河北医科大学学报 ›› 2023, Vol. 44 ›› Issue (10): 1157-1161，1184.doi: 10.3969/j.issn.1007-3205.2023.10.008

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PCT、hs-CRP及sPLA2-ⅡA检测在脓毒症临床评价中的应用价值

  

  1. 1.河北省邯郸市中心医院临检科，河北 邯郸 056000；2.河北省邯郸市中心医院检验科，河北 邯郸 056000

  • 出版日期:2023-10-25 发布日期:2023-11-03
  • 作者简介:房启文(1988-)，女，河北磁县人，河北省邯郸市中心医院中级检验师，医学硕士，从事临床检验研究。
  • 基金资助:
    河北省医学研究重点课题计划（20191840）

Application value of PCT, hs-CRP and sPLA2-ⅡA in clinical evaluation of sepsis

  1. 1.Department of Clinical Laboratory, Handan Central Hospital，Hebei Province, Handan 056001, China； 
    2.Department of Laboratory, Handan Central Hospital， Hebei Province, Handan 056001, China

  • Online:2023-10-25 Published:2023-11-03

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摘要： 目的 探讨降钙素原（procalcitonin，PCT）、高敏C-反应蛋白（hypersensitive C reactive protein，hs-CRP）和血清ⅡA型分泌磷脂酶（group ⅡA secreted phospholipase A2，sPLA2-ⅡA）在脓毒症临床评价中的应用价值。
方法 通过回顾性分析选取164例确诊为脓毒症的患者作为观察组，按血培养结果分为革兰阴性杆菌组、革兰阳性球菌组、真菌组，选取非脓毒症感染者125例作为对照组；比较观察组与对照组之间PCT、hs-CRP及sPLA2-ⅡA血清水平差异，并进一步比较观察组的各组之间PCT、hs-CRP及sPLA2-ⅡA血清水平差异；急性生理学和慢性健康评定量表（APACHE-Ⅱ评分）评估患者病情严重程度，Pearson系数分析PCT、hs-CRP及sPLA2-ⅡA与APACHE-Ⅱ评分的相关性；ROC曲线分析PCT、hs-CRP、sPLA2-ⅡA及三者联合对脓毒症的诊断价值。
结果 革兰阴性杆菌组与革兰阳性球菌组中PCT、hs-CRP及sPLA2-ⅡA表达均高于对照组（P＜0.05），真菌组中sPLA2-ⅡA表达高于对照组（P＜0.05），APACHE-Ⅱ评分≥15分的患者中sPLA2-ⅡA表达显著高于对照组（P＜0.01）；PCT、hs-CRP及sPLA2-ⅡA均与APACHE-Ⅱ评分正相关，且sPLA2-ⅡA相关性（r=0.562，P＜0.01）高于PCT（r=0.400，P＜0.01）与hs-CRP（r=0.562，P＜0.01）；sPLA2-ⅡA（AUC=0.86）对脓毒症的诊断价值高于PCT（AUC=0.71）与hs-CRP（AUC=0.65），且三者联合检测（AUC=0.93）具有更高诊断效力。
结论 相较于PCT及hs-CRP，sPLA2-ⅡA检测在脓毒症临床评价中具有潜在的应用价值。


关键词: 脓毒症, C反应蛋白质, 降钙素原

Abstract: Objective To investigate application value of procalcitonin (PCT), hypersensitive C reactive protein (hs-CRP) and group ⅡA secreted phospholipase A2 (sPLA2-ⅡA) in the clinical evaluation of sepsis. 
Methods A total of 164 patients diagnosed with sepsis were retrospectively analyzed and selected as the observation group. They were divided into gram-negative bacilli group, gram-positive cocci group and fungus group. Another 125 patients without sepsis were selected as the control group. The differences inexpression levels of serum PCT, hs-CRP and sPLA2-ⅡA were compared between observation group and the control group, and the differences in expression levels of serum PCT, hs-CRP and sPLA2-ⅡA among observation groups were compared. Acute physiology and chronic health evaluation Ⅱ (APACHE-Ⅱ) scoring system was used to evaluate the severity of the disease, and the correlation between PCT, hs-CRP, sPLA2-ⅡA and APACHE-Ⅱ score was analyzed by Pearsoncoefficient analysis. The diagnostic value of PCT, hs-CRP, sPLA2-ⅡA and their combination for sepsis was analyzed by receiver operating characteristic (ROC) curve. 
Results The expressions of PCT, hs-CRP and sPLA2-ⅡA in gram-negative bacilli group and gram-positive cocci group were higher than those in the control group (P＜0.05), and the expression of sPLA2-ⅡA was higher in fungus group than in the control group(P＜0.05). The expression of sPLA2-ⅡA in patients with APACHE-Ⅱ score ≥15 was significantly higher than that in control group (P<0.01). PCT, hs-CRP and sPLA2-ⅡA were all positively correlated with APACHE-Ⅱ score, and the correlation of sPLA2-ⅡA (r=0.562, P＜0.01) was higher than that of PCT (r=0.400, P＜0.01) and hs-CRP (r=0.562, P＜0.01). sPLA2-ⅡA (AUC=0.86) had higher diagnostic value for sepsis than PCT (AUC=0.71) and hs-CRP (AUC=0.65), and the combined detection of the three (AUC=0.93) had higher diagnostic efficacy. 
Conclusion Compared with PCT and hs-CRP, sPLA2-ⅡA detection has potential application value in clinical evaluation of sepsis. 


Key words: sepsis, C-reactive protein, procalcitonin

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