Presepsin对脓毒症患者的临床诊断意义.docVIP

Presepsin对脓毒症患者的临床诊断意义 　　doi：10.3969/j.issn.1007-614x.2014.14.64 　　摘 要 目的：探讨Presepsin临床诊断脓毒症的意义。方法：2013年1-10月收治脓毒症患者80例和严重脓毒症患者74例，在使用抗菌药前都采用一步免疫测定夹心法和最终荧光检测法进行血清Presepsin和降钙素原（PCT）水平检测。结果：80例脓毒症患者血清Presepsin和PCT水平分别是（921.4±32.3）pg/ml和（4.6±1.2）ng/ml。74例严重脓毒症患者血清Presepsin和PCT水平分别是（2 057.4±108.4）pg/ml和（6.1±3.2）ng/ml。74例严重脓毒症患者血清Presepsin水平与80例脓毒症患者血清Presepsin水平相比差异有统计学意义（P0.05）。结论：血清Presepsin水平在临床上诊断脓毒症和评估病情的严重程度上可能优于PCT。 　　关键词 Presepsin 降钙素原 脓毒症 诊断 　　The primary significance of Presepsin in the diagnosis of patients with sepsis 　　Zhou Li 　　Tianmen Wang Field Center Hospita，Hubei province，431717 　　Abstract Objective：To study the primary significance of Presepsin in the clinical diagnosis of sepsis.Methods：There were 80 cases with sepsis patients and 74 cases with severe sepsis patients at the emergency department of our hospital in January 2013 to October for the first time.Before the use of antibacterial drugs，we got the serum levels of Presepsin and PCT with the immunoassay of serum Presepsin and sandwich fluorescence assay.Results：The serum level of Presepsin was 921.4±32.3pg/ml in 80 cases of sepsis patients，and the levels of PCT was 4.6±1.2ng/ml.The serum levels of Presepsin of 74 cases of severe sepsis patients was 2057.4±108.4pg/ml，and PCT levels was 6.1±3.2ng/ml.There was more different at the serum levels of Presepsin between 74 cases of severe sepsis patients and 80 cases of sepsis patients（P0.05）.Conclusion：The severity of the serum level of Presepsin in the diagnosis of sepsis and assess the condition in the clinic may be better than PCT. 　　Key words Presepsin；Procalcitonin；Sepsis；Diagnosis 　　脓毒症是感染所致的全身炎性反应综合征，其临床表现多样，病情进展迅速，不仅使患者生存质量下降，治疗费用高昂，而且病死率高，已成重症监护病房患者的死亡原因之一。近年来，许多生物学标记物如降钙素原（PCT）、白细胞介素、C反应蛋白、髓系细胞表达的触发受体-1等在脓毒症诊断、病情评价、指导抗菌药物使用、预后评估等方面的作用研究受到广泛关注。但是由于脓毒症引起的全身炎性反应的复杂性，目前还没有理想的指标来对其诊断、分层、疗效评估、预后评估。虽然目前PCT已经被推荐用于细菌、真菌或寄生虫感染重要的监测指标，然而，有资料研究表明，PCT对于感染引起全身炎性反应的诊断价值其敏感度74.8%左右，特异度大约70%，阴性预测值约56.3%，阳性预测值约55%[1，2]。因此需要新的生物标记物如Presepsin来提高脓毒症的