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目的评价急性创伤性患者监测血可溶性白细胞分化抗原14亚型(s CD14-ST,presepsin)对脓毒症的鉴别诊断及预后价值。方法对急性创伤性脓毒症患者57例、严重脓毒症患者15例和非脓毒症患者41例进行前瞻性研究。分别检测其入院时血清presepsin、降钙素原(PCT)、C反应蛋白(CRP)和白细胞计数(WBC),根据患者入院24h内最差临床指标计算急性生理和慢性健康状况评分Ⅱ(APACHEⅡ),比较各组指标差异。Logistic回归分析脓毒症的高危因素。绘制ROC曲线并计算曲线下面积,比较各炎症指标对脓毒症诊断的价值。对presepsin和APACHEⅡ评分进行相关性分析。比较脓毒症存活组46例患者治疗前后各炎性指标变化,进行预后监测评价。结果脓毒症和严重脓毒症患者presepsin、PCT、CRP、WBC和APACHEⅡ评分均显著高于非脓毒症组(P均<0.05),严重脓毒症患者的presepsin显著高于脓毒症组(P<0.05)。年龄、presepsin升高和PCT升高是脓毒症的独立危险因素。presepsin的ROC曲线下面积(AUCROC)为0.877,以587.50pg/ml为临界值,诊断脓毒症的敏感度为87.5%,特异性为75.6%。presepsin和APACHEⅡ评分之间呈显著正相关(r=0.654,P<0.05)。结论 presepsin可作为脓毒症早期诊断标志物之一,还可进行脓毒症预后的监测。
Objective To evaluate the differential diagnosis and prognostic value of serum CD14-ST (presepsin) in sepsis in acute traumatic patients. Methods 57 patients with acute traumatic sepsis, 15 patients with severe sepsis and 41 patients with non-sepsis were prospectively studied. Serum presepsin, procalcitonin (PCT), C-reactive protein (CRP) and white blood cell count (WBC) were measured at admission and APACHE II scores were calculated according to the worst clinical indicators within 24h of admission. , Comparing the differences between the indicators of each group. Logistic regression analysis of risk factors for sepsis. Draw ROC curves and calculate the area under the curve, and compare the value of each inflammation index in the diagnosis of sepsis. Correlation analysis of presepsin and APACHE II scores. 46 patients with sepsis survival were compared before and after treatment of inflammatory changes, the prognosis monitoring evaluation. Results The presepsin, PCT, CRP, WBC and APACHEⅡ scores in sepsis and severe sepsis patients were significantly higher than those in non-sepsis patients (all P <0.05), and those in severe sepsis patients were significantly higher than those in sepsis patients (P <0.05). Age, elevated presepsin, and elevated PCT are independent risk factors for sepsis. The area under the ROC curve (AUCROC) of presepsin was 0.877, with a sensitivity of 87.5% and a specificity of 75.6% for the diagnosis of sepsis at a cutoff of 587.50 pg / ml. There was a significant positive correlation between presepsin and APACHE Ⅱ scores (r = 0.654, P <0.05). Conclusion Presepsin can be used as one of the early diagnostic markers of sepsis, and the prognosis of sepsis can be monitored.