sCD14-ST在脓毒血症早期诊断中的应用

doi:10.3969/j.issn.1673-8640.2016.07.004

摘要/Abstract

摘要： 目的

探讨可溶性白细胞分化抗原14亚型（sCD14-ST）在脓毒血症早期诊断中的临床应用价值。

方法

采用前瞻性研究,选取2012年3月至2014年8月疑似脓毒血症患者共50例,正常对照者30名。根据美国胸内科医师学会和危症监护医学学会（ACCP/SCCM）共识会议及临床相关表现将入选患者分为脓毒血症组、细菌感染性全身炎症反应综合征（SIRS）组、局部细菌感染组。收集50例患者入院治疗前、使用抗菌药物24 h、使用抗菌药物72 h及30名正常对照者的血浆和/或血清,检测其sCD14-ST、降钙素原（PCT）及C反应蛋白（CRP）水平。采用受试者工作特征（ROC）曲线研究sCD14-ST在脓毒血症早期诊断中的应用价值。

结果

入院治疗前,3个病例组血sCD14-ST、PCT和CRP水平均显著高于正常对照组（P<0.05）,其中sCD14-ST水平在3个病例组之间差异有统计学意义（P<0.05）,而脓毒血症组PCT和CRP水平与细菌感染性SIRS组比较,差异无统计学意义（P>0.05）。对脓毒血症组治疗前后的sCD14-ST、PCT和CRP的动态变化进行分析,sCD14-ST在入院治疗前、使用抗菌药物24 h和使用抗菌药物72 h 3个时间点的水平差异有统计学意义（P<0.05）。sCD14-ST、PCT和CRP的ROC曲线下面积分别为0.956、0.939和0.848。

结论

sCD14-ST与PCT和CRP相比,在诊断脓毒血症中具有明显优势,可为诊断早期脓毒血症提供重要的临床依据。

关键词: 可溶性白细胞分化抗原14亚型, 降钙素原, C反应蛋白, 脓毒血症

Abstract:

Objective To investigate the significance of soluble CD14-subtype（sCD14-ST）in the early diagnosis of sepsis. Methods Prospective study was used. A total of 30 healthy controls and 50 patients with suspected sepsis were enrolled from March 2012 to August 2014. According to the guidelines of American College of Chest Physicians/Society of Critical Care Medicine（ACCP/SCCM）,the 50 patients were classified into sepsis group,bacterial infection of systemic inflammatory response syndrome（SIRS）group and local bacterial infection group. Plasma and/or serum were/was collected at the first medical evaluation before any medical treatment and after the use of antibiotics for 24 h and 72 h. The levels of sCD14-ST,procalcitonin（PCT）and C-reactive protein（CRP）were determined. Receiver operating characteristic（ROC）curve was used to evaluate the role of sCD14-ST in the early diagnosis of sepsis. Results sCD14-ST,PCT and CRP levels were higher in 3 patient groups than in control group at the first medical evaluation before any medical treatment（P<0.05）. There was statistical significance for sCD14-ST level among the 3 patient groups（P<0.05）. There was no statistical significance for PCT and CRP levels between bacterial infection of SIRS and sepsis groups（P>0.05）. The dynamic changes of sCD14-ST,PCT and CRP levels in sepsis group before and after treatment were analyzed. sCD14-ST level had statistical significance at the first medical evaluation before any medical treatment and after the use of antibiotics for 24 h and 72 h （P<0.05）. The areas under ROC curves were 0.956 for sCD14-ST,0.939 for PCT and 0.848 for CRP, respectively. Conclusions sCD14-ST is better than PCT and CRP in the diagnosis of sepsis,which can provide a reference for the early diagnosis of sepsis.

Key words: Soluble CD14-subtype, Procalcitonin, C-reactive protein, Sepsis

中图分类号:

R446.62

廖娟, 林礼兴, 李扬宇, 秦雪君, 周子鑫, 陈蓉艳, 宋艳芳, 林青. sCD14-ST在脓毒血症早期诊断中的应用[J]. 检验医学, 2016, 31(7): 562-566.

LIAO Juan, LIN Lixing, LI Yangyu, QIN Xuejun, ZHOU Zixin, CHEN Rongyan, SONG Yanfang, LIN Qing. sCD14-ST in the early diagnosis of sepsis[J]. Laboratory Medicine, 2016, 31(7): 562-566.

图/表 3

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组别	例数	sCD14-ST（pg/mL）	PCT（ng/mL）	CRP（mg/L）
脓毒血症组	11	3 271（1 569,5 444）^*#△	14.78（0.59,41.03）^*△	15.33（8.34,24.29）^*△
细菌感染性SIRS组	19	906（519,1 345）^*△	3.37（0.75,9.61）^*△	12.05（8.87,17.35）^*△
局部细菌感染组	20	352（248,448）*	0.04（0.02,0.13）*	1.19（0.44,7.38）*
正常对照组	30	80（58,98）	0.02（0.02,0.02）	0.16（0.13,0.24）

组别	例数	sCD14-ST（pg/mL）	PCT（ng/mL）	CRP（mg/L）
脓毒血症组	11	3 271（1 569,5 444）^*#△	14.78（0.59,41.03）^*△	15.33（8.34,24.29）^*△
细菌感染性SIRS组	19	906（519,1 345）^*△	3.37（0.75,9.61）^*△	12.05（8.87,17.35）^*△
局部细菌感染组	20	352（248,448）*	0.04（0.02,0.13）*	1.19（0.44,7.38）*
正常对照组	30	80（58,98）	0.02（0.02,0.02）	0.16（0.13,0.24）

治疗时间	sCD14-ST（pg/mL）	PCT（ng/mL）	CRP（mg/L）
入院治疗前	3 271（1 569,5 444）	14.78（0.59,41.03）	15.33（8.34,24.29）
使用抗菌药物24 h	2 705（1 363,5 146）*	12.96（7.12,27.54）	16.68（10.26,20.24）
使用抗菌药物72 h	1 667（1 226,3 419）*^#	4.73（2.92,18.89）	11.38（7.77,13.69）

治疗时间	sCD14-ST（pg/mL）	PCT（ng/mL）	CRP（mg/L）
入院治疗前	3 271（1 569,5 444）	14.78（0.59,41.03）	15.33（8.34,24.29）
使用抗菌药物24 h	2 705（1 363,5 146）*	12.96（7.12,27.54）	16.68（10.26,20.24）
使用抗菌药物72 h	1 667（1 226,3 419）*^#	4.73（2.92,18.89）	11.38（7.77,13.69）

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