| 刘兆兴,张改巾,刘佳颖,徐圣博,郑 波,申传安.血清降钙素原用于烧伤脓毒症早期诊断的临床研究[J].,2019,19(6):1069-1073 |
| 血清降钙素原用于烧伤脓毒症早期诊断的临床研究 |
| Clinical Analysis of Serum Procalcitonin for the Early Diagnosis of Sepsis in Burn Patients |
| 投稿时间：2018-10-11 修订日期：2018-10-31 |
| DOI：10.13241/j.cnki.pmb.2019.06.014 |
| 中文关键词: 烧伤 脓毒症 早期诊断 降钙素原 |
| 英文关键词: Burn Sepsis Diagnosis Procalcitonin |
| 基金项目:国家自然科学基金面上项目(81373140)；全军后勤科研计划重点项目(BWS14J048) |
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| 中文摘要: |
| 摘要 目的：分析特重度烧伤患者血清降钙素原(PCT)水平，探讨其在烧伤脓毒症早期诊断中的应用价值。方法：回顾性分析2014年1月至2018年1月解放军总医院第一附属医院烧伤整形科收治的259例特重度烧伤患者的病例资料，根据患者烧伤ICU住院期间是否发生脓毒症分为脓毒症组(86例，359个检测时间点)与非脓毒症组(173例，1591个检测时间点)，收集患者年龄、性别、烧伤面积、烧伤深度、合并有吸入性损伤情况等一般资料，记录每个检测时间点的血常规、肝肾功、血气分析及血清PCT值等实验室检查结果。比较两组患者基线情况及各项脓毒症相关生物学指标，分析各项生物学指标脓毒症诊断能力及不同PCT截断值的诊断效能，并绘制受试者工作特征(ROC)曲线，评估各项生物学指标烧伤脓毒症的诊断效能。结果：两组体温、心率、呼吸频率、血小板计数、胆碱酯酶、脑钠肽差异无统计学意义(P＞0.05)，脓毒症组血清PCT水平[4.52(2.35~8.83) vs 1.33(0.74~3.24)]、白细胞计数[24.28(17.48~33.09) vs 20.11(16.01~25.4)]、血糖[13.12(9.66~17.28) vs 10.45(8.31~13.13)]、肌酐[71.60(57.94~89.62) vs 61.48(48.87~73.48)]、总胆红素差[30.07(22.63~38.69) vs 21.04(15.53~28.4)]显著高于非脓毒症组，差异有统计学意义(P＜0.05)，其区分脓毒症与非脓毒症的ROC曲线下面积分别为0.801(95 %CI为0.776~0.824，P＜0.01)、0.617(95 %CI为0.581~0.652，P＜0.01)、0.658(95% CI为0.624~0.691，P＜0.01)、0.671(95 %CI为0.640~0.702，P＜0.01)、0.722(95% CI为0.694~0.691，P＜0.01)。PCT的有效截断值为2.0 ng/mL(敏感度84.4 %、特异度62.1 %)、3.0 ng/mL(敏感度70.8 %、特异度71.8 %)、4.0 ng/mL(敏感度58.1 %、特异度81.2 %)。结论：PCT可作为烧伤脓毒症早期诊断的有效生物学指标。 |
| 英文摘要: |
| ABSTRACT Objective: To analyze the level of serum procalcitonin (PCT) in extremely severe burn patients, and to evaluate its clinical significance in the early diagnosis of sepsis. Methods: From January 2014 to January 2018, we retrospectively analyzed 259 extremely severe burn patients admitted to the Burn and Plastic Surgery Department of the First Hospital Affiliated to the Chinese PLA General Hospital. The patients were divided into sepsis group (86 cases, 359 timepoints) and non-sepsis group (173 cases, 1591 timepoints) according to whether sepsis occurred during hospitalization in burn ICU. The baseline data such as patient's basic conditions, vital signs, and the laboratory examination results of routine blood test, liver and kidney function, blood gas analysis and serum PCT were collected. Baseline and sepsis related biomarkers were compared between the two groups. The diagnostic ability of each biomarker was compared and the diagnostic capacity of different PCT cut-off values was analyzed. Data were processed with t test, Mann-Whitney U test and chi-square test. Receiver operating characteristic (ROC) curves were performed to evaluate the capacity for burn sepsis diagnosis of each biomarker. Results: There was no significant difference in temperature, heart rate, respiratory frequency, platelet count, cholinesterase and brain natriuretic peptide between the two groups (P＞0.05). PCT[4.52(2.35~8.83) vs. 1.33(0.74~3.24)], leucocyte count[24.28(17.48~33.09) vs. 20.11(16.01~25.4)], blood glucose[13.12(9.66~17.28) vs. 10.45(8.31~13.13)], urea nitrogen[71.60(57.94~89.62) vs. 61.48(48.87~73.48)] and total bilirubin[30.07(22.63~38.69) vs 21.04(15.53~28.4)] were significantly higher in septic patients than non-septic patients, and the areas under the ROC curve were 0.801(95% CI, 0.776~0.824, P＜0.01), 0.617 (95% CI, 0.581~0.652, P＜0.01), 0.658 (95% CI, 0.624~0.691, P＜0.01), 0.671 (95% CI, 0.640~0.702, P＜0.01), 0.722 (95% CI, 0.694~0.691, P＜0.01). The effective cut-off values of PCT for burn sepsis diagnosis were 2.0 ng/mL (sensitivity of 84.4 % and specificity of 62.1 %), 3.0 ng/mL (sensitivity of 70.8 % and specificity of 71.8 %), 4.0 ng/mL (sensitivity of 58.1 % and specificity of 81.2 %). Conclusion: PCT can be a useful biomarker for the early diagnosis of sepsis, which can be considered as a guide for rational use of antibiotics and provide as a reference for treatment. |
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