摘要
目的探讨血清降钙素原(PCT)、C反应蛋白(CRP)、D-二聚体(D-D)、血小板计数(PLT)等指标对细菌培养阳性脓毒症患者的诊断价值。方法选择2018年7月-2019年12月海口市人民医院收治的78例脓毒症患者作为研究对象,纳入脓毒症组;另择同期收治的114例局部感染患者及100名健康体检者分别纳入感染组及对照组。对各组受试者进行急性生理学及慢性健康状况评分系统(APACHEⅡ)评分及序贯器官衰竭估计(SOFA)评分,测定血清PCT、CRP、D-D水平及PLT水平。结果入组脓毒症患者共检出78株致病菌,其中革兰阴性(G^(-))菌41株(52.56%),革兰阳性(G^(+))菌37株(47.44%)。与对照组比较,脓毒症组、感染组APACHEⅡ评分、SOFA评分及血清PCT、D-D、CRP水平升高,PLT水平降低(P<0.05),且脓毒症组各指标升高或降低幅度显著高于感染组(P<0.05)。Pearson相关性分析显示,血清PCT、D-D、CRP水平与APACHEⅡ评分、SOFA评分呈正相关(P<0.05),血清PLT水平与APACHEⅡ评分、SOFA评分呈负相关(P<0.05)。血清PCT、D-D、CRP、PLT诊断脓毒症的曲线下面积分别为0.800、0.768、0.717、0.742,其中血清PCT诊断价值最高,四种指标联合诊断曲线下面积为0.906。G^(-)菌感染组APACHEⅡ评分、SOFA评分、血清PCT、D-D高于G^(+)菌感染组,PLT水平低于G^(+)菌感染组(P<0.05);两组CRP水平比较差异无统计学意义(P>0.05)。血清PCT、D-D、CRP、PLT诊断G^(-)菌的曲线下面积分别为0.776、0.700、0.590、0.635,其中血清PCT诊断价值最高,四种指标联合诊断曲线下面积为0.884。结论细菌培养阳性脓毒症患者可伴有血清PCT、CRP、D-D、PLT等指标的变化,其中G^(-)菌感染患者各指标变化幅度更大,临床可用于细菌性脓毒症的早期诊断、鉴别及病情评估。
Objective To explore diagnostic value of serum procalcitonin(PCT),C-reactive protein(CRP),D-dimer(DD)and platelet count(PLT)in patients with bacterial culture-positive sepsis.Methods 78 sepsis patients who were admitted to the hospital from July 2018 to December 2019 were enrolled as sepsis group.114 patients with local infection and 100 healthy volunteers who were admitted in the same period were enrolled as infection group and control group,respectively.The scoring of acute physiology and chronic health evaluation(APACHEⅡ)and sequential organ failure assessment(SOFA)was performed for subjects in each group.The levels of serum PCT,CRP,D-D and PLT were determined.Results Among the enrolled sepsis patients,78 strains of pathogenic bacteria were detected,including 41(52.56%)gram-negative(G^(-))bacteria and 37(47.44%)gram-positive(G^(+))bacteria.Compared with control group,scores of APACHEⅡ and SOFA,serum PCT,DD and CRP were increased,while PLT was decreased in sepsis group and infection group(P<0.05).The increase or decrease amplitude of all indexes in sepsis group was significantly higher than that in infection group(P<0.05).Pearson correlation analysis showed that serum PCT,D-D and CRP were positively correlated with APACHEⅡ and SOFA scores(P<0.05),while serum PLT level was negatively correlated with them(P<0.05).The areas under the curve(AUC)of PCT,D-D,CRP and PLT for diagnosis of sepsis were 0.800,0.768,0.717 and 0.742,respectively.Among them,diagnostic value of serum PCT was the highest.The AUC of the four indicators was 0.906.Scores of APACHEⅡ and SOFA,serum PCT and D-D in G^(-)bacteria infection group were higher than those in G^(+)bacteria infection group,while PLT level was lower than that in G^(+)bacteria infection group(P<0.05).There was no significant difference in CRP level between the two groups(P>0.05).AUC of serum PCT,D-D,CRP and PLT for diagnosis of G^(-)bacteria were0.776,0.700,0.590 and 0.635,respectively.Among them,diagnostic value of serum PCT was the highest.The AUC of the four indicators was 0.884.Conclusions The bacterial culture-positive sepsis patients might be accompanied with changes in serum PCT,CRP,D-D and PLT.Among them,changes amplitude of all indexes were higher in G^(-)bacteria infection patients than those in G^(+)bacteria infection group.Clinically,they could be applied for early diagnosis and identification of bacterial sepsis and disease assessment.
作者
邓超
管军
苏醒
符均
DENG Chao;GUAN Jun;SU Xing;FU Jun(Department of Critical Medicine,Haikou People's Hospital,Haikou Hospital Affiliated to Xiangya Medical College of Central South University,Haikou,Hainan 570208,China)
出处
《热带医学杂志》
CAS
2021年第7期878-882,共5页
Journal of Tropical Medicine
基金
海南省卫生计生行业科研项目(19A200164)。
