
Chinese Critical Care Medicine
基金
广东省科技计划项目（2006836007016）
广东省科研基金项目（A2007004,A2008047）
广东省自然科学基金面上项目（8151008004000010）
广东省自然科学基金（S2011010002576）
关键词
降钙素原
全身炎症反应综合征
脓毒症
预后
Procalcitonin
Systemic inflammatory response syndrome
Sepsis
Prognosis
