探讨降钙素原及C反应蛋白与重度脓毒血症患者预后的关系

目的研究降钙素原(PCT)及C反应蛋白(CRP)在术后重度脓毒血症患者预后判断中的意义。方法以2010年3月至2013年5月在佛山市高明区人民医院住院治疗的40例胸腔术后的重度脓毒血症患者作为研究对象,在脓毒血症确诊后的第1,3,5,7,10日分别抽血检测患者的PCT及CRP。结果 40例胸腔术后脓毒血症患者,治疗1个月后24例患者存活,作为存活组,16例患者死亡,其中7例2周内死亡,9例在2⁴周内死亡,并列为死亡组;存活组和死亡组PCT、CRP水平及急性生理与慢性健康评分Ⅱ(APACHEⅡ)的评分在第1,3日较高,随着治疗时间的延长,PCT、CRP水平及APACHEⅡ评分逐渐降低,而存活组患者在第10日PCT、CRP水平及APACHEⅡ评分下降幅度明显高于第1周内,死亡组PCT、CRP水平及APACHEⅡ评分在第7,10日下降幅度明显低于存活组,两组相比差异有统计学意义(P<0.05)。PCT与APACHEⅡ评分有相关性(r=0.327,P=0.021),CRP与APACHEⅡ评分存在相关性(r=0.378,P=0.002);第7日PCT、CRP及APACHEⅡ评分预测术后重度脓毒血症患者28 d死亡的ROC曲线,三项指标均有明显的敏感性和特异性,三项指标ROC曲线下面积<0.75,提示单个指标评估重度脓毒血症28 d预后有一定的不足之处。结论胸腔术后重度脓毒血症患者确诊后第7日PCT、CRP水平与脓毒血症病情严重程度密切相关,同时检测PCT和CRP对重度脓毒血症患者预后评估有重要的临床意义。

Study on the Correlation of Procalcitonin and C-reactive Protein with the Prognosis of Patients with Severe Sepsis

Objective To study the significance of procalcitonin（PCT） and C-reactive protein （CRP） in the prognosis of patients with severe sepsis after surgery.Methods A total of 40 cases of patients with severe sepsis after chest surgery admitted in People＇s Hospital of Gaoming District from Mar.2010 to May 2013 were selected as research objects.The levels of PCT and CRP of all the cases were tested at the 1^st,3^rd,5^th,7^th,10^th day after confirmed diagnosis of sepsis.Results One month after treatment,24 patients out of the 40 cases survived,which were included in the survival group.And the other 16 patients died,including seven cases died within 2 weeks,and nine cases died within 2-4 weeks,which were included in the death group.The levels of PCT,CRP and APACHE Ⅱ score were higher at the 1st and 3rd day than the other days in both the survival group and the death group,and the levels of PCT,CRP and APACHE Ⅱ scores decreased as the treatment time prolonged.In the survival group,the decreasing degree of PCT,CRP levels and APACHE Ⅱ scores on the 10^th day was significantly higher than that of the first week.The decreasing degree of PCT,CRP levels and APACHE Ⅱ scores on the 7^th and 10th day of the death group was significantly lower than that of the survival group,there was statistically significant difference between the two groups （P 〈 0.05）.There were correlations between PCT level and APACHE Ⅱ score （r =0.327,P =0.021）,and between CRP level and APACHE Ⅱ score （r =0.378,P =0.002）.In ROC curve of patients with severe sepsis on the 28^th day after operation predicted by the levels of PCT,CRP and APACHE Ⅱ scores on the 7^th day,three indicators had obvious sensitivity and specificity,and the area of such indicators under the ROC curve were less than 0.75,suggesting that a single indicator assessment of severe sepsis on the 28^th day prognosis had some shortcomings.Conclusion There is a close relationship between the levels of PCT,CRP on the 7th day after diagnosis and the severity of s