脓毒症患者血清CRP、sTREM-1和PCT水平变化及其临床意义研究
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摘要
目的:观察脓毒症患者血清C反应蛋白(CRP)、可溶性髓系细胞触发受体-1(sTREM-1)和降钙素原(PCT)水平变化,并分析其临床意义。方法:选取2015年3月至2016年8月在南通大学附属医院接受治疗的脓毒症患者为研究对象,同时选取健康成年人作为对照。观察两组CRP、sTREM-1、PCT水平和APACHEⅡ评分,比较不同疾病程度、不同部位感染、不同预后的脓毒症患者血清CRP、sTREM-1、PCT水平和APACHEⅡ评分的差异。结果:脓毒症患者血清CRP、sTREM-1、PCT水平和APACHEⅡ评分均高于对照组(t=59.240、60.680、29.603、34.983,均P<0.001);中重度脓毒症组患者的CRP、sTREM-1、PCT水平和APACHEⅡ评分均高于轻度脓毒症组(t=-15.216、-8.079、-16.366、-12.072,均P<0.001);肺部感染和腹腔感染组患者的CRP、sTREM-1、PCT水平和APACHEⅡ评分均高于血流感染组患者,而肺部感染和腹腔感染组患者之间比较差异无统计学意义;死亡组患者的CRP、sTREM-1、PCT水平和APACHEⅡ评分均高于存活组(t=-11.648、-9.807、-7.778、-6.742,均P<0.001)。结论:脓毒症患者血清CRP、sTREM-1和PCT水平较高,且与疾病严重程度和预后密切相关。
Objective: To observe the changes of C reactive protein( CRP),soluble myeloid cell triggering receptor-1( sTREM-1) and procalcitonin( PCT) levels in patients with sepsis,and to analyze its clinical significance.Methods: The subjects with sepsis treated in Affiliated Hospital of Nantong University from March 2015 to August2016 were selected as the subjects,and healthy adults who were examined in our hospital as controls. The levels of CRP,sTREM-1,PCT and APACHE Ⅱ score in the two groups were observed,and the difference of CRP,sTREM-1,PCT levels and APACHE Ⅱ score among patients with different disease degree,different site infection and different prognosis were compared. Results: The levels of CRP,sTREM-1,PCT and APACHE Ⅱ in patients with sepsis were higher than those in the control group( t = 59. 240,60. 680,29. 603,34. 983,P < 0. 001); The levels of CRP,sTREM-1,PCT and APACHE Ⅱ in patients with moderate to severe sepsis were higher than those in mild sepsis group( t =-15. 216,-8. 079,-16. 366,-12. 072,P < 0. 001); The levels of CRP,sTREM-1,PCT and APACHE Ⅱ in the patients with lung infection and abdominal infection were higher than those in the bloodstream infection group,but there was no difference between the patients with lung infection and the abdominal infection group; The CRP,sTREM-1,PCT levels and APACHE Ⅱ scores of the patients in the death group were higher than those in the survival group( t =-11. 648,-9. 807,-7. 778,-6. 742,P < 0. 001). Conclusion:The levels of CRP,sTREM-1 and PCT in patients with sepsis are higher than those without sepsis,which are closely related to the severity of the disease and prognosis.
Objective: To observe the changes of C reactive protein( CRP),soluble myeloid cell triggering receptor-1( sTREM-1) and procalcitonin( PCT) levels in patients with sepsis,and to analyze its clinical significance.Methods: The subjects with sepsis treated in Affiliated Hospital of Nantong University from March 2015 to August2016 were selected as the subjects,and healthy adults who were examined in our hospital as controls. The levels of CRP,sTREM-1,PCT and APACHE Ⅱ score in the two groups were observed,and the difference of CRP,sTREM-1,PCT levels and APACHE Ⅱ score among patients with different disease degree,different site infection and different prognosis were compared. Results: The levels of CRP,sTREM-1,PCT and APACHE Ⅱ in patients with sepsis were higher than those in the control group( t = 59. 240,60. 680,29. 603,34. 983,P < 0. 001); The levels of CRP,sTREM-1,PCT and APACHE Ⅱ in patients with moderate to severe sepsis were higher than those in mild sepsis group( t =-15. 216,-8. 079,-16. 366,-12. 072,P < 0. 001); The levels of CRP,sTREM-1,PCT and APACHE Ⅱ in the patients with lung infection and abdominal infection were higher than those in the bloodstream infection group,but there was no difference between the patients with lung infection and the abdominal infection group; The CRP,sTREM-1,PCT levels and APACHE Ⅱ scores of the patients in the death group were higher than those in the survival group( t =-11. 648,-9. 807,-7. 778,-6. 742,P < 0. 001). Conclusion:The levels of CRP,sTREM-1 and PCT in patients with sepsis are higher than those without sepsis,which are closely related to the severity of the disease and prognosis.
引文
[1]RYU J,YANG J H,LEE D,et al.Clinical usefulness of procalcitonin and C-reactive protein as outcome predictors in critically ill patients with severe sepsis and septic shock[J].PLo S One,2015,10(9):150-153.
[2]YANG Y,XIE J,GUO F,et al.Combination of C-reactive protein,procalcitonin and sepsis-related organ failure score for the diagnosis of sepsis in critical patients[J].Ann Intensive Care,2016,6(1):90-92.
[3]罗运山,刘易林,邓霞梅,等.可溶性髓样细胞触发性受体1、降钙素原、C-反应蛋白在脓毒症中的临床价值[J].实用医学杂志,2016,32(17):2861-2863.
