目的 评价降钙素原(PCT)对于早期鉴别心脏术后感染性与非感染性全身炎症反应综合征(SIRS)的诊断价值.方法 对2011年4月1日至2013年3月31日期间因心脏手术后入住东京医科齿科大学(日本)医学部附属医院重症监护病房(ICU)符合SIRS诊断的142例患者的临床资料进行回顾性分析,根据国际“拯救脓毒症宣言”2012年指南标准,将患者分为感染组(47例)和非感染组(95例).感染组患者包括脓毒症11例,严重脓毒症12例,感染性休克24例.对患者临床资料进行比较,并绘制受试者工作特征曲线(ROC曲线),评估PCT、C-反应蛋白(CRP)、白细胞计数(WBC)鉴别感染性与非感染性疾病的诊断价值,以及诊断脓毒症的严重程度.结果 感染组PCT、CRP、WBC明显高于非感染组[PCT(μg/L):2.80(1.24,10.20)比0.10(0.06,0.21),Z=-9.020,P=0.001; CRP (mg/L):158.0 (120.0,199.0)比58.0(25.0,89.0),Z=-7.264,P=0.001;WBC(×109/L):15.5(11.0,22.6)比9.3(7.2,12.6),Z=-5.792,P=0.001].PCT、CRP、WBC诊断脓毒症的临界值分别为0.47 μg/L、119.5 mg/L、10.85×109/L,三者相比较,PCT对脓毒症诊断具有最高敏感度(91.5％)及特异度(93.7％).脓毒症组、严重脓毒症组、感染性休克组WBC比较差异无统计学意义[×109/L:12.40(9.10,24.20)、13.30(9.93,16.93)、20.40(13.45,28.60),x2=5.638,P=0.060],而PCT、CRP差异具有统计学意义[PCT(μg/L):1.37 (0.72,1.85)、3.16(0.48,13.24)、3.68 (1.67,20.96),x2=7.422,P=0.024; CRP (mg/L):120.0 (74.0,180.0)、135.7(81.7,181.3)、171.1(151.5,306.0),x2=9.524,P=0.009].对于诊断严重脓毒症,PCT优于CRP,但对感染性休克无诊断效力.PCT诊断严重脓毒症临界值为2.28 μg/L时的敏感度为66.7％,特异度为90.9％; CRP诊断感染性休克临界值为149.5 mg/L时的敏感度为83.3％,特异度为66.7％.结论 与WBC、CRP等炎症指标比较,血清定量PCT测定在心脏术后感染性并发症早期诊断中具有更好的预测价值,以PCT≥0.47 μg/L为诊断脓毒症的临界值.
目的 評價降鈣素原(PCT)對于早期鑒彆心髒術後感染性與非感染性全身炎癥反應綜閤徵(SIRS)的診斷價值.方法 對2011年4月1日至2013年3月31日期間因心髒手術後入住東京醫科齒科大學(日本)醫學部附屬醫院重癥鑑護病房(ICU)符閤SIRS診斷的142例患者的臨床資料進行迴顧性分析,根據國際“拯救膿毒癥宣言”2012年指南標準,將患者分為感染組(47例)和非感染組(95例).感染組患者包括膿毒癥11例,嚴重膿毒癥12例,感染性休剋24例.對患者臨床資料進行比較,併繪製受試者工作特徵麯線(ROC麯線),評估PCT、C-反應蛋白(CRP)、白細胞計數(WBC)鑒彆感染性與非感染性疾病的診斷價值,以及診斷膿毒癥的嚴重程度.結果 感染組PCT、CRP、WBC明顯高于非感染組[PCT(μg/L):2.80(1.24,10.20)比0.10(0.06,0.21),Z=-9.020,P=0.001; CRP (mg/L):158.0 (120.0,199.0)比58.0(25.0,89.0),Z=-7.264,P=0.001;WBC(×109/L):15.5(11.0,22.6)比9.3(7.2,12.6),Z=-5.792,P=0.001].PCT、CRP、WBC診斷膿毒癥的臨界值分彆為0.47 μg/L、119.5 mg/L、10.85×109/L,三者相比較,PCT對膿毒癥診斷具有最高敏感度(91.5％)及特異度(93.7％).膿毒癥組、嚴重膿毒癥組、感染性休剋組WBC比較差異無統計學意義[×109/L:12.40(9.10,24.20)、13.30(9.93,16.93)、20.40(13.45,28.60),x2=5.638,P=0.060],而PCT、CRP差異具有統計學意義[PCT(μg/L):1.37 (0.72,1.85)、3.16(0.48,13.24)、3.68 (1.67,20.96),x2=7.422,P=0.024; CRP (mg/L):120.0 (74.0,180.0)、135.7(81.7,181.3)、171.1(151.5,306.0),x2=9.524,P=0.009].對于診斷嚴重膿毒癥,PCT優于CRP,但對感染性休剋無診斷效力.PCT診斷嚴重膿毒癥臨界值為2.28 μg/L時的敏感度為66.7％,特異度為90.9％; CRP診斷感染性休剋臨界值為149.5 mg/L時的敏感度為83.3％,特異度為66.7％.結論 與WBC、CRP等炎癥指標比較,血清定量PCT測定在心髒術後感染性併髮癥早期診斷中具有更好的預測價值,以PCT≥0.47 μg/L為診斷膿毒癥的臨界值.
