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中华实验和临床感染病杂志(电子版) ›› 2016, Vol. 10 ›› Issue (02) : 162 -165. doi: 10.3877/cma.j.issn.1674-1358.2016.02.007

临床论著

甲状腺激素、降钙素原和C-反应蛋白对脓毒症患者病情及预后评估的价值
尹小燕1, 乔建瓯2,()   
  1. 1. 200011 上海,上海交通大学医学院附属第九人民医院急诊科
    2. 200011 上海,上海交通大学医学院附属第九人民医院呼吸科
  • 收稿日期:2015-06-18 出版日期:2016-04-15
  • 通信作者: 乔建瓯
  • 基金资助:
    国家自然科学基金项目(No. 81170028)

Evaluating value of thyroid hormone and procalcitonin and C-reactive protein in patients with sepsis

Xiaoyan Yin1, Jian’ou Qiao2,()   

  1. 1. Department of Emergency, Shanghai the 9th People’s Hospital Affiliated to Shanghai Jiaotong University Medical School, Shanghai 200011, China
    2. Respiratory Medicine Department, Shanghai the 9th People’s Hospital Affiliated to Shanghai Jiaotong University Medical School, Shanghai 200011, China
  • Received:2015-06-18 Published:2016-04-15
  • Corresponding author: Jian’ou Qiao
引用本文:

尹小燕, 乔建瓯. 甲状腺激素、降钙素原和C-反应蛋白对脓毒症患者病情及预后评估的价值[J/OL]. 中华实验和临床感染病杂志(电子版), 2016, 10(02): 162-165.

Xiaoyan Yin, Jian’ou Qiao. Evaluating value of thyroid hormone and procalcitonin and C-reactive protein in patients with sepsis[J/OL]. Chinese Journal of Experimental and Clinical Infectious Diseases(Electronic Edition), 2016, 10(02): 162-165.

目的

结合脓毒症患者病情、住院病死率探讨血清甲状腺激素(TH)、血清降钙素原(PCT)和C-反应蛋白(CRP)三者对脓毒症患者预后的评估价值。

方法

采用回顾性研究,根据2008年国际脓毒症定义的脓毒症诊断标准,将入选病例分为脓毒症组、严重脓毒症组(包括严重脓毒症及脓毒症休克患者)、非全身炎症反应综合征(SIRS)对照组;脓毒症、严重脓毒症组按照患者的住院病死率,分为存活组及死亡组。测定各组患者入院24 h内的TH、PCT及CRP浓度并进行各组间的统计学分析。

结果

严重脓毒症患者血清FT3、TT3、TT4水平显著低于脓毒症及对照组(P均< 0.05),脓毒症患者血清FT3、TT3水平低于对照组(P均< 0.05);脓毒症及严重脓毒症患者血清PCT、CRP水平显著高于对照组(P均< 0.05),严重脓毒症患者较脓毒症患者血清PCT水平显著升高(P < 0.05),但两组CRP水平差异无统计学意义;死亡组FT3、TT3、PCT水平显著高于存活组(P均< 0.05),但CRP差异无统计学意义;各组的TSH含量变化无统计学意义。

结论

CRP是鉴别SIRS和非SIRS的有效指标,但并非早期诊断脓毒症的可靠指标。PCT、TH是早期诊断脓毒症并能与非SIRS鉴别的特异性较高的炎症指标;结合PCT和TH水平可以客观判断脓毒症病情的严重性。同时,TH与PCT水平与脓毒症预后显著相关,两者联合应用有望成为早期判断脓毒症预后的快速、可靠且非有创性指标。

Objective

To investigate the evaluating value of thyroid hormone, procalcitonin and C-reactive protein in patients with sepsis by analyzing the state of the disease and fatality.

Methods

According to 2008 international guidelines for management of severe sepsis and septic shock, patients were classified into 3 groups: sepsis group, severe sepsis group (including severe sepsis and septic shock patients) and non-systemic inflammatory response syndrome (SIRS) group (control group), all the data were analyzed, retrospectively. According to the hospital mortality, the two septic groups were divided into survival group and death group. The plasma thyroid hormone, procalcitonin and C-reactive protein levels were detected in 24 h after patients in admission.

Results

In the severe sepsis group, levels of FT3, TT3 and TT4 were significantly lower than those in sepsis and control groups (P all < 0.05). In the sepsis group, levels of FT3 and TT3 were lower than those in control group (P all < 0.05). In the sepsis and severe sepsis groups, levels of PCT and CRP were significantly higher than those in control group (P all < 0.05). In the severe sepsis group, the level of PCT was higher than those in sepsis group (P < 0.05), but there was no significant difference in the levels of CRP between the two groups. In the death group FT3, TT3 and PCT were significantly higher than those in survival group (P all < 0.05), but the difference of CRP had no significant difference. TSH had no significant difference in all group.

Conclusions

CRP is a useful parameter to differentiate SIRS from non-SIRS, which is not reliable indicator for the early diagnosis in patients with sepsis. PCT and TH are more specific indicators in early diagnosis of sepsis. TH and PCT could be used to predict the severity of sepsis. TH and PCT were significantly relevant to the prognosis of sepsis. TH combined with PCT are hopefully quick, reliable and non-invasive indicators in early evaluation of the prognosis of sepsis.

表1 三组患者血清TH、PCT和CRP水平的比较(±s
表2 两组患者血清TH、PCT和CRP水平的比较(±s
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