汪颖,王迪芬,刘颖,付江泉,陈先俊
WANG Ying,WANG Difen,LIU Ying,FU Jiangquan,CHEN Xianjun

• 1:贵州医科大学附院重症医学科

摘要(Abstract)：

目的:了解不同部位及不同病原体感染所引起的脓毒症患者血清降钙素原(PCT)和D-二聚体水平。方法:收集116例脓毒血症患者的临床资料,比较不同感染部位患者、不同感染病菌患者血清PCT及D-二聚体水平。结果:不同感染部位患者血清PCT及D-二聚体水平不同,血液感染患者的PCT及D-二聚体水平较其他部位感染患者明显增高,差异具有统计学意义(P<0.05);在不同病原菌的感染中,PCT由高至低分别为G-菌、G+菌、真菌,差异均具有统计学意义(P<0.05);真菌感染患者的D-二聚体水平与G-菌和G+菌感染患者相比,差异具有统计学意义(P<0.05),而G+菌和G-菌感染患者的血清D-二聚体水平比较差异无统计学意义(P>0.05)。结论:监测血清PCT和D-二聚体可能对明确脓毒症患者感染部位和感染病原菌提供参考,并对抗菌药物选择及疗程有一定指导意义。
Objective: To investigate serum procalcitonin and d-dimer level of different parts and various pathogenic microorganism infections caused sepsis. Methods: 116 sepsis patients' data were analyzed; comparing serum procalcitonin and d-dimer level of different parts and various pathogenic microorganism infections. Results: The values of procalcitonin and D-dimer in patients with bloodstream infection are significantly higher than in patients with other infection,difference was statistically significant( P < 0. 05). The PCT levels were different among different pathogens,top-to-bottom sequence as G-fungus,G + fungus,and fungus,difference was statistically significant( P < 0. 05). Comparing Ddimer level of fungus infected patients with G-fungus and G + fungus infected patients,difference was statistically significant( P < 0. 05); while serum D-dimer level comparison of G + fungus and G-fungus infected patients showed no statistical significance( P > 0. 05). Conclusions: Monitoring serum PCT and D-dimer may be helpful to determine the infection parts and to definite the pathogens in sepsis patients,and be preferable for choosing antimicrobial agents.

关键词(KeyWords)： 脓毒症;血清;降钙素原;D-二聚体;感染
sepsis;serum;procalcitonin;D-dimer;infection

Abstract:

Keywords:

基金项目(Foundation): 贵州省科技攻关项目[黔科合SY(2010)3079号];; 贵州省高层次人才科研项目(TZJF-2011-25);; 国家临床重点专科建设项目(2011-170);; 贵州省临床重点学科建设项目(2011-52)

作者(Author): 汪颖,王迪芬,刘颖,付江泉,陈先俊
WANG Ying,WANG Difen,LIU Ying,FU Jiangquan,CHEN Xianjun

DOI: 10.19367/j.cnki.1000-2707.2017.10.011

参考文献(References)：

• [1]Angus DC,Linde-Zwirble WT,Lidicker J,et al.Epidemiology of severe sepsis in the United States:analysis of incidence,outcome,and associated costs of care.Crit Care Med,2001(7):1303-1310.
• [2]Singer M,Deutschman CS,Seymour CW,et al.The third international consensus definitions for sepsis and septic shock(sepsis-3)[J].JAMA,2016(8):801-810.
• [3]Christ-Crain M1,Morgenthaler NG,Struck J,et al.Mid-regional pro-adrenomedullin as a prognostic marker in sepsis:an observational study[J].Crit Care,2005(6):816-824.
• [4]杨平,钱香,徐学静,等.血清降钙素原联合痰培养检测在呼吸道感染中的临床应用价值[J].中国医药导报,2014(34):55-58.
• [5]Levy MM,Fink MP,Marshall JC,et al.2001 SCCM/ESICM/ACCP/ATS/SIS lnternational Sepsis Definitions Conference.Crit Care Med,2003(31):1250-1256.
• [6]Russwurm S,Stonans I,Stonane E,et al.Procalcitonin and CGRP-1mma expression in various human tissues[J].Shock,2001(16):109-112.
• [7]Caatelli GP,Poqnani C,Cita M,et al.Procalcitonin,C-reactive protein.white blood cells and SOFA score in ICU:diagnosis and monitoring of sepsis[J].Minerva Anestesio I,2006(1):69-80.
• [8]马晓薇,罗永艾.降钙素原在侵袭性真菌感染诊断中的应用价值研究[J].中华医院感染学杂志,2012(4):645-646.
• [9]杜斌,陈德昌,潘家绮,等.降钙素原与白介素6的相关性优于传统的炎症指标[J].中国危重病急救医学,2002(14):474-477.
• [10]Fendler WM,Piotrowski AJ.Procalcitonin in the early diagnosis of nosocomial sepsis in preterm neonates[J].J Paediatr Child Health,2008(3):114-118.
• [11]莫丽亚,张林,邓永超等.不同类别细菌感染患儿血清降钙素原水平变化[J].中国感染控制杂志,2011(3):191-193.
• [12]Nijsten MW,Olinga P,The TH,et al.Procalcitonin behaves as a fast responding acute phase protein in vivo and invitr[J].Crit Care Med,2000(2):458-461.
• [13]Charles PE,Dalle F,Aho S,et al.Serum procalcitonin measurement contribution to the early diagnosis of candidemia incritically ill patients[J].Intensive Care Med,2006(10):1577-1583.
• [14]Nijsten MW,Olinga P,The TH,et al.Procalcitonin behaves as a fast responding acute phase protein in vivo and invitr[J].Crit Care Med,2000(2):458-461.
• [15]魏万昆,万程彬,张毅.不同真菌感染对降钙素原的差异与疾病预后的关系[J],中华医院感染学杂志,2015(9):1937-1939.
• [16]时兢,缪昉,宋菊芬,等.血清降钙素原检测对院内深部真菌感染诊断价值的探讨[J].内科急危重症杂志,2001(4):203-204.
• [17]宋艳群,陈光建,赵叶娜,等.降钙素原水平与感染源及病原学的相关性分析[J],2016(2):88-90.
• [18]高倩,王真,刘铸.降钙素原对判断急诊感染性疾病感染部位的分析[J].山西医药杂志,2017(6):628-630.
• [19]韩静静,徐亚青,邓艳萍,等.血培养及降钙素原对有其他部位感染伴血流感染ICU患者的诊断价值[J].中华全科医学,2016(6):947-949.
• [20]王兆钺.D二聚体临床应用的进展[J].血栓与止血学,2014(1):46-48.
• [21]Robador PA,San JoséG,Rodríguez C,et al.HIF-1-mediated up-regulation of cardiotrophin-1 is involved in the survival response of cardiomyocytes to hypoxia[J].Cardiovasc Res,2011(2):247-255.
• [22]Fukuoka H,Takeuchi T,Matsumoto R,et al.D-dimer as a significant marker of deep vein thrombosis in patients with subclinical or overt Cushing's syndrome[J].Endocr J,2014(10):1003-1010.
• [23]王书侠,张家明,姚孝明,等.血流感染患者D-二聚体测定的临床意义[J].检验医学与临床,2016(5):628-632.
• [24]张劲草,刘海,徐敬.D-二聚体与成人不同类型脓毒症的关系[J].世界华人消化杂志,2017(9):846-851.
• [25]HarranTF,Kardiyoloji AD,爦anllurfa.Using the D-dimer test in infective endocarditis[J].Turk Kardiyol Dern Ars,2013(7):595-597.

文章评论(Comment)：