摘要
目的结合感染相关器官功能衰竭评分（SOFA）评价血清降钙素原（PCT）和临床常用炎症指标对脓毒症的早期诊断和预后价值。方法采用前瞻性、临床病例观察及诊断试验研究。根据美国胸科医师协会／危重病医学会（ACCP／SCCM）共识会议，严格将入选病例分为全身炎症反应综合征（SIRS）组、脓毒症组、严重脓毒症组、脓毒性休克组、非SIRS对照组。测定24h内的炎症指标、SOFA评分及PCT浓度并进行相关分析。结果208例患者入选，其中对照组59例，SIRS组57例，脓毒症组52例，严重脓毒症组28例，脓毒性休克组12例。血清PCT浓度与脓毒症严重程度呈正相关．Spearman相关系数为0．909（P=0．000）。根据受试者工作特征曲线（ROC曲线）分析．PCT的ROC曲线下面积（AUC）为0．936±0．020．SOFA评分的AUC为0．973±0．011（P均=0．000）。判断最佳诊断界值PCT为〉0．375μg／L，SOFA评分为〉3．5分，其约登（Youden）指数分别为0．808和0．801。二分类Logistic回归分析显示，在排除了年龄、CRP混杂因素后PCT和SOFA评分与脓毒症发病明显相关，相对危险度（OR值）分别为84．794和10．761（P均=0．000）．并且可以预测脓毒症的发病概率。SOFA评分是脓毒症疾病预后的最显著因子，OR值为2．084（P=0．0002）。结论传统炎症指标和C-反应蛋白（CRP）是鉴别SIRS和非SIRS的有用指标，但不是早期诊断脓毒症的可靠指标。PCT是早期诊断脓毒症并能与SIRS鉴别的特异性较高的炎症指标；结合SOFA评分和PCT可以预测脓度症的发病概率；根据PCT值的变化，再结合SOFA评分可以客观判断脓毒症病情的严重性。SOFA评分与脓毒症预后明显相关。
Objective To study the diagnostic and prognostic value of procalcitonin （PCT）, common inflammatory markers combining with scores for estimating organ failure of infection related organs （SOFA） in patients with sepsis in early stage. Methods Patients were observed continuously in a perspective study with diagnostic tests. According to the definition of ACCP/SCCM Consensus Conference, patients were classified into 5 groups, including non-systemic inflammatory response syndrome （SIRS） （control） group, SIRS group, sepsis group, severe sepsis group and septic shock group. Indexes of inflammation, SOFA and concentration of PCT were determined at 24 hours, and their correlation was analyzed. Results Two hundred and eight patients were enrolled, including 59 in non-SIRS group, 57 in SIRS group, 52 in sepsis group, 28 in severe sepsis group and 12 in septic shock group. PCT concentrations were positively correlated with the severity of sepsis. Spearman＇s correlation coefficient was 0. 909 （P = 0. 000）. According to the receiver operating characteristic curves （ROC-curves） analysis principle, ROC curves were drawn and areas under these curves （AUC） was calculated. In the diagnosis of sepsis, AUC values were 0. 936± 0. 020 for PCT, 0. 973±0. 011 for SOFA （both P= 0. 000）. The best cutoff values in the diagnosis of sepsis were 0. 375 μg/L for PCT, and 3.5 for SOFA score. The Youden index of PCT and SOFA scores was 0. 808 and 0. 801, respectively. Binary Logistic regression analysis confirmed that PCT and SOFA score were highly correlated with sepsis （OR = 84. 794, 10. 761, respectively, both P = 0.000） after eliminating confusion factors including age and C-reactive protein （CRP） etc., PCT and SOFA score could be used to predict the incidence of sepsis. SOFA score was the best prognostic indicator of sepsis （OR = 2. 084, P = 0. 0002）. Conclusion The traditional inflammatory markers and CRP are useful parameters to differentiate SIRS from non-SIRS, but are not reliable indicato
出处
《中国危重病急救医学》
CAS
CSCD
北大核心
2008年第1期23-28,共6页
Chinese Critical Care Medicine
基金
云南省教委科研基金资助项目（06J2670）
