2022 年第 6 期 第 17 卷

单核细胞体积分布宽度和降钙素原联合检测对疑似感染患者脓毒症发生风险的早期预测价值

Early predictive value of monocyte distribution width combined with procalcitonin for the sepsis risk in patients with suspected infection

作者：肖泽让何书典邢柏

英文作者：Xiao Zerang He Shudian Xing Bo

单位：海南医学院第二附属医院东湖分院急诊科，海口570203

英文单位：Department of Emergency Donghu Branch of the Second Affiliated Hospital of Hainan Medical Univemity Haikou 570203 China

关键词：脓毒症；疑似感染；单核细胞体积分布宽度；降钙素原

英文关键词：Sepsis；Suspectedinfection；Monocytedistributionwidth；Procalcitonin

• 摘要：

• 目的 探讨单核细胞体积分布宽度（MDW）、降钙素原及其联合对疑似感染患者脓毒症发生风险的早期预测价值。方法 选取2020年1月至2021年10月海南医学院第二附属医院东湖分院急诊科收治的260例疑似感染患者为研究对象。根据患者入院3 d内是否发生脓毒症分为脓毒症组和非脓毒症组。比较2组患者一般资料、快速序贯器官衰竭估计（qSOFA）评分、外周血细胞参数、C反应蛋白（CRP）和降钙素原等指标。应用多因素Logistic回归方法分析疑似感染患者发生脓毒症的危险因素，绘制受试者工作特征（ROC）曲线评价各指标对疑似感染患者发生脓毒症的预测价值。结果 260例疑似感染患者中，105例（40.4%）发生了脓毒症（脓毒症组），155例（59.6%）未发生脓毒症（非脓毒症组）。脓毒症组患者年龄、合并糖尿病比例、qSOFA评分≥2分比例、血液培养阳性比例及28 d病死率均高于非脓毒症组，住院时间长于非脓毒症组，差异均有统计学意义（均P＜0.05）。脓毒症组白细胞计数、中性粒细胞计数、MDW、CRP及降钙素原水平均高于/大于非脓毒症组［11.40（7.75,15.45）×109/L比7.70（5.90,11.20）×109/L、9.70（5.95,12.70）×109/L比5.30（3.30,8.30）×109/L、25.50（23.43,27.78）fl比20.56（19.11,22.60）fl、29.96（27.68,34.06）mg/L比26.74（25.06,28.56）mg/L、10.80（3.38,29.90）μg/L比0.30（0.10,1.20）μg/L］，而淋巴细胞计数、血小板计数均低于非脓毒症组，差异均有统计学意义(均P＜0.001)。多因素Logistic回归分析结果显示，MDW、CRP、降钙素原水平升高以及qSOFA评分≥2分均为疑似感染患者发生脓毒症的独立危险因素（均P＜0.05）。ROC曲线分析结果显示，MDW、降钙素原的曲线下面积（AUC）明显大于CRP、qSOFA评分，MDW与降钙素原联合检测的AUC明显高于二者单独检测，差异均有统计学意义（均P<0.05）。结论 MDW、CRP、降钙素原水平升高以及qSOFA评分≥2分为疑似感染患者发生脓毒症的独立危险因素，MDW和降钙素原对疑似感染患者脓毒症发生风险具有较好预测价值，二者联合预测效能更高。

• Objective To explore the early predictive value of monocyte distribution width （MDW） combined with procalcitonin（PCT） for the sepsis risk in patients with suspected infection. Methods From January 2020 to October 2021, 260 patients with suspected infection admitted to Department of Emergency, Donghu Branch of the Second Affiliated Hospital of Hainan Medical University were enrolled. They were divided into the sepsis group and non-sepsis group according to whether the patients developed sepsis or not within 3 d after admission. The general condition, quick sequential organ failure assessment（qSOFA） score， peripheral blood cell parameter, C-reactive protein（CRP） and PCT were compared between the two groups. The risk factors for sepsis in patients with suspected infection were analyzed by multivariate Logistic regression analysis, and the receiver operating characteristic（ROC） curve were drawn to evaluate the predictive value of the indicators for sepsis in patients with suspected infection. Results   Among 260 cases with suspected infection, 105 cases (40.4%) had sepsis (sepsis group), and 155 cases (59.6%) had no sepsis (non-sepsis group). The age, proportions of diabetes mellitus， qSOFA score ≥ 2, positive blood culture, and 28 d mortality in sepsis group were higher than those in non-sepsis group, and length of stay in sepsis group was longer than that in non-sepsis group (all P＜0.05). The levels of leukocyte count, neutrophil count, MDW, CRP and PCT in sepsis group were higher/greater［11.40（7.75,15.45）×109/L vs 7.70（5.90,11.20）×109/L, 9.70（5.95,12.70）×109/L vs 5.30（3.30,8.30）×109/L, 25.50（23.43,27.78）fl vs 20.56（19.11,22.60）fl, 29.96（27.68,34.06）mg/L vs 26.74（25.06,28.56）mg/L, 10.80（3.38,29.90）μg/L vs 0.30（0.10,1.20）μg/L］，while the levels of lymphocyte count and platelet in sepsis group were lower than those in non-sepsis group (all P＜0.001). Multivariate Logistic regression analysis showed that the elevated levels of MDW, CRP and PCT, and qSOFA score ≥2 were independent risk factors for sepsis in patients with suspected infection. ROC curve analysis showed that the areas under the curve (AUC) of MDW and PCT were significantly higher than those of CRP and qSOFA score, and the AUC of MDW combined with PCT was significantly higher than MDW or PCT（all P<0.05）. Conclusions  The elevated levels of MDW, CRP and PCT, and qSOFA score ≥2 are independent risk factors for sepsis in patients with suspected infection. MDW and PCT have good predictive value for sepsis in patients with suspected infection, and the combined prediction efficiency is better.