목적 평개강개소원(PCT)대우조기감별심장술후감염성여비감염성전신염증반응종합정(SIRS)적진단개치.방법 대2011년4월1일지2013년3월31일기간인심장수술후입주동경의과치과대학(일본)의학부부속의원중증감호병방(ICU)부합SIRS진단적142례환자적림상자료진행회고성분석,근거국제“증구농독증선언”2012년지남표준,장환자분위감염조(47례)화비감염조(95례).감염조환자포괄농독증11례,엄중농독증12례,감염성휴극24례.대환자림상자료진행비교,병회제수시자공작특정곡선(ROC곡선),평고PCT、C-반응단백(CRP)、백세포계수(WBC)감별감염성여비감염성질병적진단개치,이급진단농독증적엄중정도.결과 감염조PCT、CRP、WBC명현고우비감염조[PCT(μg/L):2.80(1.24,10.20)비0.10(0.06,0.21),Z=-9.020,P=0.001; CRP (mg/L):158.0 (120.0,199.0)비58.0(25.0,89.0),Z=-7.264,P=0.001;WBC(×109/L):15.5(11.0,22.6)비9.3(7.2,12.6),Z=-5.792,P=0.001].PCT、CRP、WBC진단농독증적림계치분별위0.47 μg/L、119.5 mg/L、10.85×109/L,삼자상비교,PCT대농독증진단구유최고민감도(91.5％)급특이도(93.7％).농독증조、엄중농독증조、감염성휴극조WBC비교차이무통계학의의[×109/L:12.40(9.10,24.20)、13.30(9.93,16.93)、20.40(13.45,28.60),x2=5.638,P=0.060],이PCT、CRP차이구유통계학의의[PCT(μg/L):1.37 (0.72,1.85)、3.16(0.48,13.24)、3.68 (1.67,20.96),x2=7.422,P=0.024; CRP (mg/L):120.0 (74.0,180.0)、135.7(81.7,181.3)、171.1(151.5,306.0),x2=9.524,P=0.009].대우진단엄중농독증,PCT우우CRP,단대감염성휴극무진단효력.PCT진단엄중농독증림계치위2.28 μg/L시적민감도위66.7％,특이도위90.9％; CRP진단감염성휴극림계치위149.5 mg/L시적민감도위83.3％,특이도위66.7％.결론 여WBC、CRP등염증지표비교,혈청정량PCT측정재심장술후감염성병발증조기진단중구유경호적예측개치,이PCT≥0.47 μg/L위진단농독증적림계치.
Objective To assess the value of procalcitonin (PCT) for the differential diagnosis between infectious and non-infectious systemic inflammatory response syndrome (SIRS) after cardiac operation.Methods Patients diagnosed with SIRS after cardiac surgery and admitted to Department of Cardiovascular Surgery of Tokyo Medical and Dental University Graduate School between April 1st,2011 and March 31st,2013 were retrospectively studied.A total of 142 patients with SIRS were included,and they were divided into infectious group (n =47) or non-infectious group (n =95) according to the diagnostic criteria of the Surviving Sepsis Campaign Guidelines for Management of Severe Sepsis and Septic Shock:2012 (SSCG2012).The patients with infectious SIRS were included,and there were 11 with sepsis,12 with severe sepsis without shock,and 24 with septic shock respectively.The clinical data of patients were compared,and the receiver operating characteristic curve (ROC curve) was plotted to assess the diagnostic value of infection and non-infectious diseases for PCT,C-reactive protein (CRP) and white blood cell count (WBC),as well as the diagnosis of the severity of sepsis.Results PCT,CRP,and WBC were significantly higher in the infectious SIRS group than those in the non-infectious SIRS group [PCT (μg/L):2.80 (1.24,10.20) vs.0.10 (0.06,0.21),Z=-9.020,P=0.001; CRP (mg/L):158.0 (120.0,199.0) vs.58.0 (25.0,89.0),Z=-7.264,P=0.001; WBC (× 109/L):15.5 (11.0,22.6) vs.9.3 (7.2,12.6),Z=-5.792,P=0.001].PCT had the highest sensitivity (91.5％) and specificity (93.7％) for differential diagnosis,with a cut-off value for infectious SIRS of 0.47 μg/L,and the cut-offvalue of CRP and WBC were 119.5 mg/L and 10.85 × 109/L,respectively.There was no significant difference in WBC among sepsis group,severe sepsis group,and septic shock group [× 109/L:12.40 (9.10,24.20),13.30 (9.93,16.93),20.40 (13.45,28.6),x2=5.638,P=0.060],while PCT,CRP had significant difference [PCT(μg/L):1.37 (0.72,1.85),3.16 (0.48,13.24),3.68 (1.67,20.96),x2=7.422,P=0.024; CRP (mg/L):120.0(74.0,180.0),135.7 (81.7,181.3),171.1 (151.5,306.0),x2=9.524,P=0.009].PCT was more reliable than CRP in diagnosing severe sepsis without shock,but it was ineffective for diagnosing septic shock.The cut-off value of PCT for diagnosing severe sepsis without shock was 2.28 μg/L,and the sensitivity was 66.7％,specificity was 90.9％.Cut-off value of CRP for the diagnosis of septic shock was 149.5 mg/L,with the sensitivity of 83.3％,and the specificity of 66.7％.Conclusions PCT was a useful marker for the diagnosis of infectious SIRS after cardiac operation as compared with WBC and CRP.The optimal PCT cut-off value for diagnosing infectious SIRS was 0.47 μg/L.
