CAJ | 학술논문

血中炎性指标水平与细菌性血流感染所致脓毒症患者病情严重程度的相关性分析
혈중염성지표수평여세균성혈류감염소치농독증환자병정엄중정도적상관성분석
Analysis of correlation between inflammatory parameters and severity of sepsis caused by bacterial ;bloodstream infection in septic patients

万方数据

中华危重病急救医学中華危重病急救醫學 중화위중병급구의학
Chinese Critical Care Medicine
2015年 6期 448-453 ,共6页

赵磊%臧学峰%陈炜%盛博%古旭云%张静姝

조뢰%장학봉%진위%성박%고욱운%장정주

血流感染%脓毒症%降钙素原%C-反应蛋白%内毒素%急性生理学与慢性健康状况评分系统Ⅱ评分血流感染%膿毒癥%降鈣素原%C-反應蛋白%內毒素%急性生理學與慢性健康狀況評分繫統Ⅱ評分
혈류감염%농독증%강개소원%C-반응단백%내독소%급성생이학여만성건강상황평분계통Ⅱ평분
Bloodstream infection%Sepsis%Procalcitonin%C-reactive protein%Endotoxin%Acute physiology and chronic health evaluationⅡscore

目的：探讨血中降钙素原（PCT）、C-反应蛋白（CRP）、内毒素、白细胞计数（WBC）、中性粒细胞比例（Neut%）等炎性指标在细菌性血流感染致脓毒症患者中的差异及与疾病严重程度的相关性。方法回顾性分析2012年2月至2015年3月入住首都医科大学附属北京世纪坛医院重症医学科血培养阳性的292例脓毒症患者的临床资料，收集所有患者性别、年龄、急性生理学与慢性健康状况评分系统Ⅱ（APACHEⅡ）评分、细菌类型等一般资料，比较其24 h内的炎性指标（PCT、CRP、内毒素、WBC、Neut%）水平的差异，分析其与APACHEⅡ评分的相关性，并分析各炎性指标的诊断效应。结果①Pearson相关分析显示，细菌性血流感染患者（n＝292）血中PCT（r＝0.638）、CRP（r＝0.620）、内毒素（r＝0.284）、WBC（r＝0.209）等炎性指标与APACHEⅡ评分均呈显著正相关（均P＝0.000），其中革兰阳性（G+）菌组（n＝86）血中PCT（r＝0.626）、CRP （r＝0.616）、Neut%（r＝0.297）与APACHEⅡ评分呈显著正相关（均P＜0.01），革兰阴性（G-）菌组（n＝206）血中PCT（r＝0.631）、CRP（r＝0.616）、内毒素（r＝0.301）、WBC（r＝0.226）与APACHEⅡ评分呈显著正相关（均P＜0.01）。②G+菌和G-菌两组中严重脓毒症/脓毒性休克患者PCT、CRP水平明显高于脓毒症患者〔G+菌组PCT（μg/L）：0.92（0.38，4.75）比0.43（0.22，1.00），CRP（mg/L）：118.45±62.60比57.97±32.41；G-菌组 PCT（μg/L）：6.92（1.94，25.90）比1.28（0.27，4.12），CRP（mg/L）：130.99±60.18比49.18±26.87，均 P＜0.01〕，而内毒素、WBC在G-菌组中严重脓毒症/脓毒性休克患者水平明显高于脓毒症患者〔内毒素（ng/L）：19.40（9.62，33.87）比10.00（5.00，18.52），WBC（×109/L）：12.13±6.72比9.61±5.01，均P＜0.01〕；且G-菌严重脓毒症/脓毒性休克患者PCT、内毒素水平明显高于G+菌严重脓毒症/脓毒性休克患者〔PCT（μg/L）：6.92（1.94，25.90）比0.92（0.38，4.75），内毒素（ng/L）：19.40（9.62，33.87）比2.56（1.11，4.01），均P＜0.01〕。③各炎性指标对血流感染致严重脓毒症/脓毒性休克患者的诊断效应显示，G+菌组：PCT受试者工作特征曲线（ROC）下面积（AUC）＝0.683，切点值为0.55μg/L时敏感度63.2%、特异度69.0%；CRP AUC＝0.802，切点值为92.25 mg/L时敏感度73.7%、特异度86.2%；WBC AUC＝0.614，切点值为7.35×109/L时敏感度75.4%、特异度48.3%；Neut%AUC＝0.622，切点值为0.882时敏感度43.9%、特异度79.3%。G-菌组：PCT AUC＝0.780，切点值为6.80μg/L时敏感度51.0%、特异度93.9%；CRP AUC＝0.907，切点值为90.10 mg/L时敏感度73.2%、特异度95.9%；内毒素AUC＝0.694，切点值为17.54 ng/L时敏感度57.3%、特异度75.5%；WBC AUC＝0.611，切点值为10.54×109/L时敏感度54.1%、特异度69.4%；Neut%AUC＝0.621，切点值为0.843时敏感度65.6%、特异度61.2%。结论 PCT和CRP在细菌性血流感染患者血炎性指标中与疾病严重程度相关性最佳，而CRP在严重脓毒症/脓毒性休克时对细菌性血流感染的诊断效应最佳。
