中华危重病急救医学
中華危重病急救醫學
중화위중병급구의학
Chinese Critical Care Medicine
2014年
3期
153-158
,共6页
生物标志物%脓毒症%严重脓毒症%降钙素原%白细胞介素-6%D-二聚体%诊断
生物標誌物%膿毒癥%嚴重膿毒癥%降鈣素原%白細胞介素-6%D-二聚體%診斷
생물표지물%농독증%엄중농독증%강개소원%백세포개소-6%D-이취체%진단
Biomarker%Sepsis%Severe sepsis%Procalcitonin%Interleukin-6%D-dimer%Diagnosis
目的 探讨一种生物标志物组合对脓毒症和重度脓毒症患者的诊断能力.方法 采用前瞻性研究方法,选择2010年3月至2013年3月首都医科大学附属北京朝阳医院急诊抢救室救治的652例全身炎症反应综合征(SIRS)患者.于入院时即检测降钙素原(PCT)、白细胞介素-6(IL-6)、D-二聚体、C-反应蛋白(CRP)、B型脑钠肽(BNP)、白细胞计数(WBC)、杆状核中性粒细胞比例和血小板计数(PLT)等生物标志物.根据脓毒症诊断将所有患者分为脓毒症组(452例)和非脓毒症组(200例)；根据脓毒症严重程度将所有患者分为重度脓毒症组(包括脓毒性休克,190例)和非重度脓毒症组(462例).用logistic回归分析确定诊断脓毒症和重度脓毒症的独立因素,并组建生物标志物最佳组合.采用受试者工作特征曲线(ROC曲线)评估生物标志物组合和各生物标志物单独使用时的诊断能力.结果 PCT、IL-6和D-二聚体既是诊断脓毒症也是诊断重度脓毒症的独立预测因素.将这3种生物标志物组合用于诊断脓毒症时的ROC曲线下面积(AUC)为0.866,高于PCT、IL-6和D-二聚体单独使用时的AUC(分别为0.803、0.770和0.737)；且标志物组合的敏感度、特异度、阳性预测值和阴性预测值也均比单独使用时得到提高(标志物组合分别为81.2％、81.0％、90.6％和65.6％,PCT分别为75.2％、80.0％、89.5％、58.8％,IL-6分别为81.0％、61.0％、82.4％、58.7％,D-二聚体分别为79.9％、59.0％、81.5％、56.5％).3种生物标志物组合用于诊断重度脓毒症的AUC为0.815,优于PCT、IL-6和D-二聚体单独使用时的0.758、0.740和0.704;且标志物组合的敏感度、特异度、阳性预测值和阴性预测值也均比单独使用时得到提高(标志物组合分别为81.6％、73.6％、56.0％和90.6％,PCT分别为79.5％、65.0％、48.2％、88.5％,IL-6分别为65.8％、70.6％、47.9％、83.4％,D-二聚体分别为60.5％、73.2％、48.1％、81.8％).结论 将PCT、IL-6和D-二聚体3种生物标志物联合使用可以有效提高对脓毒症和重度脓毒症的诊断能力.
目的 探討一種生物標誌物組閤對膿毒癥和重度膿毒癥患者的診斷能力.方法 採用前瞻性研究方法,選擇2010年3月至2013年3月首都醫科大學附屬北京朝暘醫院急診搶救室救治的652例全身炎癥反應綜閤徵(SIRS)患者.于入院時即檢測降鈣素原(PCT)、白細胞介素-6(IL-6)、D-二聚體、C-反應蛋白(CRP)、B型腦鈉肽(BNP)、白細胞計數(WBC)、桿狀覈中性粒細胞比例和血小闆計數(PLT)等生物標誌物.根據膿毒癥診斷將所有患者分為膿毒癥組(452例)和非膿毒癥組(200例)；根據膿毒癥嚴重程度將所有患者分為重度膿毒癥組(包括膿毒性休剋,190例)和非重度膿毒癥組(462例).用logistic迴歸分析確定診斷膿毒癥和重度膿毒癥的獨立因素,併組建生物標誌物最佳組閤.採用受試者工作特徵麯線(ROC麯線)評估生物標誌物組閤和各生物標誌物單獨使用時的診斷能力.結果 PCT、IL-6和D-二聚體既是診斷膿毒癥也是診斷重度膿毒癥的獨立預測因素.將這3種生物標誌物組閤用于診斷膿毒癥時的ROC麯線下麵積(AUC)為0.866,高于PCT、IL-6和D-二聚體單獨使用時的AUC(分彆為0.803、0.770和0.737)；且標誌物組閤的敏感度、特異度、暘性預測值和陰性預測值也均比單獨使用時得到提高(標誌物組閤分彆為81.2％、81.0％、90.6％和65.6％,PCT分彆為75.2％、80.0％、89.5％、58.8％,IL-6分彆為81.0％、61.0％、82.4％、58.7％,D-二聚體分彆為79.9％、59.0％、81.5％、56.5％).3種生物標誌物組閤用于診斷重度膿毒癥的AUC為0.815,優于PCT、IL-6和D-二聚體單獨使用時的0.758、0.740和0.704;且標誌物組閤的敏感度、特異度、暘性預測值和陰性預測值也均比單獨使用時得到提高(標誌物組閤分彆為81.6％、73.6％、56.0％和90.6％,PCT分彆為79.5％、65.0％、48.2％、88.5％,IL-6分彆為65.8％、70.6％、47.9％、83.4％,D-二聚體分彆為60.5％、73.2％、48.1％、81.8％).結論 將PCT、IL-6和D-二聚體3種生物標誌物聯閤使用可以有效提高對膿毒癥和重度膿毒癥的診斷能力.