[4]仝珊,卢彩兰,李燕,等.脓毒症患者血脂水平与超敏C反应蛋白APACHEⅡ评分关系研究[J].山西医药杂志,2014,43(3):250-252.
[5]苏进志.脓毒血症患者血清降钙素原和C-反应蛋白变化及与APACHEⅡ评分的相关性[J].白求恩医学杂志,2015,13(6):657-658.
[6]ABDOLLAHI A,SHOAR S,NAYYERI F,et al.Diagnostic value of simultaneous measurement of procalcitonin,interleukin-6and hs-CRP in prediction of early-onset neonatal sepsis[J].Mediterr J Hematol Infect Dis,2012,4(1):e2012028.
[7]ORATI J A,ALMEIDA P,SANTOS V,et al.Serum C-reactive protein concentrations in early abdominal and pulmonary sepsis[J].Rev Bras Ter Intensiva,2013,25(1):6-11.
[8]JEON J H,NAMGUNG R,PARK M S,et al.Positive maternal C-reactive protein predicts neonatal sepsis[J].Yonsei Med J,2014,55(1):113-117.
[9]王胜云,陈德昌.降钙素原和C-反应蛋白与脓毒症患者病情严重程度评分的相关性研究及其对预后的评估价值[J].中华危重病急救医学,2015,27(2):97-101.
[10]马静,李红兵,张祎捷,等.血清降钙素原、超敏C反应蛋白在肺炎合并脓毒症患者中的临床意义[J].中国实用医药,2014,9(5):124-125.
[11]史玉霞.髓系细胞触发受体-1在低水平降钙素原脓毒症患者的诊断意义[J].现代预防医学,2014,34(15):2828-2829.
[12]CRISTIAN P,DANIEL B,PATRICE M,et al.Value of s TREM-1,procalcitonin and CRP as laboratory parameters for postmortem diagnosis of sepsis[J].J Infect,2013,67(6):545-555.
[13]卞东会,陈铭锐,于仁义,等.血必净注射液治疗重度烧伤合并脓毒症的临床疗效分析[J].现代医学,2017,45(4):483-486.
[14]王自财,张小莉,黄循斌,等.脓毒症患儿血浆可溶性髓系细胞触发受体1、降钙素原和C反应蛋白水平变化的研究[J].海南医学,2013,24(11):1625-1628.
[15]张声,张卫星,罗华,等.脓毒症患者血清降钙素原和C反应蛋白水平检测的临床价值[J].现代医学,2015,43(3):303-306.
[2]YANG Y,XIE J,GUO F,et al.Combination of C-reactive protein,procalcitonin and sepsis-related organ failure score for the diagnosis of sepsis in critical patients[J].Ann Intensive Care,2016,6(1):90-92.
[3]罗运山,刘易林,邓霞梅,等.可溶性髓样细胞触发性受体1、降钙素原、C-反应蛋白在脓毒症中的临床价值[J].实用医学杂志,2016,32(17):2861-2863.
[4]仝珊,卢彩兰,李燕,等.脓毒症患者血脂水平与超敏C反应蛋白APACHEⅡ评分关系研究[J].山西医药杂志,2014,43(3):250-252.
[5]苏进志.脓毒血症患者血清降钙素原和C-反应蛋白变化及与APACHEⅡ评分的相关性[J].白求恩医学杂志,2015,13(6):657-658.
[6]ABDOLLAHI A,SHOAR S,NAYYERI F,et al.Diagnostic value of simultaneous measurement of procalcitonin,interleukin-6and hs-CRP in prediction of early-onset neonatal sepsis[J].Mediterr J Hematol Infect Dis,2012,4(1):e2012028.
[7]ORATI J A,ALMEIDA P,SANTOS V,et al.Serum C-reactive protein concentrations in early abdominal and pulmonary sepsis[J].Rev Bras Ter Intensiva,2013,25(1):6-11.
[8]JEON J H,NAMGUNG R,PARK M S,et al.Positive maternal C-reactive protein predicts neonatal sepsis[J].Yonsei Med J,2014,55(1):113-117.
[9]王胜云,陈德昌.降钙素原和C-反应蛋白与脓毒症患者病情严重程度评分的相关性研究及其对预后的评估价值[J].中华危重病急救医学,2015,27(2):97-101.
[10]马静,李红兵,张祎捷,等.血清降钙素原、超敏C反应蛋白在肺炎合并脓毒症患者中的临床意义[J].中国实用医药,2014,9(5):124-125.
[11]史玉霞.髓系细胞触发受体-1在低水平降钙素原脓毒症患者的诊断意义[J].现代预防医学,2014,34(15):2828-2829.
[12]CRISTIAN P,DANIEL B,PATRICE M,et al.Value of s TREM-1,procalcitonin and CRP as laboratory parameters for postmortem diagnosis of sepsis[J].J Infect,2013,67(6):545-555.
[13]卞东会,陈铭锐,于仁义,等.血必净注射液治疗重度烧伤合并脓毒症的临床疗效分析[J].现代医学,2017,45(4):483-486.
[14]王自财,张小莉,黄循斌,等.脓毒症患儿血浆可溶性髓系细胞触发受体1、降钙素原和C反应蛋白水平变化的研究[J].海南医学,2013,24(11):1625-1628.
[15]张声,张卫星,罗华,等.脓毒症患者血清降钙素原和C反应蛋白水平检测的临床价值[J].现代医学,2015,43(3):303-306.