목적：탐토혈중강개소원（PCT）、C-반응단백（CRP）、내독소、백세포계수（WBC）、중성립세포비례（Neut%）등염성지표재세균성혈류감염치농독증환자중적차이급여질병엄중정도적상관성。방법회고성분석2012년2월지2015년3월입주수도의과대학부속북경세기단의원중증의학과혈배양양성적292례농독증환자적림상자료，수집소유환자성별、년령、급성생이학여만성건강상황평분계통Ⅱ（APACHEⅡ）평분、세균류형등일반자료，비교기24 h내적염성지표（PCT、CRP、내독소、WBC、Neut%）수평적차이，분석기여APACHEⅡ평분적상관성，병분석각염성지표적진단효응。결과①Pearson상관분석현시，세균성혈류감염환자（n＝292）혈중PCT（r＝0.638）、CRP（r＝0.620）、내독소（r＝0.284）、WBC（r＝0.209）등염성지표여APACHEⅡ평분균정현저정상관（균P＝0.000），기중혁란양성（G+）균조（n＝86）혈중PCT（r＝0.626）、CRP （r＝0.616）、Neut%（r＝0.297）여APACHEⅡ평분정현저정상관（균P＜0.01），혁란음성（G-）균조（n＝206）혈중PCT（r＝0.631）、CRP（r＝0.616）、내독소（r＝0.301）、WBC（r＝0.226）여APACHEⅡ평분정현저정상관（균P＜0.01）。②G+균화G-균량조중엄중농독증/농독성휴극환자PCT、CRP수평명현고우농독증환자〔G+균조PCT（μg/L）：0.92（0.38，4.75）비0.43（0.22，1.00），CRP（mg/L）：118.45±62.60비57.97±32.41；G-균조 PCT（μg/L）：6.92（1.94，25.90）비1.28（0.27，4.12），CRP（mg/L）：130.99±60.18비49.18±26.87，균 P＜0.01〕，이내독소、WBC재G-균조중엄중농독증/농독성휴극환자수평명현고우농독증환자〔내독소（ng/L）：19.40（9.62，33.87）비10.00（5.00，18.52），WBC（×109/L）：12.13±6.72비9.61±5.01，균P＜0.01〕；차G-균엄중농독증/농독성휴극환자PCT、내독소수평명현고우G+균엄중농독증/농독성휴극환자〔PCT（μg/L）：6.92（1.94，25.90）비0.92（0.38，4.75），내독소（ng/L）：19.40（9.62，33.87）비2.56（1.11，4.01），균P＜0.01〕。③각염성지표대혈류감염치엄중농독증/농독성휴극환자적진단효응현시，G+균조：PCT수시자공작특정곡선（ROC）하면적（AUC）＝0.683，절점치위0.55μg/L시민감도63.2%、특이도69.0%；CRP AUC＝0.802，절점치위92.25 mg/L시민감도73.7%、특이도86.2%；WBC AUC＝0.614，절점치위7.35×109/L시민감도75.4%、특이도48.3%；Neut%AUC＝0.622，절점치위0.882시민감도43.9%、특이도79.3%。G-균조：PCT AUC＝0.780，절점치위6.80μg/L시민감도51.0%、특이도93.9%；CRP AUC＝0.907，절점치위90.10 mg/L시민감도73.2%、특이도95.9%；내독소AUC＝0.694，절점치위17.54 ng/L시민감도57.3%、특이도75.5%；WBC AUC＝0.611，절점치위10.54×109/L시민감도54.1%、특이도69.4%；Neut%AUC＝0.621，절점치위0.843시민감도65.6%、특이도61.2%。결론 PCT화CRP재세균성혈류감염환자혈염성지표중여질병엄중정도상관성최가，이CRP재엄중농독증/농독성휴극시대세균성혈류감염적진단효응최가。
Objective To discuss the differences of inflammatory parameters such as procalcitonin ( PCT ), C-reactive protein ( CRP ), endotoxin, white blood cell ( WBC ), neutrophil ratio ( Neut%) in blood of septic patients caused by bacterial bloodstream infection, and their correlation with the severity of disease. Methods 292 septic patients with positive blood culture were enrolled in Beijing Shijitan Hospital Affiliated to Capital Medical University from February 2012 to March 2015, and their gender, age, acute physiology and chronic health evaluation Ⅱ( APACHEⅡ) score, bacterial species and other general information were retrospectively collected. The differences in inflammatory parameters ( PCT, CRP, endotoxin, WBC, Neut%) in septic patients caused by bacterial bloodstream infection were compared, their correlations with APACHEⅡ scores within 24 hours were analyzed, and their diagnostic efficacies were also analyzed. Results ①It was shown by Pearson correlation coefficients that positively statistical correlation was found between PCT ( r=0.638 ), CRP ( r=0.620 ), endotoxin ( r=0.284 ), WBC ( r=0.209 ) and APACHEⅡscore ( all P=0.000 ) in bacterial bloodstream infective patients ( n=292 ), and positively statistical correlation was found between PCT ( r=0.626 ), CRP ( r=0.616 ), Neut%( r=0.297 ) and APACHEⅡscore ( all P<0.01 ) in Gram positive bacterial ( G+) group ( n = 86 ), and positively statistical correlation was shown between PCT ( r=0.631 ), CRP ( r=0.616 ), endotoxin ( r=0.301 ), WBC ( r=0.226 ) and APACHEⅡscore ( all P<0.01 ) in Gram negative bacterial ( G-) group ( n=206 ).