降钙素原在血流感染中的临床应用分析  

Cost-effective analysis of procalcitonin in the diagnosis of bloodstream infection

作　　者：张丽[1] 侯毅翰[1] 张民伟[1] 魏乔[1] 高流芳[1] 

机构地区：[1]厦门大学附属第一医院重症医学科,福建厦门361003

出　　处：《东南国防医药》2013年第6期603-605,共3页Military Medical Journal of Southeast China

摘　　要：目的 评价血清降钙素原（Procalcitonin,PCT）区分革兰阴性菌（G-菌）或革兰阳性菌（G＋菌）血流感染的意义.方法收集我院重症医学科（ICU）2012年1月-2013年6月血流感染病例66例,根据血培养结果分为革兰阳性菌感染组（G＋菌感染组）与革兰阴性菌感染组（G-菌感染组）,在根据病情严重性进一步分组后,统计分析PCT、C反应蛋白（CRP）、白细胞计数（WBC）等炎症指标.结果 PCT在G-和G＋菌感染组间存在显著差异（P〈0.01）;且在G-菌组中严重脓毒症和脓毒症患者间PCT亦存在显著差异（P〈0.05）.血清PCT检测用于区分G-、G＋菌血流感染的ROC曲线下面积为0.937（95%CI：0.877～0.997,P〈0.01）,当PCT为7.71 ng/ml时,对G-菌感染组诊断价值较高,敏感性82.1%,特异性89.3%,阳性预测值 91.5%,阴性预测值 77.9%.结论 PCT可作为区分G-、G＋菌导致的血流感染的生物学标志之一,且与G-菌引起的脓毒症的严重程度密切相关.以PCT〉7.7 ng/ml为界点诊断G-菌导致的血流感染具有较高的敏感性和特异性.Objective To evaluate the significance of Procalcitonin （PCT） in distinguishing Gram negative （G-） and Gram positive （ G＋ ） septic bloodstream infections. Methods Sixty-Six septic cases admitted by the Intensive Care Unit of our hospital （The first affiliated hospital of Xiamen University） from 2012.01 to 2013.06 were enrolled into this study,which were divided into G＋ septic group and G- septic group by the blood culture results. Further stratification can be done according to the severity of patient＇s inflamma- tion condition. Some inflammatory indicators, such as PCT, C-reactive protein, white blood cell count were collected and analyzed statis- tically. Results PCT concentrations in G- septic groups were significantly higher than that of G ＋ septic groups （P 〈 0.01 ）, also dif- ferent between the severe septic patients and the moderate septic patients in the G- groups （P 〈 0.05）. The area under the ROC curve of PCT in diagnosis of distinguishing between Gram negative （ G- ） and Gram positive （ G ＋ ） septic bloodstream infection was 0. 937 （95% CI： 0.877 -0.997, P 〈 0.01 ）. When we used 7.71 ng/ml as a cut-off value, the value of serum procalcitonin levels in diagno- sis of G ＋, G- septic patients in blood- stream infection was the best. The diagnostic sensitivity, specificity, positive predictive value, negative predictive value of PCT was 82. 1% ,89.3% ,91.5% ,and 77.9%. Conclusion PCT could be used as one of good inflamma- tory biomarkers for differentiating Gram negative from Gram positive septic bloodstream infections. Moreover, high PCT concentrations have a positive predictive value for sepsis and correlate with the severity of inflammation. When 7.71 ng/ml was used as a cut-off val- ue,the diagnostic value of serum PCT on G- septic infection is rather good sensitivity and specificity.

关 键 词：降钙素原 血流感染 脓毒症 

分 类 号：R446.5[医药卫生—诊断学]