急診病患細菌感染PCT與其它生物發炎指標效益性的比較

Comparisons of the Benefits Yielded between Procalcitonine and Other Inflammatory Biomarkers in Bacterial Infected Patients Presented in ED

吳宇暉(Yu-Hui Wu) ； 廖芳足(Fang-Tsu Liao) ； 傅文玫(Wen-Mei Fu) ； 呂榮傑(Jung-Jei Lu) ； 邱淑玲(Shu-Ling Chiou) ； 李津津(Chin-Chin Lee) ； 謝佳穎(Chia-Ying Hsieh)

《Journal of Biomedical & Laboratory Sciences》 23卷1期 (2011/03) Pp. 8-13

https://doi.org/10.30046/JBLS.201103.0002

摘要

由於細菌感染與病毒感染的臨床症狀和徵兆很相似，因此在早期很難將兩者作區分；並且一般傳統檢測方法的敏感度與特異性不高，所以容易延誤診斷的時間而演變成敗血症(Sepsis)。然而，早在1992年的研究指出，前降鈣素(Procalcitonin; PCT)在燒燙傷且伴隨著敗血症感染的病患中，PCT濃度會上升；反之，當病患遭受到病毒感染時，血液中PCT濃度並不會明顯上升，因此PCT可以作爲區分細菌感染與非細菌感染的理想生物標記。本實驗研究目的在於確認PCT是否可作爲急診診斷敗血症的生物標記，以及比較PCT與現有的C反應蛋白(C reactive protein; CRP)，白血球(White Blood Cell; WBC)、嗜中性球(Seg-neutrophil; Seg)、淋巴球(Lymphocyte; lym)等檢測方法在診斷上的效用。本研究從98年6月到98年9月期間，在急診室收集94位SIRS(System Inflammatory Response Syndrome)的病患，同時進行PCT、CRP、WBC、Lym、Seg等檢測項目。
實驗結果顯示在94位急診病患中，區分急診病患爲敗血症及非敗血症的生物檢驗標記表現最好的是PCT，其次依序爲CRP、Seg、WBC、最差爲Lym。在檢測項目對於疾病診斷功能方面，我們可以從ROC(Receiver Operating Characteristic)曲線得知，PCT，CRP，WBC，Lym，Seg的AUC(area under the curve)值分別爲0.867，0.741，0.638，0.276，0.735 (95% CI)，凸顯PCT具有最佳的診斷效果。因此，由本臨床試驗結果顯示，PCT比起現有的CRP，WBC，Lym，Seg等檢測方法，更適合做爲急診上診斷敗血症的生物標記。

關鍵字

SIRS全身發炎反應症候群 ； SEPSIS敗血症 ； PCT前降鈣素 ； biomarker生物標記

並列摘要

Objective: Since the clinical symptoms between bacterial and viral infections are similar, it is difficult to distinguish one from another in the early stage. While the sensitivity and specificity of conventional diagnostic methods remains undesirable, delayed diagnosis which easily results in septicemia is often seen. Previous study done in 1992 indicated that the concentration of Procalcitonin (PCT) increased in burn patients complicated with sepsis. On the contrary, insignificant increase in blood PCT concentrations were observed in patients suffered from viral infections. Thus, it was suggested that PCT can be used as a potential biomarker to differentiate between bacterial and non-bacterial infections.
The purpose of this study was to confirm whether PCT could serve as a biomarker for diagnosing sepsis in emergency department (ED) and to compare the diagnostic efficacy between PCT and other existing detection methods such as C-reactive protein (CRP), white blood cell (WBC), Seg-neutrophil (Seg) and Lymphocyte (Lym). In this study, ninety-four patients with System Inflammatory Response Syndrome (SIRS) were included from Nov 2008 to June 2009. In these patients, PCT, CRP, WBC, Lym and Seg levels were assessed, and the area under receiver operating characteristics (ROC) curve were calculated to be 0.867, 0.741, 0.638, 0.276 and 0.735 respectively. Hence, our result suggested that following by CRP, Seg and WBC, PCT is the best bio-marker in discriminating between sepsis and non-sepsis in ED, and Lym is the poorest biomarker in sepsis prediction.

並列關鍵字

System Inflammatory Response Syndrome ； Sepsis ； Procalcitonin ； Biomarker