血清PCT,CRP及NEU％联合检测对细菌性血流感染的早期诊断价值  

Early Diagnostic Value of Combined Detection of Serum PCT,CRP and NEU% in Patients with Bacterial Bloodstream Infection

作　　者：张婷[1] 丁爽[2] 李洪春[1,2] 马萍[1,2] 

机构地区：[1]徐州医学院医学技术学院,江苏徐州221004 [2]徐州医学院附属医院检验科,江苏徐州221002

出　　处：《现代检验医学杂志》2014年第3期75-77,80,共4页Journal of Modern Laboratory Medicine

摘　　要：目的 探讨联合检测血清降钙素原（procalcitonin,PCT）,C-反应蛋白（C-reactive protein,CRP）及中性粒细胞百分比（percentage ofneutrophils,NEU％）早期预测细菌性血流感染（bloodstream infection,BSI）的可行性.方法 回顾性分析2012年11月-2013年7月徐州医学院附属医院的住院患者376例,均为入院后首次送检血培养并同时检测血常规、PCT及CRP者.血液病患者排除在外.按血培养结果将患者分为血培养阳性组和血培养阴性组,比较两组中PCT,CRP和NEU％的水平变化,并绘制ROC曲线评价各指标的诊断价值.将系列联合检测与诊断价值较高指标的灵敏度和特异度进行比较.结果 103例患者的血培养为阳性,273例患者的血培养为阴性.血培养阳性组患者的PCT,CRP和NEU％水平显著高于血培养阴性组（9.95±21.40 ng/ml vs 3.94±20.03 ng/ml,Z=9.992,P=0.000;112.84±84.95 mg/mlvs 74.25±70.79 mg/ml,Z=4.503,P=0.000;85.61％±9.90％ vs 78.66％±13.22％,Z=5.302,P=0.000）,秩和检验得出差异具有统计学意义.PCT的AUC为0.818,经Z检验,大于CRP（AUC=0.651,Z=4.175,P=0.000）和NEU％ （AUC=0.677,Z=3.597,P=0.000）,差异具有统计学意义.PCT,CRP和NEU％诊断细菌性BSI的灵敏度和特异度分别为75.2％和78.8％,99.0％和6.6％,92.4％和21.2％,三者系列联合检测灵敏度为70.5％,特异度为81.3％.联合检测较PCT单项检测灵敏度有所下降,经χ^2检验差异无统计学意义（χ^2=2.25,P=0.134）,但特异度升高,差异具有统计学意义（χ^2=4.2,P=0.041）.当三项指标均阴性时,排除细菌性BSI的特异度高达100％.结论 联合检测PCT,CRP及NEU％可为临床早期预测细菌性BSI提供更便捷、可靠的诊断方法.Objective To investigate the feasibility of early prediction of bacterial bloodstream infection （BSI） in patients by combined detection of serum procalcitonin（PCT）,C-reactive protein （CRP） and percentage of neutrophils （NEU%）.Methods A retrospective analysis was taken on 376 in-patients who were executed blood culture at the fist time after been admitted to the Affiliated Hospital of Xuzhou Medical College during the period of November 2012 to July 2013,and the blood routine test,serum PCT and CRP detection were taken at the same time.Patients with hematologic disease were excluded.Patients were divided into the positive blood culture group and the negative blood culture group.Compared the PCT,CRP and NEU% levels between the two groups and analyzed each indicator in the performance of bacterial BSI diagnosis by drawing ROC curve.Compared the sensitivity and specificity of combined detection with a single indicator which had a better diagnostic value.Results 103 patients were of positive blood culture,273 patients were of negative blood culture.PCT,CRP and NEU% levels were significantly higher in the positive blood culture group than the negative blood culture group （9.95 ±21.40 ng/ml vs 3.94±20.03 ng/ml,Z=9.992,P=0.000;112.84±84.95 mg/ml vs 74.25±70.79 mg/ml,Z=-4.503,P=0.000;85.61%±9.90% vs 78.66%±13.22%,Z=-5.302,P=0.000）,the differences were significant analyzed by rank test.PCT had an AUC value of 0.818,which was higher than that of CRP（AUC=0.651,Z=4.175,P=0.000） and NEU% （AUC=0.677,Z=3.597,P=0.000）,the differences were significant analyzed by Z test.The sensitivity and specificity of PCT,CRP and NEU% were 75.2% and 78.8%,99.0% and 6.6%,92.4% and 21.2% respectively in the diagnostic of bacterial bloodstream infection,while combined detection had a sensitivity of 70.5% and a specificity of 81.3 %.The combined detection made a non significant decrease in sensitivity （χ^2 =2.25,P=0.134）,but a significant in crease in the specificity （χ^2 =4.2,P=0.041） comparing with sing

关 键 词：细菌感染 血流感染 降钙素原 C-反应蛋白 中性粒细胞百分比 

分 类 号：R535.3[医药卫生—内科学] R446.112[医药卫生—临床医学]