PCT和CRP联合检测在革兰阴性杆菌血流感染脓毒症患者中的临床研究  

Clinical significance of combined monitoring plasma PCT and CRP in patients with gram - negative bloodstream infections

作　　者：李丽娟[1] 林江涛[1] 苏楠[1] 陶新曹[1] 李俊[1] 李一鸣[1] 陈炜[2] 王锁柱[2] 

机构地区：[1]北京中日友好医院呼吸内科,北京100029 [2]北京世纪坛医院ICU,北京100083

出　　处：《中国急救医学》2013年第7期608-611,共4页Chinese Journal of Critical Care Medicine

基　　金：北京市教育委员会科技发展基金项目（D200710025027）

摘　　要：目的 探讨革兰阴性杆菌血流感染脓毒症患者的外周血PCT、CRP水平动态变化对病情严重程度及预后的预测价值.方法 采用前瞻性研究方法,选择2011-02-2012-05在北京世纪坛医院重症医学科（ICU）入住的患者40例,均入ICU 48 h后血培养为革兰阴性杆菌的血流感染.在入科的1、3、5、7、14 d抽取外周血检测PCT、CRP水平,根据确诊28 d是否死亡分为存活组和死亡组,比较两组PCT、CRP水平及其与预后的关系.结果 血浆PCT、CRP水平与感染部位和细菌种类无相关关系（P〉0.05）.存活组患者入院1、3、5 d PCT、CRP水平并不低于死亡组（P〉0.05）,但7、14 d PCT、CRP水平明显低于死亡组（P〈0.01）.存活组患者入院1、3、5 d PCT与CRP水平呈明显正相关（P〈0.01,P〈0.05）.受试者工作特征（ROC）曲线显示,14 d PCT、CRP水平对28 d病死率有很好的预测价值,PCTAUC=0.969,CRPAUC=0.948.入院14 d PCT〉1.01 μg/L和CRP〉68.5 mg/L者的中位生存期（16.8 d）远远小于PCT〈1.01 μg/L和CRP〈68.5 mg/L者（28.0 d）.结论 动态监测革兰阴性杆菌血流感染脓毒症患者外周血PCT、CRP水平的变化趋势,有助于预后的判断,但PCT、CRP水平与感染部位和细菌种类无关.Objective To investigate the clinical significance of combined monitoring plasma procalcitonin （PCT） and C- reactive protein （CRP） in patients with gram- negative bloodstream infections. Methods Forty patients with gram - negative bloodstream infections in ICU of Beijing Shijitan Hospital from January 2011 to May 2012 were enrolled in this prospective study. Blood samples for testing PCT and CRP concentrations were taken on the 1, 3, 5, 7 and 14 day of hospitalization. According to 28 - day mortality the patients were divided into survival group and death group. Plasma PCT and CRP concentration between the two groups were compared and the correlation to the prognosis of the disease was also analyzed. Results There was no relationship between the plasma PCT, CRP concentrations and the infection sites and the types of infectious bacteria （ P 〉 0.05 ）. The PCT, CRP concentrations on the 1, 3, 5 day of hospitalization in non - survival group were not statistically significant higher than those in survival group, but the PCT, CRP concentrations of the 7, 14 day of hospitalization in the non - survival group were statistically significant higher than those in survival group （P 〈 0.01 ）. The PCT and CRP concentrations on the 1, 3, 5 day in survival group were positively associated. PCT, CRP concentrations on day 14 had a statistical significance for prediction of the 28 - day mortality. The area under the receiver operating characteristic （ROC） curve of PCT and CRP was 0. 969 and 0. 948, respectively. The median survival time of patients whose 14 - day PCT concentration 〉 1.01 μg/mL and CRP 〉68.5 mg/L（ 16.8 d）was far less than the patients whose PCT 〈1.01 μg/mL and CRP 〈 68.5 mg/L （28.0 d）. Conclusion Dynamic monitoring of PCT and CRP concentrations contributes to the prognosis of patients with gram - negative bloodstream infections, but the PCT and CRP concentrations do not correlate to the infection sites or the types of infectious bacteria.

关 键 词：降钙素原(PCT) C反应蛋白(CRP) 革兰阴性杆菌 血流感染 

分 类 号：R378[医药卫生—病原生物学]