降钙素原联合IL-6在SIRS病因及病情诊断中的临床意义
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摘要
目的:探讨降钙素原(PCT)联合白细胞介素-6(IL-6)在全身性炎症反应综合征(SIRS)病因及病情诊断中的临床意义。方法:115例SIRS患者分为脓毒症组(n=46)和非感染SIRS组(n=69)。测定两组入院24h内PCT、IL-6血清水平。同时记录白细胞计数(WBC)、中性粒细胞计数(N)、中性粒细胞百分比(N%)、C-反应蛋白(CRP)及急性生理和慢性健康评分(APACHEⅡ评分)、序贯器官衰竭评分(SOFA评分)。结果:脓毒症组与非感染SIRS组在APACHEⅡ评分、SOFA评分、院内病死率方面有统计学差异(P<0.05)。脓毒症组CRP、PCT、IL-6血清水平及N%较非感染SIRS组显著升高(P<0.05)。PCT和IL-6与APACHEⅡ评分呈正相关(r=0.580,0.463),N、N%、PCT、IL-6与SOFA评分呈正相关(r=0.371,0.393,0.426,0.371),PCT与院内病死率呈正相关(r=0.349)。ROC曲线分析显示,与CRP、N、N%等炎症指标比较,PCT、IL-6、感染评分的AUC较大,诊断感染的价值较高。结论:PCT与IL-6联合应用较单一标记物检测可更有效地提高对脓毒症的鉴别能力。
Objective:To investigate the clinical application of procalcitonin(PCT)combined with interleukin-6(IL-6)in the diagnosis of systemic inflammatory response syndrome(SIRS).Methods:A total of 115 cases of SIRS were divided into sepsis group(n=46)and noninfectious SIRS group(n=69).The serum levels of PCT and IL-6 were detected within 24 hours of admission in two groups.White blood cell count,neutrophil counts(N),neutrophil percentage(N%),C-reactive protein(CRP)and Acute Physiology and Chronic Health Evaluation(APACHE)Ⅱscore,Sequential Organ Failure Assessment(SOFA)Score were recorded.Results:There were significant differences in APACHE Ⅱ score,SOFA score,hospital mortality between sepsis group and noninfectious SIRS group(P<0.05).The serum levels of CRP,PCT,IL-6 and N%in sepsis group were significantly higher than those in noninfectious SIRS group(P<0.05).PCT and IL-6 were positively correlated with APACHE Ⅱscores(r=0.580,0.463),N,N%,PCT,IL-6 were positively correlated with SOFA scores(r=0.371,0.393,0.371,0.393),and PCT was positively correlated with hospital mortality(r=0.349).ROC curve analysis showed that compared with CRP,N,N% and other inflammatory markers,the AUC of PCT,IL-6 and infection score was larger,and these three indicators were more valuable for clinical diagnosis.Conclusions:The combined detection of PCT and IL-6 is more effective than single detection in prognosis of sepsis.
Objective:To investigate the clinical application of procalcitonin(PCT)combined with interleukin-6(IL-6)in the diagnosis of systemic inflammatory response syndrome(SIRS).Methods:A total of 115 cases of SIRS were divided into sepsis group(n=46)and noninfectious SIRS group(n=69).The serum levels of PCT and IL-6 were detected within 24 hours of admission in two groups.White blood cell count,neutrophil counts(N),neutrophil percentage(N%),C-reactive protein(CRP)and Acute Physiology and Chronic Health Evaluation(APACHE)Ⅱscore,Sequential Organ Failure Assessment(SOFA)Score were recorded.Results:There were significant differences in APACHE Ⅱ score,SOFA score,hospital mortality between sepsis group and noninfectious SIRS group(P<0.05).The serum levels of CRP,PCT,IL-6 and N%in sepsis group were significantly higher than those in noninfectious SIRS group(P<0.05).PCT and IL-6 were positively correlated with APACHE Ⅱscores(r=0.580,0.463),N,N%,PCT,IL-6 were positively correlated with SOFA scores(r=0.371,0.393,0.371,0.393),and PCT was positively correlated with hospital mortality(r=0.349).ROC curve analysis showed that compared with CRP,N,N% and other inflammatory markers,the AUC of PCT,IL-6 and infection score was larger,and these three indicators were more valuable for clinical diagnosis.Conclusions:The combined detection of PCT and IL-6 is more effective than single detection in prognosis of sepsis.
引文
1 Meisner M.Update on procalcitonin measurements[J].Ann Lab Med,2014,34(4):263-273.
2于湘友,郗晓婧,钟华,等.PCT清除率用于评估ICU脓毒症患者预后的临床研究[J].中华急诊医学杂志,2013,22(2):205-208.
3沈丽娟,吴锡平,关云艳,等.脓毒症患者血清IL-6和NTproBNP的变化及其临床意义[J].临床急诊杂志,2013,14(3):119-122.
4 Dellinger RP,Levy MM,Rhodes A,et al.Surviving sepsis campaign:international guidelines for management of severe sepsis and septic shock,2012[J].Intensive Care Med,2013,39:165-228.
5 Singer M,Deutschman CS,Seymour CW,et al.The Third International Consensus Definitions for Sepsis and Septic Shock(Sepsis-3)[J].JAMA,2016,315(8):801-810.
6沈耀红,臧亚勤,黄玉萍,等.降钙素原及传统炎症指标对儿童社区获得性肺炎的诊断价值[J].江苏医药,2017,43(9):667-669.
7 Gonsalves MD,Sakr Y.Early identification of sepsis[J].Curr Infect Dis Rep,2010,12(5):329-335.
8陈敏英.生物标志物在脓毒症诊断与治疗中的价值[J].医学与哲学,2017,38(1B):25-28.
9杨琴,曹军皓,丁进亚,等.血清降钙素原、白细胞介素6和C反应蛋白在脓毒血症和全身炎症反应综合征鉴别诊断中的意义[J].临床军医杂志,2013,41(7):675-677.
10 Meisner M.Update on procalcitonin measurements[J].Ann Lab Med,2014,34(4):263-273.
2于湘友,郗晓婧,钟华,等.PCT清除率用于评估ICU脓毒症患者预后的临床研究[J].中华急诊医学杂志,2013,22(2):205-208.
3沈丽娟,吴锡平,关云艳,等.脓毒症患者血清IL-6和NTproBNP的变化及其临床意义[J].临床急诊杂志,2013,14(3):119-122.
4 Dellinger RP,Levy MM,Rhodes A,et al.Surviving sepsis campaign:international guidelines for management of severe sepsis and septic shock,2012[J].Intensive Care Med,2013,39:165-228.
5 Singer M,Deutschman CS,Seymour CW,et al.The Third International Consensus Definitions for Sepsis and Septic Shock(Sepsis-3)[J].JAMA,2016,315(8):801-810.
6沈耀红,臧亚勤,黄玉萍,等.降钙素原及传统炎症指标对儿童社区获得性肺炎的诊断价值[J].江苏医药,2017,43(9):667-669.
7 Gonsalves MD,Sakr Y.Early identification of sepsis[J].Curr Infect Dis Rep,2010,12(5):329-335.
8陈敏英.生物标志物在脓毒症诊断与治疗中的价值[J].医学与哲学,2017,38(1B):25-28.
9杨琴,曹军皓,丁进亚,等.血清降钙素原、白细胞介素6和C反应蛋白在脓毒血症和全身炎症反应综合征鉴别诊断中的意义[J].临床军医杂志,2013,41(7):675-677.
10 Meisner M.Update on procalcitonin measurements[J].Ann Lab Med,2014,34(4):263-273.