血清降钙素原、C反应蛋白在脓毒症早期诊断及病情评估中的研究分析

发布时间：2018-08-24 18:13

【摘要】：目的:本研究通过对脓毒症患者血清降钙素原(PCT)、C反应蛋白(CRP)指标的检测,可以为临床进行早期准确诊断,尽早进行有效合理治疗,取得良好的预后提供有利的指导依据。方法:随机选取2013年1月1日-2015年12月31日入住江苏大学附属医院ICU的重症患者302例纳入本研究,按照脓毒症诊断标准将302例患者分为三组:脓毒症组、脓毒性休克组与非脓毒症组。其中脓毒症组102例,男56例,女46例,年龄39-68岁;脓毒性休克组87例,男47例,女40例,年龄42-75岁;非脓毒症组113例为对照组,其中男50例,女63例,年龄40-74岁。全部患者的血清中PCT的检测用酶联荧光分析法测定,CRP采用荧光免疫定量法检测,最终检测指标在各组间进行对比,分析组间差别,并对PCT、CRP指标绘制受试者工作特征曲线(ROC曲线),比较各检测炎症指标对诊断脓毒症的敏感度、特异度、阳性预测值、阴性预测值、准确率等指标。采用统计专业软件对最终数据进行统计分析,P0.05为有统计学意义。结果:1、比较脓毒性休克组、脓毒症组与对照组患者的年龄、性别、APACHEⅡ分、ICU住院时间(天)等指标上均无显著性差距(P0.05),在ISS评分、住院死亡率[n(%)]上有明显差异(P0.05)。2、脓毒症患者血清PCT水平达(6.03±3.98 ug/L),高于对照组患者水平(1.68±0.93 ug/L),脓毒性休克组患者的PCT水平(14.03±9.61 ug/L)较脓毒症组高,均具有明显差异(P0.05);脓毒症患者血清中CRP的水平达(34.91±15.71mg/L),高于对照组患者水平(12.41±7.98 mg/L),脓毒性休克组患者的CRP水平(148.29±32.04 mg/L)较脓毒症组高,均具有明显差异(P0.05)。3、脓毒性休克组、脓毒症组和对照组患者血清PCT检测阳性率分别为93.1%、80.4%、29.2%,3组比较差异有统计学意义(X2=104.335;P0.05);脓毒性休克组、脓毒症组和对照组患者血清CRP检测阳性率分别为90.8%、79.4%、25.7%,3组比较差异有统计学意义(X2=107.702;P0.05)。4、PCT、CRP联合检测诊断脓毒症的敏感度、特异度、阳性预测值、阴性预测值、准确率(84.7%、87.6%、92.0%、77.3%、85.8%)均明显高于PCT单独检测(75.7%、77.0%、84.7%、65.4%、76.2%),同样高于CRP单独检测(77.8%、74.3%、83.5%、66.7%、76.5%),具有明显差异(P0.05)。PCT、CRP联合检测ROC曲线下面积为0.922,曲线下面积的95%置信区间为(0.872,0.971);PCT水平ROC曲线下面积为0.850,曲线下面积的95%置信区间为(0.777,0.923);CRP水平的检测水准描记出的ROC相应曲线下规模为0.814,曲线下具体取值的95%置信区间为(0.730,0.898)。结论:1、血清PCT、CRP水平可用来评估脓毒症患者的病情严重程度,其水平越高,病情越严重。2、血清PCT、CRP联合检测较PCT或CRP单独检测敏感度及特异度大大提高,提示通过对PCT、CRP水平的联合检测可提高脓毒症早期诊断的准确率。
[Abstract]:Objective: to detect the serum calcitonin proto (PCT) C-reactive protein (PCT) (CRP) in patients with sepsis, and to provide a good basis for early diagnosis, effective and reasonable treatment and good prognosis. Methods: 302 severe patients admitted to the affiliated Hospital of Jiangsu University from January 1, 2013 to December 31, 2015 were randomly selected and divided into three groups according to the diagnostic criteria of sepsis: sepsis group. Septic shock group and non sepsis group. There were 102 cases of sepsis group (56 males, 46 females, aged 39-68), 87 septic shock patients (47 males, 40 females, aged 42 to 75 years) and 113 non-septic patients (50 males and 63 females, aged 40-74 years). The detection of PCT in serum of all the patients was detected by enzyme linked fluorescence assay (Elisa) and fluorescence immunoassay (FIA). The final detection indexes were compared among the groups and the differences between the groups were analyzed. The sensitivity, specificity, positive predictive value, negative predictive value, accuracy and so on of the inflammatory indexes for the diagnosis of sepsis were compared by drawing the ROC curve of the PCT,CRP index, and comparing the sensitivity, the specificity, the positive predictive value, the negative predictive value and the accuracy rate of each inflammatory index in the diagnosis of sepsis. Statistical analysis of the final data using statistical professional software is statistically significant. Results there was no significant difference in age, sex Apache 鈪，

本文编号：2201631