Objective To evaluate neutrophil VCS parameters combined with inflammatory biomarkers for early diagnosis of sepsis and discrimination of nonsystemic infection. Methods According to the standard of diagnosis about serious systemic infection from ACCP in 2001,selected 68 patients who had systemic infection and positive blood culture as septic group,59 patients who had nonsystemic infection and negative blood cultures as nonsystemic infection group ,64 healthy people as normal control from March 2012 to January 2013. Complete blood count,neutrophil VCS parameters,CRP,IL-6 and PCT were measured in all objects. The differences of WBC, Neu% , CRP, IL-6 , PCT, MNV, MNC, MNS and NDW among the three groups were compared. From the receiver operator curves of every single index and combined index,areas under curves,Cutoff levels,sensitivities,specificities,Youden indexes,positive likelihood ratios and negative likelihood ratios were evaluated. Results The medians (quartiles) of WBC,Neu% ,CRP,IL-6 ,PCT,MNV, MNC,MNS and NDW in control,nonsystemic infection group and septic group were 6. 2(1. 9) × 109/L, 8. 4(6. 5) × 109/L, 13. 3 (14. 4) × 109/L; 61. 2 ( 9. 9) % , 76. 4 (25. 8)%, 91. 1(12. 9)%;3.0(0)mg/L,47. 9(91. 5)mg/L,171. 4(154. 5)mg/L;5. 6(3. 4)pg/ml, 25. 5(42. 51)pg/ml, 738. 2 (4917. 6)pg/ml;0. 2(0. 2)ng/ml,0. 3(1. 4) ng/ml, 24. 7(92. 4) ng/ml; 146 (6. 1), 150. 4(10. 3) , 163. 3(24. 2); 141. 3(6. 0), 144. 4(8. 3) ,149. 7(14. 4) ; 141. 9(5. 9), 142. 3(7. 2) ,139. 1 (10. 3) and 19. 9 (1. 5) , 22. 9 (4. 0) , 29. 9 (5. 9) respectively. There were no significant difference in MNS among the three groups and Neu% between nonsystemic infection group and control (P>0. 05). The other parameters in septic group were higher than those in the other groups (P<0. 05). The areas under curves of WBC, Neu% ,CRP, IL-6,PCT, MNV,MNC,MNS and NDW in septic group were 0.737,0.804,0.898, 0. 946,0. 951,0. 857,0. 758,0. 603 and 0. 934 respectively. When the best Cut-off levels of IL-6, PCT, NDW and MNV were 64.8 pg/ml,l. 5 ng/ml,158. 9 and 26.2 respectively, the sensitivity and specificity were 86. 8% , 90. 2% ; 91. 2% , 88. 6% ; 70. 6%,93. 5% and 77. 9%,94. 3%. The combined area under curve of the four parameters was 0. 975,the sensitivity and specificity was 95. 6% and 95. 5% respectively. Conclusion Combining IL-6 with PCT, MNV and NDW can be used for providing laboratory basis for early diagnosis of sepsis and discrimination of nonsystemic infection.%目的 探讨中性粒细胞VCS参数联合炎症标志物早期诊断脓毒血症和鉴别非系统性感染的临床价值.方法 参照2001年美国临床药学学会关于严重系统性感染的诊断标准,选取2012年3月～2013年1月住院治疗且血培养为阳性患者68例作为脓毒血症组;局部组织感染且血培养为阴性患者59例作为非系统性感染组;无感染症状人群64例作为对照组.所有对象同时行血常规、中性粒细胞VCS参数和炎症标志物(CRP,IL-6,PCT)的检测,比较WBC,Neu%,CRP,IL-6,PCT,MNV,MNC,MNS和NDW指标组间差异.绘制各单项指标和联合指标的ROC曲线,计算AUC和Cut-off值所对应的灵敏度,特异度,Youden指数,阳性似然比和阴性似然比.结果 WBC,Neu%,CRP,IL-6,PCT,MNV,MNC,MNS和NDW在对照组、非系统性感染组和脓毒血症组的中位数(四分位间距)分别为6.2(1.9)×109/L,8.4(6.5)×109/L,13.3(14.4)×109/L;61.2(9.9)%,76.4(25.8)%,91.1(12.9)%;3.0(0)mg/L,47.9(91.5)mg/L,171.4(154.5)mg/L;5.6(3.4)pg/ml,25.5(42.51)pg/ml,738.2(4917.6)pg/ml;0.2(0.2)ng/ml,0.3(1.4)ng/ml,24.7(92.4)ng/ml;146(6.1),150.4(10.3),163.3(24.2);141.3(6.0),144.4(8.3),149.7(14.4);141.9(5.9),142.3(7.2),139.1(10.3);19.9(1.5),22.9(4.0),29.9(5.9).除了MNS在三组间,Neu%在非系统性感染组与对照组间差异无统计学意义外(P>0.05),其余参数在脓毒血症组均高于非系统性感染组和对照组(P<0.05).脓毒血症组WBC,Neu%,CRP,IL-6,PCT,MNV,MNC,MNS和NDW的AUC分别为0.737,0.804,0.898,0.946,0.951,0.857,0.758,0.603和0.934.IL-6,PCT,MNV和NDW的最佳Cut-off值分别为64.8 pg/ml,1.5 ng/ml,158.9和26.2,对应的敏感度和特异度分别为86.8%,90.2%;91.2%,88.6%;70.6%,93.5%和77.9%,94.3%.四者联合的AUC为0.975,其敏感度和特异度可达95.6%和95.5%.结论 IL-6,PCT,MNV和NDW四项联合运用,可以为临床早期诊断脓毒血症和鉴别非系统性感染提供实验室依据.
展开▼