목적 탐토일충생물표지물조합대농독증화중도농독증환자적진단능력.방법 채용전첨성연구방법,선택2010년3월지2013년3월수도의과대학부속북경조양의원급진창구실구치적652례전신염증반응종합정(SIRS)환자.우입원시즉검측강개소원(PCT)、백세포개소-6(IL-6)、D-이취체、C-반응단백(CRP)、B형뇌납태(BNP)、백세포계수(WBC)、간상핵중성립세포비례화혈소판계수(PLT)등생물표지물.근거농독증진단장소유환자분위농독증조(452례)화비농독증조(200례)；근거농독증엄중정도장소유환자분위중도농독증조(포괄농독성휴극,190례)화비중도농독증조(462례).용logistic회귀분석학정진단농독증화중도농독증적독립인소,병조건생물표지물최가조합.채용수시자공작특정곡선(ROC곡선)평고생물표지물조합화각생물표지물단독사용시적진단능력.결과 PCT、IL-6화D-이취체기시진단농독증야시진단중도농독증적독립예측인소.장저3충생물표지물조합용우진단농독증시적ROC곡선하면적(AUC)위0.866,고우PCT、IL-6화D-이취체단독사용시적AUC(분별위0.803、0.770화0.737)；차표지물조합적민감도、특이도、양성예측치화음성예측치야균비단독사용시득도제고(표지물조합분별위81.2％、81.0％、90.6％화65.6％,PCT분별위75.2％、80.0％、89.5％、58.8％,IL-6분별위81.0％、61.0％、82.4％、58.7％,D-이취체분별위79.9％、59.0％、81.5％、56.5％).3충생물표지물조합용우진단중도농독증적AUC위0.815,우우PCT、IL-6화D-이취체단독사용시적0.758、0.740화0.704;차표지물조합적민감도、특이도、양성예측치화음성예측치야균비단독사용시득도제고(표지물조합분별위81.6％、73.6％、56.0％화90.6％,PCT분별위79.5％、65.0％、48.2％、88.5％,IL-6분별위65.8％、70.6％、47.9％、83.4％,D-이취체분별위60.5％、73.2％、48.1％、81.8％).결론 장PCT、IL-6화D-이취체3충생물표지물연합사용가이유효제고대농독증화중도농독증적진단능력.
Objective To determine a combination of biomarkers that assure the diagnosis of sepsis and severe sepsis in patients in emergency department (ED).Methods A total of 652 patients with systemic inflammatory response syndrome (SIRS) were enrolled for this prospective study in the ED of Beijing Chaoyang Hospital of the Capital Medical University between March 2010 and March 2013.Eight biomarkers were determined,including levels of procalcitonin (PCT),interleukin-6 (IL-6),D-dimer,C-reactive protein (CRP),brain natriuretic peptide (BNP),white blood cell count (WBC),percentage of immature neutrophil,and platelet count (PLT).Patients were divided into the sepsis group (452 cases) and non-sepsis group (200 cases) according to the diagnostic criteria of sepsis.Then all these patients were stratified into severe sepsis group (190 cases,including septic shock) and non-severe sepsis group (462 cases) according to the diagnosis of severe sepsis.Logistic regression was performed to identify the independent factors for the diagnosis of sepsis and severe sepsis,and the optimal combination of biomarkers was established.Receiver operating characteristic (ROC) curves were used to evaluate the diagnostic ability of the combination and the biomarkers.Results PCT,IL-6 and D-dimer were independent factors for diagnosis of sepsis and severe sepsis.The area under the ROC curve (AUC) of the combination of three biomarkers was 0.866 for diagnosis of sepsis,and it was higher than the AUC of PCT (0.803),IL-6 (0.770) and D-dimer (0.737) alone,and this new combination showed better sensitivity,specificity,positive predictive (PPV),and negative predictive (NPV) values than that when the three biomarkers was used individually (the results of combination were 81.2％,8 1.0％,90.6％,56.5％ ; that of PCT were 75.2％,80.0％,89.5％,58.8％; that ofIL-6 were 81.0％,61.0％,82.4％,58.7％; and that of D-dimer were 79.9％,59.0％,81.5％,56.5％,respectively).The AUC of the combination was 0.815 for the diagnosis of severe sepsis and was better than the three biomarkers used alone,which was 0.758 for PCT,0.740 for IL-6,and 0.704 for D-dimer respectively.Moreover,the sensitivity,specificity,PPV and NPV of the combination were higher than that of the three biomarkers used singularly (the results of combination were 81.6％,73.6％,56.0％,90.6％; that of PCT were 79.5％,65.0％,48.2％,88.5％; that of IL-6 were 65.8％,70.6％,47.9％,83.4％; and that of D-dimer were 60.5％,73.2％,48.1％,81.8％,respectively).Conclusion The combination of PCT,IL-6 and D-dimer enhances the diagnostic ability for sepsis and severe sepsis.
