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目的探讨降钙素原(PCT)与C-反应蛋白(CRP)对重症监护病房(ICU)严重脓毒症和脓毒性休克患者严重程度的评估价值以及与急性生理学与慢性健康状况评分系统Ⅱ评分(APPACHEⅡ评分)及序贯器官衰竭评分(SOFA评分)的相关性。方法对2013年1月至2015年1月收住大同市第五人民医院重症医学科的104例脓毒症患者根据是否休克分为2组:脓毒性休克组(51例)和严重脓毒症组(53例)。2组患者在入住ICU后收集性别、年龄、既往史,急查血常规、即刻血糖、血气分析、肝肾功能,细菌培养,APPACHEⅡ评分及SOFA评分。入科24 h内抽血化验降钙素原、C-反应蛋白。观察2组患者PCT、CRP、SOFA评分、APACHEⅡ评分差异,脓毒症患者PCT、CRP与SOFA评分、APACHEⅡ评分的相关性,绘制受试者工作曲线(ROC),评价PCT、CRP、SOFA评分和APACHEⅡ评分对不同程度脓毒症的诊断价值。结果脓毒性休克组严重脓毒症PCT[(24.3±5.7)ng/ml和(4.2±2.6)ng/ml,P<0.01]、CRP[(97.1±10.8)mg/L和(64.2±11.3)mg/L,P<0.05)]、APACHEⅡ评分[(20.9±7.1)分和(16.3±5.7)分,P<0.01]、SOFA评分[(10.6±4.1)分和(5.4±3.0)分,P<0.05)]与严重服毒症组比较,脓毒性休克组各指标均明显升高。PCT、CRP与SOFA评分呈显著正相关(PCT:r=0.531,P<0.01。CRP:r=0.426,P<0.01),而二者与APACHEⅡ评分均无相关性(PCT:r=0.032,P>0.05;CRP:r=0.05,P>0.05)。PCT对评价脓毒症严重程度的ROC曲线下面积(AUC)明显大于CRP的AUC[0.787(95%可信区间0.679,0.894);0.671(95%可信区间0.546,0.796)]及APACHEⅡ评分的AUC[0.787(95%可信区间0.679,0.894);0.687(95%可信区间0.562,0.812)]。PCT对脓毒症严重程度评估的敏感度及特异性均高(截断值在0.795 ng/ml时,敏感度88.6%,特异度63.9%)。CRP的敏感度高但特异性低(截断值为35.00 mg/L时,敏感度88.6%,特异性41.7%)。SOFA评分的特异性高但敏感度低(截断值在9.00分时,敏感度65.7%,特异性91.7%)。APACHEⅡ评分敏感度高及特异性比PCT低(截断值为18.5分时,敏感度74.3%,特异度58.3%)。结论 PCT与CRP水平能很好地反映脓毒症患者的严重程度,且与SOFA评分有良好的相关性,PCT对脓毒症患者严重程度的评估,敏感性特异性均高。
Objective To investigate the value of procalcitonin (PCT) and C-reactive protein (CRP) in assessing the severity of severe sepsis and septic shock in intensive care unit (ICU) and the score of acute physiology and chronic health evaluation system Ⅱ (APPACHE Ⅱ score) and sequential organ failure score (SOFA score). Methods From January 2013 to January 2015, 104 patients with sepsis admitted to the Fifth People’s Hospital of Datong, China, were divided into two groups based on whether they were shocked: septic shock (n = 51) and severe sepsis Group (53 cases). Two groups of patients were collected after ICU admission sex, age, past history, urgent blood test, immediate blood glucose, blood gas analysis, liver and kidney function, bacterial culture, APPACHE Ⅱ score and SOFA score. Intake subjects within 24h blood test calcitonin, C-reactive protein. The levels of PCT, CRP, SOFA, APACHEⅡscore, PCT, CRP and SOFA scores, APACHEⅡscore in sepsis patients were plotted, and the working curve (ROC), PCT, CRP, SOFA score and APACHE Ⅱ score on the diagnosis of different degrees of sepsis. Results Severe sepsis in the septic shock group was significantly higher in PCT (24.3 ± 5.7 ng / ml vs 4.2 ± 2.6 ng / ml, P <0.01), CRP (97.1 ± 10.8) mg / L and (64.2 ± 11.3) (20.9 ± 7.1) and (16.3 ± 5.7), P <0.01], and SOFA scores [(10.6 ± 4.1) and (5.4 ± 3.0), P <0.05)] Compared with severe poisoning group, each index of septic shock group were significantly increased. PCT, CRP and SOFA scores were significantly and positively correlated (PCT: r = 0.531, P <0.01.CRP: r = 0.426, P <0.01) > 0.05; CRP: r = 0.05, P> 0.05). The area under the ROC curve (AUC) for PCT in assessing the severity of sepsis was significantly greater than the AUC of CRP [0.787 (95% confidence interval 0.679, 0.894); 0.671 (95% confidence interval 0.546, 0.796)] and the APACHE II score AUC [0.787 (95% confidence interval 0.679, 0.894); 0.687 (95% confidence interval 0.562, 0.812)]. The sensitivity and specificity of PCT for the assessment of sepsis severity were high (sensitivity of 88.6% and specificity of 63.9% at a cutoff of 0.795 ng / ml). CRP has high sensitivity but low specificity (sensitivity of 88.6% and specificity of 41.7% at a cutoff of 35.00 mg / L). The SOFA score has high specificity but low sensitivity (cutoff at 9.00 minutes, sensitivity of 65.7%, specificity of 91.7%). The APACHE II score was more sensitive and specific than PCT (sensitivity of 74.3% and specificity of 58.3% at a cutoff of 18.5). Conclusions The levels of PCT and CRP can reflect the severity of sepsis patients well, and have a good correlation with SOFA score. PCT has a high sensitivity and specificity for evaluating the severity of sepsis.