ICU老年脓毒症患者的诊断生物标志物组合研究

发布时间：2018-01-07 02:32

本文关键词：ICU老年脓毒症患者的诊断生物标志物组合研究　出处：《广东医学》2017年06期 　论文类型：期刊论文

【摘要】：目的确立重症监护病房(ICU)老年脓毒症患者诊断的最佳生物标志物组合。方法前瞻性分析181例全身炎症反应综合征(SIRS)老年患者。于入院时检测降钙素原(PCT)、C-反应蛋白(CRP)、前白蛋白(PA)和中性粒细胞百分比(Neut%)等指标,观察患者的疾病进展,根据脓毒症诊断标准将所有患者分为脓毒症组(56例)和非脓毒症组(125例);logistic回归分析确定诊断脓毒症的影响因素,并确定最佳生物标志物组合,采用受试者工作特征曲线(ROC曲线)评估生物标志物组合和各生物标志物单独使用时的诊断效能。结果脓毒症组和非脓毒症组PCT、CRP、PA和Neut%差异均有统计学意义(P0.05);logistic回归显示PCT、CRP和PA是预测脓毒症的危险因素。将PCT、CRP和PA等3种生物标志物组合用于诊断脓毒症时的ROC曲线下面积(AUC)为0.889,高于PCT、CRP和PA单独使用时的AUC分别为0.831、0.757和0.722;且标志物组合的敏感度、特异度、阳性预测值和阴性预测值比单独使用时均有所提高。结论 PCT、CRP和PA三种生物标志物联合使用可以有效提高对老年人脓毒症的诊断能力。
[Abstract]:Objective to establish the ICU (ICU) in elderly patients with sepsis diagnosis of sepsis best biological marker combination. Methods prospective analysis of 181 cases of systemic inflammatory response syndrome (SIRS) patients on admission. The detection of procalcitonin (PCT), C- reactive protein (CRP), prealbumin (PA) and neutral granulocyte percentage (Neut%) and other indicators, to observe the progress of the disease, according to the diagnostic criteria of sepsis patients were divided into sepsis group (56 cases) and non sepsis group (125 cases); analysis of factors affecting the diagnosis of sepsis logistic regression, and to determine the optimal combinations of biomarkers, the receiver operating characteristic curve (ROC curve) to evaluate biological marker combinations and biomarkers when used alone. The diagnostic efficacy of the sepsis group and non sepsis group, PCT, CRP, PA and Neut% had significant difference (P0.05); logistic regression analysis showed that PCT, CRP and PA pre The risk factors of sepsis. The measurement of PCT, CRP and PA 3 kinds of combinations of biomarkers for ROC curve area under the diagnosis of sepsis (AUC) was 0.889, higher than that of PCT, CRP and PA when used alone AUC 0.831,0.757 and 0.722 respectively; and the combination of markers of sensitivity, specificity degree, positive and negative predictive values than when used alone were improved. Conclusion PCT, CRP and PA three kinds of biomarkers combined can effectively improve the diagnosis ability of the elderly sepsis.

【作者单位】：天津市第三中心医院天津市人工细胞重点实验室卫生部人工细胞工程技术研究中心检验科;天津市第三中心医院天津市人工细胞重点实验室卫生部人工细胞工程技术研究中心ICU;
【分类号】：R459.7
【正文快照】： 脓毒症是指明确或可疑的感染引起的全身炎症反应综合征(SIRS),可发展为严重脓毒症和脓毒症休克,是重症监护病房(ICU)最常见和严重的并发症。随着人口老龄化、肿瘤发病率的上升及侵入性医疗手段的增加,脓毒症的发病率和病死率都在不断升高[1]。由于脓毒症的诊断缺乏金标准,且老

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