②It was shown that PCT and CRP of both G+/G-bacterial severe sepsis and septic shock subgroup were significantly higher than those of sepsis subgroup, respectively [ G+ group: PCT (μg/L ):0.92 ( 0.38, 4.75 ) vs. 0.43 ( 0.22, 1.00 ), CRP ( mg/L ):118.45±62.60 vs. 57.97±32.41;G-group:PCT (μg/L ):6.92 ( 1.94, 25.90 ) vs. 1.28 ( 0.27, 4.12 ), CRP ( mg/L ):130.99±60.18 vs. 49.18±26.87, all P<0.01 ], and the endotoxin and WBC in G-bacterial severe sepsis and septic shock subgroup were significantly higher than those of sepsis subgroup [ endotoxin ( ng/L ): 19.40 ( 9.62, 33.87 ) vs. 10.00 ( 5.00, 18.52 ), WBC ( ×109/L ): 12.13±6.72 vs. 9.61±5.01, both P<0.01 ]. The PCT and endotoxin in G-bacterial severe sepsis and septic shock subgroup were significantly higher than those in G+severe sepsis and septic shock subgroup [ PCT (μg/L ):6.92 ( 1.94, 25.90 ) vs. 0.92 ( 0.38, 4.75 ), endotoxin ( ng/L ):19.40 ( 9.62, 33.87 ) vs. 2.56 ( 1.11, 4.01 ), both P<0.01 ].③The diagnostic efficacy of inflammatory parameters for severe sepsis and septic shock subgroup were: PCT area under receiver operating characteristic ( ROC ) curve ( AUC ) = 0.683, the cut-off point = 0.55 μg/L, sensitivity 63.2%, specificity 69.0%; CRP AUC = 0.802, the cut-off point = 92.25 mg/L, sensitivity 73.7%, specificity 86.2%; WBC AUC = 0.614, the cut-off point = 7.35×109/L, sensitivity 75.4%, specificity 48.3%; Neut% AUC = 0.622, the cut-off point = 0.882, sensitivity 43.9%, specificity 79.3%in G+group. At the same time, it was shown that PCT AUC=0.780, the cut-off point=6.80μg/L, sensitivity 51.0%, specificity 93.9%; CRP AUC = 0.907, the cut-off point = 90.10 mg/L, sensitivity 73.2%, specificity 95.9%;endotoxin AUC=0.694, the cut-off point=17.54 ng/L, sensitivity 57.3%, specificity 75.5%;WBC AUC=0.611, the cut-off point = 10.54×109/L, sensitivity 54.1%, specificity 69.4%; Neut% AUC = 0.621, the cut-off point = 0.843, sensitivity 65.6%, specificity 61.2%in G-group. Conclusions The plasma PCT and CRP have the best correlation between inflammatory parameters and severity of disease in bloodstream infective sepsis patients. CRP has the best diagnostic effect in severe sepsis/septic shock patients with bloodstream infection.