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目的探讨降钙素原(procalcitonin,PCT)在预测脓毒血症中的价值。方法疑诊脓毒血症患者648例,血培养阴性568例,血培养阳性80例中脓毒血症76例(脓毒血症组)、真菌感染4例;同期非脓毒血症患者298例为感染组,体检健康者98例为对照组,测定各组PCT、C反应蛋白(C-reactive protein,CRP)、白细胞计数(white blood cell count,WBC)、中性粒细胞百分比(the percentage of neutrophile,NEU)、血小板计数(platelet,PLT)及血沉水平;采用ROC曲线分析PCT诊断脓毒血症的效能;采用Pearson相关分析PCT与PLT、WBC、NEU的相关性。结果脓毒血症组PCT[1.08(0.48,2.00)μg/L]高于血培养阴性组[0.42(0.12,0.78)μg/L](P<0.01),PLT[(136.30±44.37)×10~9/L]低于血培养阴性组[(206.20±81.85)×10~9/L](P<0.01),CRP、WBC、NEU、血沉与血培养阴性组比较差异无统计学意义(P>0.05);脓毒血症组中革兰阳性菌感染35例,革兰阴性菌感染41例,革兰阳性菌感染者PCT[0.76(0.46,1.76)μg/L]低于革兰阴性菌者[1.08(0.63,1.48)μg/L]、PLT[(160.61±39.19)×10~9/L]高于革兰阴性菌者[(113.65±34.61)×10~9/L](P<0.05),CRP、WBC、NEU、血沉与革兰阴性菌者比较差异无统计学意义(P>0.05);ROC曲线分析结果显示,PCT诊断脓毒血症的cut-off值为0.8μg/L,AUC为0.76,敏感性为0.75,特异性为0.80;脓毒血症组PCT[1.08(0.48,2.00)μg/L]、CRP[(98.16±34.20)mg/L]、WBC[(13.73±6.62)×10~9/L]、NEU[(88.62±23.35)%]、血沉[(72.66±25.33)mm/h]高于对照组[0.09(0.28,0.44)μg/L、(5.94±2.10)mg/L、(6.42±1.85)×10~9/L、(59.91±14.33)%、(10.82±3.77)mm/h],PLT[(136.30±44.37)×10~9/L]低于对照组[(210.16±48.62)×10~9/L](P<0.01);感染组PCT[0.31(0.18,0.77)μg/L]、CRP[(33.84±10.23)mg/L]、WBC[(11.61±3.34)×10~9/L]、NEU[(85.66±25.45)%]、血沉[(39.42±10.21)mm/h]均高于对照组(P<0.01);脓毒血症组PCT、CRP、血沉高于感染组,PLT低于感染组,差异均有统计学意义(P<0.01);Pearson相关分析结果显示,脓毒血症患者PCT与WBC、NEU、PLT均呈负相关(r=-0.252,P=0.004;r=-0.148,P=0.008;r=-0.474,P=0.002)。结论脓毒血症患者PCT水平增高,PLT水平降低;PCT诊断脓毒血症具有较高的敏感性与特异性;PCT与PLT呈明显负相关,二者联合可能提高对脓毒血症的预测价值。
Objective To investigate the value of procalcitonin (PCT) in predicting sepsis. Methods 648 cases of suspected sepsis, blood culture negative 568 cases, blood culture positive 80 cases of sepsis 76 cases (sepsis group), fungal infection in 4 cases; the same period non-sepsis patients 298 The cases were infected and healthy subjects were taken as control group. The levels of PCT, C-reactive protein (CRP), white blood cell count (WBC), the percentage of neutrophils of neutrophile (NEU), platelet (PLT) and erythrocyte sedimentation rate (SOT). The ROC curve was used to analyze the efficacy of PCT in the diagnosis of sepsis. The Pearson correlation was used to analyze the correlation between PCT, PLT, WBC and NEU. Results The PCT [1.08 (0.48, 2.00) μg / L] in the sepsis group was significantly higher than that in the blood culture negative group [0.42 (0.12,0.78) μg / L] (P <0.01). There was no significant difference between CRP, WBC, NEU, ESR and blood culture negative group (P <0.01) > 0.05). In sepsis group, 35 cases were gram-positive bacteria, 41 gram-negative bacteria and gram negative bacteria were lower than gram-negative bacteria (113.65 ± 34.61) × 10 ~ (9) / L] (P <0.01), and those with Gram-negative bacteria [ 0.05), CRP, WBC, NEU, ESR and Gram-negative bacteria were no significant difference (P> 0.05); ROC curve analysis showed that the cut-off value of PCT diagnosis sepsis was 0.8μg / L , The AUC was 0.76, the sensitivity was 0.75 and the specificity was 0.80. The PCT [1.08 (0.48,2.00) μg / L], CRP [(98.16 ± 34.20) mg / L] and WBC [(13.73 ± 6.62) × 10 ~ 9 / L], NEU [(88.62 ± 23.35)%], ESR (72.66 ± 25.33) mm / h were significantly higher than those of the control group (0.09 0.28,0.44 μg / L, 5.94 ± 2.10 (6.42 ± 1.85) × 10 ~ 9 / L, (59.91 ± 14.33)%, (10.82 ± 3.77) mm / h] (P <0.01). The levels of PCT [0.31 (0.18,0.77) μg / L] in infected group were significantly lower than those in control group [(210.16 ± 48.62) × 10-9 / L] (33.84 ± 10.23) mg / L], WBC [(11.61 ± 3.34) × 10 ~ 9 / L], NEU (85.66 ± 25.45)% and ESR (39.42 ± 10.21) mm / (P <0.01). The levels of PCT, CRP and ESR in sepsis group were higher than those in the infected group, and the PLT in the septic group was lower than that in the infected group (P <0.01). Pearson correlation analysis showed that sepsis There was a negative correlation between PCT and WBC, NEU and PLT (r = -0.252, P = 0.004; r = -0.148, P = 0.008; r = -0.474, P = 0.002). Conclusions Patients with sepsis have higher PCT levels and lower PLT levels. PCT has a higher sensitivity and specificity for the diagnosis of sepsis. PCT is negatively correlated with PLT, and the combination of the two may increase the prediction of sepsis value.