可溶性CD14亚型、白介素-6和C反应蛋白对脓毒症休克预后的评估价值
The evaluation value of soluble CD14 subtype, interleukin 6 and C-reactive protein on prognosis of septic shock

王小军.可溶性CD14亚型、白介素-6和C反应蛋白对脓毒症休克预后的评估价值[J].内科急危重症杂志,2021,27(1):36-39

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DOI：10.11768/nkjwzzzz20210111

中文关键词: 脓毒症休克预后评估可溶性CD14亚型白细胞介素 6 C反应蛋白

英文关键词:

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作者	单位	E-mail
王小军	延安大学附属医院	wanghaijing198701@163.com

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中文摘要:

目的：探讨血可溶性CD14亚型（sCD14-ST）、白细胞介素6（IL-6）和C反应蛋白（CRP）对脓毒症休克患者的病情和预后的评估价值。方法：选择脓毒症休克患者55例和全身炎症反应综合征(SIRS)患者42例，同时选择50例健康者，比较3组受试者血sCD14-ST、IL-6、CRP水平的差异，通过受试者工作特征曲线评估各指标对脓毒症休克患者的病情和预后的评估价值。结果： sCD14-ST与肌酐、ICU治疗期间肾脏替代治疗天数、白细胞计数（WBC）、CRP、IL-6、胆红素等临床和实验室参数相关。SIRS、脓毒症休克患者外周血中的sCD14-ST、IL-6、CRP水平呈显著增加的趋势，且脓毒症休克患者明显高于SIRS患者。 ICU治疗第1天，sCD14-ST水平对脓毒症休克病情的预测价值与IL-6、CRP相当；ICU治疗第3天，sCD14-ST的预测价值明显优于CRP，与IL-6的预测价值相当；ICU治疗第8天，sCD14-ST的预测价值明显优于IL-6和CRP。sCD14-ST对预后评估价值显著优于IL-6和CRP。ICU治疗第1天，IL-6和CRP对30d和6个月的病死率具有较准确的预判；ICU治疗第3天，IL-6对30d的病死率具有较准确评估价值；其他时间点IL-6和CRP的预测能力均不理想（治疗第3天和第8天CRP的AUC分别为0.61、0.66；治疗第8天IL-6的AUC为0.65）。结论：血sCD14-ST、IL-6和CRP水平对脓毒症休克患者在重症监护治疗的第1周具有较高的预测和预后评估价值。与IL-6、CRP比较，血sCD14-ST水平在ICU治疗第1、3、8天对脓毒症休克的预测和预后评估更具有价值。

英文摘要:

Objective: To investigate the value of CD14 subtype (presepsin), interleukin 6 (IL-6) and C-reactive protein (CRP) in the diagnosis and prognosis evaluation of septic shock patients. Methods: Totally 55 septic shock patients and 42 systemic inflammatory response syndrome (SIRS) patients were enrolled in this study, and 50 healthy patients were selected as the control group. The differences in presepsin, IL-6 and CRP levels among three groups were statistically analyzed to evaluate the value of these biomarkers in the diagnosis and prognosis of septic shock. Results: Presepsin was related to creatinine level, days of renal replacement therapy during ICU treatment, WBC, CRP, IL-6, bilirubin and other clinical and experimental parameters. The levels of presepsin, IL-6 and CRP in SIRS and septic shock patients significantly increased, and the concentration in septic shock patients was significantly higher than that in SIRS patients. The diagnostic value of presepsin levels to septic shock was comparable to that of IL-6 and CRP at day 1 of ICU treatment. At day 3 of ICU treatment, the diagnostic value of presepsin was significantly better than that of CRP, but still not significantly different from that of IL-6. The diagnostic value of presepsin was significantly higher than that of IL-6 and CRP at day 8. The prognostic value of presepsin was numerically greater than IL-6 and CRP. At day 1 of ICU treatment, IL-6 and CRP had a good predictive value for the mortality at day 30 and month 6. At day 3 of ICU treatment, IL-6 had a good 30-day mortality predictive value. However, at other time points, the predictive capacity of IL-6 and CRP was not ideal (AUC was less than 0.75). Conclusion: The detection of presepsin, IL-6 and CRP levels had diagnostic and predictive value for septic shock patients in the first week of ICU treatment. The presepsin is more valuable for the diagnosis and prognosis evaluation of sepsis shock at days 1, 3 and 8 of ICU treatment than IL-6 and CRP.