2018 年第 7 期 第 13 卷

脓毒症休克患者血清C反应蛋白和降钙素原及D-二聚体的变化

Changes of serum levels of C-reactive protein, procalcitonin and D-dimer in patients with septic shock

作者：郜茜王昀

英文作者：

单位：810000西宁，青海大学附属医院消化内科

英文单位：

关键词：脓毒症；C反应蛋白；降钙素原；D-二聚体；受试者工作特征曲线

英文关键词：

• 摘要：

• 【摘要】目的    探讨血清C反应蛋白、降钙素原、D-二聚体水平在脓毒症休克与脓毒症患者中的差异。方法    选择青海大学附属医院重症医学科2016年4月至2017年5月收治的脓毒症患者96例，根据脓毒症3.0的诊断标准分为脓毒症组（54例）及脓毒症休克组（42例）,根据患者预后分为死亡组（29例）和存活组（67例），比较不同分组患者治疗前和治疗24 h后血清C反应蛋白、降钙素原和D-二聚体水平的差异，采用受试者工作特征曲线分析各指标诊断脓毒症休克的敏感度、特异度以及Youden指数。结果    治疗前和治疗24 h后脓毒症休克组C反应蛋白、降钙素原、D-二聚体均高于脓毒症组，治疗24 h后与治疗前比较，2组C反应蛋白、降钙素原、D-二聚体均显著降低,差异均有统计学意义（均P<0.05）。脓毒症休克组病死率高于脓毒症组［45.2%（19/42）比18.5%（10/54）］,差异有统计学意义（χ2=8.00，P<0.05），脓毒症患者出现休克可以使死亡风险增加3.63倍（P<0.05）。治疗前和治疗24 h后死亡组(n=29)C反应蛋白、降钙素原、D-二聚体均高于存活组(n=67),差异均有统计学意义（均P<0.05）。血清C反应蛋白、降钙素原和D-二聚体诊断脓毒症休克的曲线下面积分别为0.69、0.71、0.80，敏感度分别为0.54、0.71、0.69，特异度分别为0.86、0.67、0.86，Youden指数分别为22.02、7.35、28.08。结论    C反应蛋白、降钙素原和D-二聚体水平与脓毒症疾病严重程度及预后有关，病程中持续高水平的C反应蛋白、降钙素原和D-二聚体提示疾病预后较差。

• 【Abstract】Objective    To discuss the changes of serum levels of C-reactive protein, procalcitonin and D-dimer in patients with septic shock. Methods    Clinical records of 96 patients with septic shock were retrospectively analyzed from April 2016 to May 2017 in Affiliated Hospital of Qinghai University. The patients were divided into sepsis group（n＝54） and septic shock group（n＝42） according to the diagnostic criteria of sepsis 3.0; they were divided into death group（n＝29） and survival group（n＝67） according to the outcomes. Levels of serum C-reactive protein, procalcitonin and D-dimer before and 24 after treatment were recorded; the sensitivity, specificity and Youden index of these serum indicators in diagnosis of septic shock were analyzed by the receiver operating characteristic（ROC） curve. Results    Levels of C-reactive protein, procalcitonin and D-dimer before and after treatment in sepsis shock group were significantly higher than those in sepsis group(P<0.05); levels of C-reactive protein, procalcitonin and D-dimer after treatment were significantly lower than those before treatment in both groups(P<0.05). The mortality rate in sepsis shock group was significantly higher than that in sepsis group［45.2%（19/42） vs 18.5%（10/54）］（χ2=8.00, P<0.05）; the death risk of sepsis shock group increased by 3.63 times compared to that of sepsis group（P<0.05）. Levels of C-reactive protein, procalcitonin and D-dimer before and after treatment in death group were significantly higher than those in survival group(P<0.05). Areas under ROC curve of C-reactive protein, procalcitonin and D-dimer in diagnosis of septic shock were 0.69, 0.71, 0.80; the sensitivities were 0.54, 0.71, 0.69; the specificities were 0.86, 0.67, 0.86; the Youden indexes were 22.02, 7.35, 28.08. Conclusions    erum levels of C-reactive protein, procalcitonin and D-dimer are associated with the severity and prognosis of sepsis.

  【Key words】Sepsis;C-reactive protein;Procalcitonin;D-dimer;Receiver operating characteristic curve