摘要
目的 探讨一种生物标志物组合对脓毒症和重度脓毒症患者的诊断能力.方法 采用前瞻性研究方法,选择2010年3月至2013年3月首都医科大学附属北京朝阳医院急诊抢救室救治的652例全身炎症反应综合征（SIRS）患者.于入院时即检测降钙素原（PCT）、白细胞介素-6（IL-6）、D-二聚体、C-反应蛋白（CRP）、B型脑钠肽（BNP）、白细胞计数（WBC）、杆状核中性粒细胞比例和血小板计数（PLT）等生物标志物.根据脓毒症诊断将所有患者分为脓毒症组（452例）和非脓毒症组（200例）；根据脓毒症严重程度将所有患者分为重度脓毒症组（包括脓毒性休克,190例）和非重度脓毒症组（462例）.用logistic回归分析确定诊断脓毒症和重度脓毒症的独立因素,并组建生物标志物最佳组合.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能力.结果 PCT、IL-6和D-二聚体既是诊断脓毒症也是诊断重度脓毒症的独立预测因素.将这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0.866,高于PCT、IL-6和D-二聚体单独使用时的AUC（分别为0.803、0.770和0.737）；且标志物组合的敏感度、特异度、阳性预测值和阴性预测值也均比单独使用时得到提高（标志物组合分别为81.2％、81.0％、90.6％和65.6％,PCT分别为75.2％、80.0％、89.5％、58.8％,IL-6分别为81.0％、61.0％、82.4％、58.7％,D-二聚体分别为79.9％、59.0％、81.5％、56.5％）.3种生物标志物组合用于诊断重度脓毒症的AUC为0.815,优于PCT、IL-6和D-二聚体单独使用时的0.758、0.740和0.704;且标志物组合的敏感度、特异度、阳性预测值和阴性预测值也均比单独使用时得到提高（标志物组合分别为81.6％、73.6％、56.0％和90.6％,PCT分别为79.5％、65.0％、48.2％、88.5％,IL-6分别为65.8％、70.6％、47.9％、83.4％,D-二聚体分别为60.5％、73.2％、48.1％、81.8％）.结论 将PCT、IL-6和D-二聚体3种生物标志物联合使用可以有效提高对脓毒症和重度脓毒症的诊断能力.
Objective To determine a Combination of biomarkers that assure the diagnosis of sepsis and severe sepsis in patients in emergency department （ED）. Methods A total of 652 patients with systemic inflammatory response syndrome （ SIRS ） were enrolled for this prospective study in the ED of Beijing Chaoyang Hospital of the Capital Medical University between March 2010 and March 2013. Eight biomarkers were determined, including levels of procalcitonin （PCT）, interleukin-6 （IL-6）, D-dimer, C-reactive protein （CRP）, brain natriuretic peptide （BNP）, white blood cell count （WBC）, percentage of immature neutrophil, and platelct count （PLT）. Patients were divided into the sepsis group （452 cases） and non-sepsis group （200 cases） according to the diagnostic criteria of sepsis. Then all these patients were stratified into severe sepsis group （ 190 cases, including septic shock） and non-severe sepsis group （462 cases） according to the diagnosis of sew^re sepsis. Logistic regression was performed to identify the independent factors for the diagnosis of sepsis and severe sepsis, and the optimal combination of biomarkers was established. Receiver operating characteristic （ ROC ） curves were used to evaluate the diagnostic ability of the combination and the biomarkers. Results PCT, IL-6 and D-dimer were independent factors for diagnosis of sepsis and severe sepsis. The area under the ROC curve （AUC） of the combination of three biomarkers was 0.866 for diagnosis of sepsis, and it was higher than the AUC of PCT （0.803）, IL-6 （0.770） and D-dimcr （0.737） alone, and this new combination showed better sensitivity, specificity, positive predictive （PPV）, and negative predictive （NPV） values than that when the three biomarkers was used individually （the results of combination were 81.2%, 81.0%, 90.6%, 56.5% ; that of PCT were 75.2%, 80.0%, 89.5%, 58.8%; that of IL-6 were 81.0%, 61.0%, 82.4%, 58.7%; and that of D-dimer were 79.9%, 59.0%, 81.5%, 56.5%, respectively）. The AUG of the combination was 0.815 for the diagnosis of severe sepsis and was better than the three biomarkers used alone, which was 0.758 for PCT, 0.740 for IL-6, and 0.704 for D-dimer respectively. Moreover, the sensitivity, specificity, PPV and NPV of the combination were higher than that of the three biomarkers used singularly （the results of combination were 81.6%, 73.6%, 56.0%, 90.6%; that of PCT were 79.5%, 65.0%, 48.2%, 88.5%; that of IL-6 were 65.8%, 70.6%, 47.9%, 83.4%; and that of D-dimer were 60.5%, 73.2%, 48.1%, 81.8%, respectively）. Conclusion The combination of PCT, IL-6 and D-dimer enhances the diagnostic ability for sepsis and severe sepsis.
出处
《中华危重病急救医学》
CAS
CSCD
北大核心
2014年第3期153-158,共6页
Chinese Critical Care Medicine
基金
卫生部国家临床重点专科建设项目（2012-649）
北京市优秀博士学位论文专项资金项目（20121002501）
