ICU血行感染早期降钙素原变化幅度的比较  

Difference of Serum Procalcitonin Elevation in Critically Ill Patients at the Onset of Blood-stream Infection

作　　者：符加红[1] 赵阳[1] 栾婷[1] 常旳 臧彬[1] 

机构地区：[1]中国医科大学附属盛京医院重症医学科,辽宁沈阳110004

出　　处：《中国呼吸与危重监护杂志》2014年第2期158-161,共4页Chinese Journal of Respiratory and Critical Care Medicine

基　　金：辽宁省自然科学基金(编号:201102293)

摘　　要：目的 探讨ICU内革兰阴性杆菌、阳性球菌和真菌血症患者降钙素原（ PCT） 的变化幅度及其临床意义。方法 回顾性分析2011 年1 月至2013 年4 月盛京医院重症医学科血行感染的患者, 纳入革兰阴性杆菌菌血症患者49 例, 革兰阳性球菌血症患者22 例, 念珠菌血症患者17 例。比较三组患者菌血症发生3 d 内PCT 水平是否存在差异, 比较三组急性生理学和慢性健康状态评分Ⅱ（ APACHEⅡ评分） 、WBC、乳酸、肌酐和C 反应蛋白（ CRP） 等指标的差异。绘制受试者工作特征曲线（ ROC 曲线） , 评价PCT 鉴别三种菌血症的能力。结果 革兰阴性杆菌组PCT 平均为（ 13. 9 ±18. 0） ng/mL[ 中位数： 8. 32 ng/mL, 范围（ 2. 47 ～78. 26） ng/mL, 革兰阳性球菌组PCT 平均为（ 1. 34 ±1. 25） ng/mL[ 中位数： 0. 75 ng/mL, 范围（ 0. 10 ～4. 81） ng/mL] , 真菌血症组PCT 平均为（ 1. 21 ±0. 92） ng/mL[ 中位数：0. 64 ng/mL, 范围（ 0. 30 ～2. 89） ng/mL] 。阴性杆菌菌血症PCT显著高于阳性球菌和真菌组, 差异显著（ P 〈0. 01） , ROC 曲线下面积为0. 980（ 95% CI 0. 945 ～1. 016） ; 而阳性球菌和真菌血症两组PCT差异无明显统计学意义（ P = 0. 833） , 两组ROC 曲线下面积为0. 049（ 95% CI,0. 266 ～0. 632, P =0. 590） 。结论 革兰阴性杆菌菌血症PCT升高幅度显著高于阳性球菌和念珠菌,但阳性球菌和念珠菌血症患者发病早期PCT升高幅度无明显差异, PCT不能用以区分阳性球菌和念珠菌菌血症。Objective To investigate the extent of procalcitonin （ PCT） elevation at the onset of blood-stream infection and to explore its implication in distinguishing gram-negative, gram-positive and candiasis blood-stream infection.Methods The medical records of patients admitted in Shengjing Hospital between August 2009 and January 2013, who had blood-stream infection caused either by gram-positive,gram-negative bacteria or candiasis at the onset of infection, were retrospectively analyzed. 49 cases were included in the gram-negative bacteremia group,22 cases in the gram-positive bacteremia group, and 17 cases in the candidemia group. PCT values within 3 days at the onset of blood-stream infection were recorded and compared between groups. Differences in clinical values including APACHEⅡ score, white blood cell count （ WBC） , lactate, creatinine and C-reactive protein （ CRP） were also detected. ROC curve were drawn to evaluate the ability of PCT in distinguishing the three kinds of blood-stream infection. Results PCT value in the gram-negative bacteremia group was （ 13. 9 ±18. 0） ng/mL（ Median： 8. 32 ng/mL, range： 12. 47-78. 26 ng/mL） , and were （ 1. 34 ±1. 25） ng/mL（ Median： 0. 75 ng/mL, range： 0. 10-4. 81 ng/mL） and（ 1. 21 ±0. 92） ng/mL（ Median： 0. 64 ng/mL, range： 0. 30-2. 89 ng/mL） in the gram-positive bacteremia group and the candidemia group respectively. PCT level in the gram-negative bacteremia group was higher than those in the gram-positive bacteremia group and the candidemia group with a diagnostic significance （ AUC = 0. 980, 95% CI 0. 945-1. 016, P 〈 0. 05） . There was no statistical significance of PCT in discriminating gram-positivebacteremia and candidemia （ AUC =0. 049, 95% CI 0. 266-0. 632, P =0. 590） .Conclusion In critically ill patients with clinical blood-streaminfection, PCT significantly elevated in gramnegative bacteremia, however it cannot discrimin

关 键 词：降钙素原 真菌血症 菌血症 

分 类 号：R459.7[医药卫生—急诊医学]