摘要
目的 探讨血浆内毒素的检测对革兰阴性菌脓毒血症的诊断价值及对其预后的评估作用. 方法 2014年12月至2016年1月入住我院急诊ICU脓毒血症患者,根据病原学结果,将其分为革兰阴性菌感染（A组）组非革兰阴性菌感染组（B组）;根据预后情况,又分为存活组（C组）和死亡组（D组）.采用鲎试剂的显色基质法,检测血浆内毒素含量,以≥0.4EU/ml为阳性结果,分别分析比较两组的内毒素检测的阳性率.采用受试者工作特诊曲线（ROC）分析血浆内毒素检测的灵敏度和特异度等.结果 最终有78例患者纳入本研究,其中A组56例,B组22例,C组59例,D组19例;内毒素检测阳性者,A组27例,B组8例,C组23例,D组12例.A组与B组,C组与D组,两组间内毒素检测阳性率均无显著性差异（p〉0.05）.ROC曲线分析表明,以≥0.4EU/ml为界点,血浆内毒素检测革兰氏阴性杆菌脓毒血症的灵敏度为53.6%,特异度为59.1.9%,阳性预测值为77.14%,阴性预测值为32.56%,曲线下面积为0.625（p〉0.05）.结论 血浆内毒素检测并不能作为诊断革兰氏阴性杆菌脓毒血症的诊断指标,对其预后无评估作用.
Objective To investigate the value of detection of endotoxin in plasma for diagnosis and prognosis of patients with sepsis due togram-negative bacteria. Methods According to microbiologic studies and prognosis, Patients with sepsis admitted to emergency department ICU fromDec, 2014 to Jan, 2016 were divided into two groups respectively, patients infected with gram-negative organisms （group A） and patients infected withnon- gram-negative organisms （group B）, survival group （group C） and death group （group D）. Endotoxin in plasma were detected with chromogeniclimulus amebocyte lysate（LAL） assay, and assays were defined as positive if the results ≥0.4EU/ml. The ratio of positive assay were compared betweengroup A and group B, as well as group C and group D respectively. Receiver operating characteristic curve（ROC） were adopted to analyze the sensitivityand specificity of LAL assays. Results Ultimatedly, there were 78 patients enrolled in our study, of them, 56 patients in group A , 22 patients in groupB, 59 patients in group C and 19 ptients in group D. There were positive assay in 27 patients of group A, 8 patients in group B, 23 patients in group C, 12patients in group D. Analysis displayed that there were no significant difference in the ratio of positive assays between group A and group B, as well asgroup C and group D（p〉0.05）. ROC curve showed the sensitivity, specificity of LAL asssys were53.6 % ,40.9%, positive predictive value and negativepredictive value were 77.14%, 32.56% respectively, while the cut off ≥0.4EU/ml. The area under the curve is 0.625（p〉0.05）. ConclusionsDetection of endotoxin with chromogenic LAL assay in plasma could not be used in diagnosis as well as appraisal of prognosis in patients with sepsis dueto gram-negative bacteria.
出处
《中华临床医师杂志（电子版）》
CAS
2016年第4期217-218,共2页
Chinese Journal of Clinicians(Electronic Edition)
基金
厦门市科技局惠民项目
厦门市科技局课题（3502Z2013005）
