中国血液净化

中国血液净化 ›› 2022, Vol. 21 ›› Issue (06): 432-435.doi: 10.3969/j.issn.1671-4091.2022.06.011

• 临床研究 • 上一篇    下一篇

脓毒血症患者血清PCT、内毒素、CRP水平与病原菌及预后的关系分析

吴 波   张琼芳   王 芳   葛一漫   刘 茜   许安春   

  1. 成都中医药大学附属医院检验科
  • 收稿日期:2021-11-15 修回日期:2022-04-02 出版日期:2022-06-12 发布日期:2022-06-12
  • 通讯作者: 吴波 babipub777@163.com E-mail:babipub777@163.com
  • 基金资助:
    成都中医药大学附属医院科技发展基金(19LW12；20YY18；20ZYTS06)

The relationship between serum levels of procalcitonin, endotoxin and C-reactive protein and pathogenic bacteria and prognosis in sepsis patients 

WU Bo, ZHANG Qiong-fang, WANG Fang, GE Yi-man, LIU Qian, XU An-chun   

  • Received:2021-11-15 Revised:2022-04-02 Online:2022-06-12 Published:2022-06-12
  • Contact: WU Bo babipub777@163.com E-mail:babipub777@163.com

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摘要： 探讨脓毒血症患者血清降钙素原(PCT)、内毒素、C反应蛋白(CRP)水平与病原菌及预后的关系。 方法 回顾性分析2020年1月～2021年1月收治的74例经血培养确诊脓毒血症患者的临床资料。根据血培养结果分为革兰氏阴性菌组(46例)、革兰氏阳性菌组(28例)；根据住院第28d预后情况分为生存组(55例)、死亡组(19例)。对比革兰氏阴性菌组与革兰氏阳性菌组患者、生存组与死亡组患者血清PCT、内毒素、CRP水平。采用Spearman相关分析血清PCT、内毒素、CRP水平和脓毒血症患者病原菌种类的相关性。采用受试者工作特征曲线分析血清PCT、内毒素、CRP水平对脓毒血症患者预后的预测价值。 结果  革兰氏阴性菌组患者血清PCT、内毒素、CRP水平[(3.79±0.57)ng/ml、(0.60±0.13)ng/L、(36.35±4.59)mg/L]明显高于革兰氏阳性菌组[(1.72±0.46)ng/ml、(0.18±0.04)ng/L、(18.42±3.14)mg/L]患者(t=16.251、16.585、18.215，P均＜0.001)，预后差于革兰氏阳性菌组患者(死亡率：34.78%比10.71%，χ2=5.284，P=0.022)。死亡组患者血清PCT、内毒素、CRP水平[(3.41±0.74)ng/ml、(0.55±0.12)ng/L、(35.76±7.21)mg/L]明显高于生存组[(2.34±0.59)ng/ml、(0.38±0.11)ng/L、(27.41±5.08)mg/L]患者(t=6.374、5.674、5.517，P均＜0.001)。Spearman相关分析显示：脓毒血症患者血清PCT、内毒素、CRP水平均与病原菌类型呈负相关(r=-0.785、-0.793、-0.822，P均＜0.001)。ROC曲线显示：血清PCT、内毒素、CRP水平对脓毒血症患者预后具有一定预测价值(AUC=0.862、0.831、0.827，  P均＜0.001)，且3项联合(AUC=0.911，P＜0.001)预测价值较高。  结论  PCT、内毒素、CRP在革兰氏阴性菌感染所致脓毒血症患者血清中表达明显高于革兰氏阳性菌感染所致脓毒血症患者，3项指标联合检测可作为预测脓毒血症患者预后的辅助手段。

关键词: 脓毒血症, 降钙素原, 内毒素, C反应蛋白, 病原菌, 预后

Abstract: Objective  To explore the relationship between serum levels of procalcitonin (PCT), endotoxin and C-reactive protein (CRP) and pathogens and prognosis in sepsis patients.  Methods  A total of 74 sepsis patients confirmed by positive blood culture between January 2020 and January 2021 were retrospective analyzed. According to blood culture results, they were divided into Gram-negative bacteria group (n=46) and Gram-positive bacteria group (n=28); according to the prognosis at the 28th day after hospitalization, they were divided into survival group (n=55) and death group (n=19). The serum levels of PCT, endotoxin and CRP were compared between Gram-negative bacteria group and Gram-positive bacteria group as well as between survival group and death group. Spearman correlation analysis was used to analyze the correlation between serum levels of PCT, endotoxin and CRP and bacterial pathogens in sepsis patients. The receiver operating characteristic curve (ROC curve) was used to explore the value of serum levels of PCT, endotoxin and CRP for prognosis prediction in sepsis patients.  Results  The serum levels of PCT, endotoxin and CRP were 3.79±0.57ng/ml, 0.60±0.13ng/L and 36.35±4.59mg/L respectively in Gram-negative bacteria group, significantly higher than those of 1.72±0.46ng/ml, 0.18±0.04ng/L and 18.42±3.14mg/L respectively in Gram-positive bacteria group (t=16.251, 16.585 and 18.215 respectively; P<0.001). The mortality rate was 34.78% in Gram-negative bacteria group, higher than that of 10.71% in Gram-positive bacteria group (χ2=5.284, P=0.022). The serum levels of PCT, endotoxin and CRP were (3.41±0.74)ng/ml, (0.55±0.12)ng/L and (35.76±7.21)mg/L respectively in death group, higher than those of (2.34±0.59)ng/ml, (0.38±0.11)ng/L and (27.41±5.08)mg/L respectively in survival group (t=6.374, 5.674 and 5.517 respectively; P<0.001). Spearman correlation analysis showed that the serum levels of PCT, endotoxin and CRP in sepsis patients were negatively correlated with the type of pathogen (r=-0.785, -0.793 and -0.822 respectively; P<0.001). ROC curve showed that serum levels of PCT, endotoxin and CRP were valuable for prognosis prediction in sepsis patients (AUC=0.862, 0.831 and 0.827 respectively; P<0.001), and combination of the three levels was more valuable for the prognosis prediction (AUC=0.911, P<0.001).  Conclusion  The serum levels of PCT, endotoxin and CRP were higher in sepsis patients due to Gram-negative bacterial infection than those due to Gram-negative bacterial infection. Combination of the three serum biomarkers can be used as an adjuvant to predict prognosis in sepsis patients.

Key words: Sepsis, Procalcitonin, Endotoxin, C-reactive protein, Pathogenic bacteria, Prognosis