生物标志物在脓毒症诊断和危险分层中的临床价值探讨

摘要

Objective To evaluate the clinic value of pro - atrial natriuretic peptide ( pro-ANP), pro - adrcnomedullin ( pro - ADM ), procalcitonin ( PCT), C - reactive protein ( CRP ) and interleukin - 6 ( IL - 6) levels in prognosis judgment and risk stratification in sepsis. Methods We performed a prospective trial involving 149 critically ill patients who were admitted to the intensive care unit in our hospital. According to the international criteria, the patients were classified into four groups:Systemic inflammatory response syndrome(SIRS)group( n =72),sepsis group( n =33),severe sepsis group( n =27) and septic shock group( n=17 ). The levels of plasma pro - ANP and pro - ADM were measured in each group,and compared with the other biomarkers( i.e. PCT,CRP and IL-6)and the acute physiologic and chronic health evaluation(APACHE) Ⅱ score. Pro- ANP and pro -ADM were detected using a new sandwich immunoassay. Results The plasma concentrations of pro-ANP, pro - ADM and PCT exhibited a gradual increase,and the median pro- ANP,pro- ADM and PCT were highest in the septic shock group ( all P＜0.05 ). Compared with the other biomarkers, in the sepsis, severe sepsis and septic shock groups,the plasma concentrations of pro - ANP and pro - ADM, and APACHE Ⅱ scores in the non - survivors were significantly higher than in the survivors. In a receiver operating curve analysis of survival of patients with sepsis,the areas under the curve(AUC)for pro - ANP,pro - ADM were 0.88 and 0.86,which was similar to the ROC curve for PCT(0.82) ,acute physiology and chronic health evaluation Ⅱ score(0.82),and was significantly higher than the areas under the ROC curve for CRP(0.54)and IL-6(0.69). Conclusion The biomarker of pro - ANP, pro - ADM, and PCT was a valuable tool for prognostic judgment and individual risk stratification of sepsis patients.%目的 评价前心房利钠肽(pro-ANP)、前肾上腺髓质素(pro-ADM)、降钙素原(PCT)、白介素-6(IL-6)和C-反应蛋白(CRP)在脓毒症预测和危险分层中的价值.方法 前瞻性的将149例入住重症加强病房的危重病患者按标准分为全身性炎症反应综合征(SIRS)组(72例)、脓毒症组(33例)、严重脓毒症组(27例)、脓毒症性休克组(17例)4组,采用新型夹心免疫荧光测量法检测各组中pro-ANP和pro-ADM浓度,并和急性生理学与慢性健康状况评分系统Ⅱ(APACHEⅡ评分)及PCT、CRP和IL-6等相比较.结果 SIRS组、脓毒症、严重脓毒症和脓毒症性休克组,血浆pro-ANP、pro-ADM、PCT浓度逐渐升高,差异有统计学意义(P均＜0.05),CRP和IL-6浓度差异无统计学意义(P均＞0.05).在脓毒症组中,与其他标志物相比,死亡患者的pro-ANP、pro-ADM浓度比存活患者明显升高,差异有统计学意义(P<0.05).在脓毒症患者的受试者工作曲线分析中,pro-ANP(0.88)、pro-ADM(0.86)和PCT(0.82)、APACHEⅡ评分(0.82)的曲线下面积相同,明显高于CRP(0.54)和IL-6(0.69).结论 生物标志物pro-ANP、pro-ADM、PCT对脓毒症患者的预测和危险分层是一个有用的工具.