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目的 分析血清降钙素原(PCT)、C-反应蛋白(CRP)和白细胞介素6(IL-6)联合检测对脓毒症预后评估的临床价值。方法 回顾性收集2005年1月-2015年1月本院收治的162例脓毒症患者。根据患者入院后28d转归分为生存组83例和死亡组79例。比较两组间PCT、CRP、IL-6及序贯器官衰竭评分(SOFA)、急性生理学与慢性健康状况评分系统Ⅱ(APACHEⅡ)和急诊脓毒症死亡风险评分(MEDS)差异,并比较PCT、CRP和IL-6判断预后的能力。结果 162例年龄19~83(57.06±15.37)岁,男102例(63.0%),女60例(37.0%)。死亡组并发心血管疾病、中枢神经疾病和消化道疾病例数高于生存组(P<0.05)。死亡组的PCT、CRP、IL-6、SOFA、APACHEⅡ和MEDS评分数值高于生存组(P<0.05)。将PCT、CRP和IL-6联合检测时用于判断脓毒症预后的ROC曲线下面积(AUC)为0.955,大于PCT(AUC=0.941)、CRP(AUC=0.780)和IL-6(AUC=0.884)单独检测时的面积。联合检测的敏感度(86.5%)、特异度(96.4%)、阳性预测值(95.6%)和阴性预测值(85.1%)均大于PCT(敏感度77.2%,特异度95.2%,阳性预测值93.8%,阴性预测值81.4%)、CRP(敏感度72.2%,特异度83.1%,阳性预测值80.2%,阴性预测值75.8%)和IL-6(敏感度86.1%,特异度72.3%,阳性预测值74.7%,阴性预测值84.5%)的单独检测。结论 PCT、CRP和IL-6联合检测比单独检测能更有效地判断脓毒症预后情况。
Objective To analyze the clinical value of combined detection of serum procalcitonin (PCT), C-reactive protein (CRP) and interleukin-6 (IL-6) in the prognosis of sepsis. Methods A total of 162 sepsis patients admitted to our hospital from January 2005 to January 2015 were retrospectively collected. According to the 28d after admission, the patients were divided into survival group (83 cases) and death group (79 cases). The differences of PCT, CRP, IL-6 and SOFA, APACHEⅡ and MEDS in emergency sepsis between the two groups were compared. The differences of PCT, CRP and IL-6 to determine the prognosis of the ability. Results 162 cases were 19 to 83 years (57.06 ± 15.37) years old, including 102 males (63.0%) and 60 females (37.0%). Death cases were complicated by cardiovascular diseases, central nervous system diseases and digestive diseases cases than the survival group (P <0.05). The values of PCT, CRP, IL-6, SOFA, APACHEⅡ and MEDS in death group were higher than those in survival group (P <0.05). The area under the ROC curve (AUC) for the determination of the prognosis of sepsis when PCT, CRP and IL-6 were combined was 0.955, greater than the PCT (AUC = 0.941), CRP (AUC = 0.780) and IL- 0.884) area when tested alone. Sensitivity (86.5%), specificity (96.4%), positive predictive value (95.6%) and negative predictive value (85.1%) were higher than those of PCT (sensitivity 77.2%, specificity 95.2%, positive predictive value 93.8 %, Negative predictive value 81.4%), CRP (sensitivity 72.2%, specificity 83.1%, positive predictive value 80.2%, negative predictive value 75.8%) and IL-6 (sensitivity 86.1%, specificity 72.3% Value of 74.7%, negative predictive value of 84.5%) of the separate test. Conclusion The combined detection of PCT, CRP and IL-6 can be more effective in judging the prognosis of sepsis than the single detection.