| 摘要: |
| 目的研究血清降钙素原（PCT）和T细胞亚群联合检测用于早期诊断脓毒症的临床价值，以改善脓毒症患者的救治效果。方法收集入住ICU的危重患者共225例，其中入院时脓毒症患者60例，非脓毒症患者165例。检测所有患者入住ICU时PCT水平和T细胞亚群，采用ROC曲线分析PCT和辅助性CD4+T细胞诊断脓毒症的临界值，依据两项临界值构建联合诊断脓毒症的生物评分（0~2分），然后采用ROC曲线及多因素logistic回归分析法分析联合诊断的生物评分能否提高诊断脓毒症的正确率。结果脓毒症患者血清PCT水平为8.4（1.4~21.8）ng/ml，明显高于非脓毒症患者[0.4（0.1~0.8）ng/ml]（P＜0.05）；脓毒症患者的CD3+T细胞和辅助性CD4+T细胞降低，细胞毒CD8+T细胞升高（均P＜0.05）。PCT和CD4+T细胞诊断脓毒症的最佳临界值分别为0.95ng/ml和26.89%。制定生物评分后，通过多因素logistic回归分析，血清PCT水平、CD4+T细胞和生物评分均能够独立预测脓毒症，但生物评分预警脓毒症的效果最好（OR=32.76，95%CI9.82~82.13），ROC曲线下面积为0.956（95%CI0.925~0.988）。结论联合检测血清PCT水平和T细胞亚群能够较好地早期预警脓毒症，其价值优于单项指标。 |
| 关键词: 脓毒症 降钙素原 T 细胞亚群 |
| DOI： |
| 分类号: |
| 基金项目:杭州市富阳区科技局项目 |
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| The effect of combining procalcitonin and T cell subsets in diagnosis of sepsis |
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GAO Jianbo, ZHANG Mao, TANG Weidong
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Fuyang People's Hospital
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| Abstract: |
| Objective The aim of the study was to investigate the effect of combining procalcitonin and T cell subsets in diagnosis of sepsis. Methods A prospectively study was performed in critically ill patients admitted into the intensive care unit during January 1 to June 30 of the year 2012. Patients' information was recorded. Bloods were sampled and tested for procalcitonin andT cell subsets at admission. Receive operating characteristic curve (ROC curve) was used to evaluate the ability of procalcitonin and T cell subsets in assessing sepsis. A Bioscore was constructed according the cutoffs of PCT and T cell subsets. Then ROC curve and multivariate logistic analysis were used to determine whether the bioscore could improve the diagnostic performance. Results During this study period, 225 critically ill patients were admitted into the ICU and 60 patients were sepsis. The concentration of PCT in patients with sepsis was obvious higher than patients without sepsis (8.4 vs. 0.4ng/mL,
P＜0.001). Besides, CD3+T cell and CD4+T cell decreased while CD8+T cell increased in patients with sepsis. From the results of
ROC curves, the cutoffs of PCT and CD4+T cell were 0.95 ng/mL and 26.89% respectively. The performance of Bioscore was better than PCT and CD4+T cell, the AUC was 0.956 (95% CI, 0.925~0.988). In the multivariate analysis, PCT, CD4+T cell and Bioscore were all independent predictors of sepsis. But the performance of Bioscore was better than any of biomarkers (OR, 32.76; 95% CI, 9.82~82.13). Conclusion Our study demonstrated the high performances of the bioscore combining PCT and T cell subsets in diagnosis of sepsis. Much more multicentre studies should be performed to predictor sepsis. |
| Key words: Sepsis Procalcitonin T cell subsets |
