血清降钙素原对血液透析患者导管相关性感染的诊断价值  

Value of serum procalcitonin in diagnosis of catheter-related infections in hemodialysis patients

作　　者：马立彬[1] 邓刚[1] 王本勇[1] 杨秀[1] 邱冬豪[1] 仇煜荔 王鸣[1] 

机构地区：[1]杭州市第一人民医院肾内科,浙江杭州310006

出　　处：《中华医院感染学杂志》2014年第4期1033-1035,共3页Chinese Journal of Nosocomiology

基　　金：杭州市科技计划基金资助项目(20110733Q12);浙江省中医药科技计划基金资助项目(2013ZA107)

摘　　要：目的探讨血清降钙素原(PCT)在血液透析患者导管相关性感染中的变化及诊断价值。方法收集医院自2010年3月-2013年3月137例行颈内静脉留置长期导管的血液透析患者,根据导管是否感染分为3组:全身感染组45例和局部感染组47例和未感染组45例;全身感染组患者均采集外周静脉血和颈内静脉长期置管的导管动、静脉端血培养;采用免疫发光法定量测定所有患者血清PCT水平,计算PCT预测脓毒症的敏感性、特异度指标,使用SPSS 17.0软件进行统计分析。结果血液透析合并导管相关性感染患者中,全身感染组患者PCT、CRP水平明显高于局部感染组患者(P<0.01),也明显高于未感染组患者(P<0.01);全身感染组治疗后,血清PCT、CRP和白细胞计数明显下降,与治疗前比较,差异有统计学意义(P<0.01);全身感染组患者血培养阳性率84.40%,分离革兰阳性菌33株占86.84%,分离革兰阴性菌5株占13.16%;以PCT>2μg/L为诊断脓毒症界限,诊断脓毒症的敏感性为97.80%、特异性为95.70%、阳性预测值是95.60%、阴性预测值是97.70%。结论血清PCT指标能早期正确鉴别血液透析患者合并导管相关性感染引起的全身感染,血清PCT水平高低可作为导管相关性感染是否合并脓毒症的指标以及观察使用抗菌药物疗效的参考依据。OBJECTIVE To observe the change of serum procalcitonin （PCT） in hemodialysis patients with catheter- related infections and discuss its diagnostic value. METHODS A total of 137 hemodialysis patients, who underwent long term jugular vein catheter indwelling in the hospital from Mar 2010 to Mar 2013 , were enrolled in the study and divided into three groups as the follows： the systemic infection group （45 cases ）, the local infection group （47 cases ）, and the non-infection group （45 cases） the peripheral venous blood and the long-term internal jugular vein catheter of arterial and venous blood were collected for culture the levels of serum PCT of all the patients were determined by means of immune luminous quantitative, the indicators of the sensitivity and specificity of Pct in predication of sepsis were calculated, and the statistical analysis was performed with the use of SPSS17.0 software. RESULTS Of the hemodialysis patients complicated with catheter-related infections, the levels of serum PCT and CRP of the patients with systemic infections were higher than those of the patients with local infections （P0.01） or the patients in the control group（P%0.01）. After the treatment, the levels of serum PCT and CRP and the WBC counts were significantly decreased in the systemic infection group, as compared with those before the treatment, the differences were statistically significant （P%0.01）. The positive rate of blood culture was 84.4 in the systemic infection group i totally 33（86.84） strains of gram-positive bacteria and 5 （13.16G） strains of gram-negative bacteria have been isolated. With PCT greater than 2/g / L considered as the boundaryfor diagnosis of sepsis, the sensitivity was 97.8%, the specificity 95.7%, the positive prediction value 95.6%, the negative prediction value 97.7 %. CONCLUSION The serum PCT indicator can accurately identify the systemic infections in the hemodialysis patients complicated with catheter-related infections in early stage, and t

关 键 词：降钙素原 血液透析 导管相关性感染 脓毒症 

分 类 号：R446[医药卫生—诊断学]