| 摘要: |
| ［摘要］ 目的 分析单核细胞分布宽度（MDW）联合降钙素原（PCT）预测重症监护病房（ICU）疑似感染患者发生脓毒症的效能。方法 招募2024年10月至2025年4月中国人民解放军联勤保障部队第九四〇医院重症医学科收治的疑似感染患者64例。根据入住ICU后3 d内脓毒症发生情况将其分为脓毒症组（32例）和非脓毒症组（32例）。比较两组临床资料及实验室指标，采用多因素logistic回归分析影响脓毒症发生的影响因素，通过受试者工作特征（ROC）曲线评估研究指标预测脓毒症发生的效能。结果 与非脓毒症组相比，脓毒症组患者年龄更大，体质量更低，序贯器官衰竭评估（SOFA）评分和急性生理学与慢性健康状况评价Ⅱ（APACHE Ⅱ）评分更高，合并高血压比例更高，差异有统计学意义（P<0.05）。两组感染部位分布差异有统计学意义（P<0.05）。脓毒症组总胆红素（TBIL）、血肌酐（SCr）、乳酸（Lac）、活化部分凝血活酶时间（APTT）、C反应蛋白（CRP）、白细胞介素-6（IL-6）、PCT及MDW水平显著高于非脓毒症组（P<0.05），白蛋白（ALB）水平显著低于非脓毒症组（P<0.05）。脓毒症组血培养阳性率显著高于非脓毒症组（P<0.05）。多因素logistic回归分析结果显示，较高的PCT［OR（95%CI）=2.105（1.020～4.326），P=0.044］和MDW［OR（95%CI）=2.013（1.172～3.414），P=0.011］水平是促进脓毒症发生的独立危险因素（P<0.05）。ROC曲线分析结果显示，PCT、MDW均可有效预测脓毒症发生（P<0.05），且两者联合的预测效能较单项指标更优（Z两指标联合-PCT=3.452，P=0.001；Z两指标联合-MDW=2.683，P=0.007），灵敏度为81.25%，特异度为96.88%。结论 MDW和PCT水平升高与ICU疑似感染患者发生脓毒症相关，二者联合检测有助于临床早期识别脓毒症高风险患者。 |
| 关键词: 脓毒症 单核细胞分布宽度 降钙素原 早期诊断 |
| DOI：10.3969/j.issn.1674-3806.2026.08.11 |
| 分类号:R 442.9 |
| 基金项目:甘肃省自然科学基金项目（编号：21JR11RA002）；医院拔尖培育项目（编号：2021yxky003） |
|
| Analysis of the efficacy of monocyte distribution width combined with procalcitonin in predicting sepsis in ICU patients with suspected infection |
|
Yao Weiqing1,2, Xiao Hong1, Gao Yujuan1, Kou Chunhuan1, Liu Li1, Wang Chenchen1, Li Fu3, Zhang Zhaojie3, Liu Dong1,3
|
|
1.Intensive Care Unit, the 940 Hospital of Joint Logistics Support Force of Chinese PLA, Lanzhou 730050, China; 2.Department of Medicine, Northwest Minzu University, Lanzhou 730030, China; 3.Department of Plateau Medicine, the 940 Hospital of Joint Logistics Support Force of Chinese PLA, Lanzhou 730050, China
|
| Abstract: |
| ［Abstract］ Objective To analyze the efficacy of monocyte distribution width(MDW) combined with procalcitonin(PCT) in predicting sepsis in intensive care unit(ICU) patients with suspected infection. Methods A total of 64 patients with suspected infection who were admitted to the Intensive Care Unit of the 940 Hospital of Joint Logistics Support Force of Chinese PLA from October 2024 to April 2025 were recruited. According to the occurrence of sepsis within 3 days after admission to the ICU, the patients were divided into sepsis group(32 patients) and non-sepsis group(32 patients). The clinical data and laboratory indicators were compared between the two groups. Multivariate logistic regression was used to analyze the risk factors influencing the occurrence of sepsis, and the efficacy of research indicators in predicting the occurrence of sepsis was evaluated through receiver operating characteristic(ROC) curve. Results Compared with those in the non-sepsis group, the patients in the sepsis group were older and had lower body weight, higher Sequential Organ Failure Assessment(SOFA) scors and Acute Physiology and Chronic Health Evaluation Ⅱ(APACHE Ⅱ) scores, and a higher proportion of comorbid hypertension, with statistically significant differences(P<0.05). The difference in the distribution of infection sites was statistically significant between the two groups(P<0.05). The levels of total bilirubin(TBIL), serum creatinine(SCr), lactate(Lac), activated partial thromboplastin time(APTT), C-reactive protein(CRP), interleukin-6(IL-6), PCT and MDW in the sepsis group were significantly higher than those in the non-sepsis group(P<0.05), and the level of albumin(ALB) in the sepsis group was significantly lower than that in the non-sepsis group(P<0.05). The blood culture positivity rate in the sepsis group was significantly higher than that in the non-sepsis group(P<0.05). The results of multivariate logistic regression analysis showed that higher levels of PCT［OR(95%CI)=2.105(1.020-4.326), P=0.044］ and MDW［OR(95%CI)=2.013(1.172-3.414), P=0.011］ were independent risk factors for facilitating the occurrence of sepsis(P<0.05). The results of ROC curve analysis showed that both PCT and MDW could effectively predict the occurrence of sepsis(P<0.05), and the predictive efficacy of the combination of the two indicators was better than that of a single indicator(Zcombination of the two indicators-PCT=3.452, P=0.001; Zcombination of the two indicators-MDW=2.683, P=0.007), with a sensitivity of 81.25% and a specificity of 96.88%. Conclusion Elevated levels of MDW and PCT are associated with the occurrence of sepsis in ICU patients with suspected infection. The combined detection of MDW and PCT is helpful for early clinical identification of patients at high risk of sepsis. |
| Key words: sepsis monocyte distribution width(MDW) procalcitonin(PCT) early diagnosis |
