血清降钙素原在不同种类细菌脓毒症的早期鉴别诊断价值  

Value of serum procalcitonin in early differential diagnosis of different types of bacteria sepsis

作　　者：刘英其 

机构地区：[1]义乌市第二人民医院检验科,浙江义乌322002

出　　处：《中华医院感染学杂志》2013年第3期500-502,共3页Chinese Journal of Nosocomiology

摘　　要：目的探讨血清降钙素原(PCT)对不同种类医院获得性细菌脓毒症的早期鉴别诊断价值。方法以医院获得性革兰阴性菌脓毒症、革兰阳性菌脓毒症、全身炎症反应综合征(SIRS)患者及健康人群(对照组)各50例为研究对象,于入院第1天晨时采集血清观察PCT、C-反应蛋白(CRP)、白细胞(WBC)、中性粒细胞(PMN)、中性粒细胞比例(N)等指标变化,同时记录当日最高体温。结果患者入院第1天PCT水平革兰阴性菌脓毒症组为9.56μg/L、革兰阳性菌脓毒症组为4.64μg/L、SIRS组为0.36μg/L及对照组为0.08μg/L,革兰阴性细菌脓毒症组PCT水平显著高于革兰阳性细菌脓毒症组(P<0.01),革兰阴性菌脓毒症组CRP、WBC、PMN、N水平与革兰阳性细菌脓毒症组相近,PCT受试者特征操作曲线面积(AUC)为0.926,高于CRP的0.747mg/L、WBC的0.807×109/L、N的0.771,革兰阴性组PCT受试者特征操作AUC 0.926,明显高于革兰阳性菌脓毒症组患者的0.807,差异有统计学意义(P<0.05)。结论 PCT是细菌性脓毒症诊断的一个较好指标,其灵敏度和特异度均高于其他炎性指标,对革兰阴性菌、革兰阳性菌脓毒症的鉴别有一定的作用。OBJECTIVE To explore the value of serum procalcitonin（PCT） in early diagnosis of hospital-acquired bacterial sepsis.METHODS The patients with hospital-acquired gram-negative bacteria sepsis,gram-positive bacteria sepsis,SIRS patients,and the healthy controls（the control group）,with 50 cases in each group,were selected as the study objects,the levels of serum PCT,C-reactive protein（CRP）,white blood cell（WBC）,polymorphonuclear neutrophils（PMN） and neutrophil percentage（N） on the first day of enrollment were observed,meanwhile,the maximal body temperature was recorded.RESULTS The serum PCT level of the gram-negative bacteria sepsis group（9.56μg/L）and gram-positive bacteria sepsis group（4.64μg/L）on the 1st day was higher than that in the SIRS group（0.36μg/L）and the control group（0.08μg/L）,and the difference was statistically significant（P0.01）.The serum PCT level of the gram-negative bacteria sepsis was higher than that in the gram-positive bacteria sepsis group,and the difference was statistically significant（P0.01）,and the difference in the level of CRP,WBC,PMN or N between the two groups was not statistically significant.The area under the ROC curve（AUC）of PCT was bigger than that of CRP,WBC and N（0.926 vs 0.747,0.807×109/L,0.771）,as well as,the AUC of PCT in patients with the gram-negative bacteria sepsis was higher than that of the gram-positive bacteria sepsis cases（0.926 vs 0.807）,the difference was statistically significant（P0.05）.CONCLUSION Serum PCT,as a more reliable indicator for the diagnosis of the bacterial sepsis,whose sensitivity and specificity are superior to other inflammations indicators,play an important role in differentiation between the gram-positive bacteria sepsis and gram-negative bacteria sepsis.

关 键 词：降钙素原 革兰阳性菌 革兰阴性菌 脓毒症 

分 类 号：R378[医药卫生—病原生物学]