秦海萍,庄建晴,曹维锷,王伟
QIN Haiping,ZHUANG Jianqing,CAO Weie,WANG Wei

• 1:徐汇区中心医院急诊科

摘要(Abstract)：

目的:探讨降钙素原(PCT)联合内毒素(ET)在老年脓毒症的诊断、抗菌药物使用、病情评估等方面的作用。方法:老年脓毒症患者30例作为脓毒症组,非脓毒症细菌感染患者30例作为感染组,同期非感染性疾病患者30例作为对照组;分别于入院后24 h内、第3天、第7天抽取受检者外周静脉血,测定PCT和ET水平,根据检测结果绘制ROC曲线,分析PCT和ET浓度对老年脓毒症的诊断价值,用Youden指数最大值对应的最佳诊断界值和入院24 h内ET>20 ng/L为阳性将脓毒症组和感染组患者又分别分为PCT大于临界值组和PCT小于临界值组及ET阳性组和ET阴性组,分别比较不分组的两组患者抗生素使用时间和住院时间;同时比较ET分组的患者标本培养出革兰阴性菌比率。结果:感染组和脓毒症组各时间点的PCT、ET浓度均高于对照组(P<0.01);感染组和脓毒症组PCT、ET浓度随时间延长逐步下降(P<0.01);脓毒症组PCT浓度高于感染组,在各时间点差异均有统计学意义(P<0.01),而ET在脓毒症组和感染组相比差异无统计学意义(P>0.05);入院24 h内PCT、ET浓度诊断老年脓毒症的受试者工作特征曲线(ROC曲线),曲线下面积分别为0.953、0.561,PCT诊断老年脓毒症的准确性较高(P<0.01),其最佳诊断界值为5.16μg/L;PCT≥5.16μg/L组患者抗生素使用时间长于PCT<5.16μg/L(P<0.05),而住院时间组间差异无统计学意义(P>0.05);ET阳性组标本培养出革兰阴性菌比率高于ET阴性组,差异有统计学意义(P<0.01),而抗生素使用时间和住院时间组间差异无统计学意义(P>0.05)。结论:PCT对老年脓毒症的诊断价值较高,可指导抗生素使用时间,并间接提示病情严重度;ET可提示老年脓毒症的病原菌类型,指导早期临床抗菌药物的使用。
Objective: To investigate the efficacy of serum procalcitonin( PCT) and endotoxin( ET)in diagnosis,antibiotic using and condition assessment of elderly patients with sepsis. Methods: 60 elderly patients with sepsis and bacterial infection( non- sepsis) from emergency ward and ICU served as sepsis group and infectious group,while choosing the same period of hospitalized 30 patients with non- infectious diseases as the control group. PCT and ET levels were detected in three groups within24 hours,3 d and 7 d after admission. Statistical analysis was conducted to build ROC curve to analyze diagnosis value of PCT and ET concentrations in elderly sepsis. Adopting the best diagnostic cutoff value corresponding to the maximum Youden index to further divide sepsis group and infectious group into above PCT cutoff value group and below PCT cutoff value group,comparing the intake time of antibiotics and hospitalization of both groups; for those ET > 20 ng / L admitted within 24 h as positive were divide into ET positive group and ET negative group,comparing intake time of antibiotics and hospitalization of both groups,and also the infectious rate of sample cultured GNB. Results: PCT and ET concentration levels of infection and sepsis groups were higher than control group at each time point,the difference was statistically significant( P < 0. 01); PCT and ET concentration levels of infection and sepsis groups,respectively showed a gradual decline in three time points( P < 0. 01); PCT concentrations of sepsis group were higher than infection group,statistically significant differences were at all time points( P < 0. 01),while ET concentrations had no statistically significant difference at each time points between the two groups( P > 0. 05); in experimental groups,the area under receiver operating characteristic curve( ROC curve) for elderly sepsis diagnosis of PCT and ET concentration within 24 hours of admission were 0. 953 and 0. 561,therefore PCT had a higher diagnosis value in elderly sepsis( P < 0. 01) and the best diagnostic critical value is 5. 16 μg / L; this study divided experimental cases into PCT≥5. 16 μg / L and PCT < 5. 16 μg / L groups: the former group had significantly longer antibiotic using time than the latter group( P < 0. 05),while hospitalization time had no statistically significant difference between two groups( P > 0. 05); ET positive group cultured GNB ratio was higher than that of ET negative group,differences was statistically significant( P < 0. 01),but antibiotic using time and hospitalization time had not statistically significant difference( P > 0. 05).Conclusion: PCT had higher diagnostic value for elderly sepsis,its concentration level can guide antibiotic using time and indirect prompt the severity of the condition; while ET could indicate pathogen types in elderly sepsis patients,which can guide the early clinical use of antibiotics.

关键词(KeyWords)： 降钙素原;内毒素;脓毒症;老年
procalcitonin;endotoxin;sepsis;elderly

Abstract:

Keywords:

基金项目(Foundation):

作者(Author): 秦海萍,庄建晴,曹维锷,王伟
QIN Haiping,ZHUANG Jianqing,CAO Weie,WANG Wei

DOI: 10.19367/j.cnki.1000-2707.2016.04.033

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