降钙素原在菌血症中的预测价值研究  

Evaluation of procalcitonin for the prediction of bacteremia

作　　者：区云枝[1] 刘春林[1] 邱铨 陈艺莹 李健芳[2] 

机构地区：[1]南方医科大学附属南海医院检验科,广东佛山528200 [2]广东医学院检验系,广东东莞523808

出　　处：《国际检验医学杂志》2014年第12期1557-1559,共3页International Journal of Laboratory Medicine

摘　　要：目的：探讨降钙素原（PCT）预测菌血症的价值。方法回顾性收集临床各科室首次初诊菌血症成人患者，记录初次血培养采集时，白细胞计数（WBC）、中性粒细胞绝对值（NEU）、PCT结果，运用受试者工作特性曲线（ROC）评价各炎症指标对菌血症的预测价值。结果在研究期间，共纳入120例临床初诊菌血症成人患者，其中菌血症组有47例（39．2％），非菌血症组73例（60．8％）。菌血症组 WBC、NEU、PCT水平显著高于非菌血症组，差异有统计学意义（P＜0．01）。PCT 预测菌血症曲线下面积最大，为0．836（95％CI：0．767∽0．904），显著高于 WBC（0．676，95％CI：0．600∽0．792）、NEU（0．696，95％CI：0．617∽0．795），差异均有统计学意义（P＜0．01）。而 WBC 与 NEU 曲线下面积差异无统计学意义（P＞0．05）。当 PCT 临界值为0．43 ng/mL时，基本排除菌血症（阴性预测值为94．7％）；当PCT最佳临界值为2．27 ng/mL时，其诊断菌血症的灵敏度为74．47％，特异度为90．00％，阳性预测值为83．3％，阴性预测值为84．0％。结论相比 WBC、NEU，PCT 在预测菌血症时显示出更好的价值，而且PCT检测时间短，可以为临床提供快速诊断，指导早期经验用药。Objective To evaluate the diagnostic value of procalcitonin （PCT）in bacteremia.Methods Clinical data of adult pa-tients with suspected bacteremia were retrospectively analyzed for white blood cell counts（WBC）,neutrophil absolute （NEU）and PCT levels in blood samples collected at the first time of blood culture.Receiver operating characteristic （ROC）curve was used to evaluate the values of different indexes for the prediction of bacteremia.Results A total of 120 patients were enrolled,including 47 patients （39.2%）with bacteremia and 73 patients （60.8%）without bacteremia.PCT,WBC and NEU levels were significantly higher in bacteremia patients than patients without bacteremia （P〈0.01）.Area under ROC curve of PCT was 0.836 （95%CI：0.767-0.904）,which was significantly higher than WBC （0.676,95%CI：0.676-0.600）and NEU （0.696,95% CI：0.696-0.617）.While area under ROC curve of WBC and NEU were no significantly different （P〉0.05）.Taking 0.43 ng/mL as cutoff value,the negative predictive value of PCT was 94.7%.The best cutoff value of PCT was 2.27 ng/mL,which was associated with sensitivity of 74.47%,specificity of 90.00%,positive predictive value of 83.3% and negative predictive value of 84.0%.Conclusion PCT might be with more clinical value for the prediction of bacteremi than WBC and NEU.

关 键 词：血培养 菌血症 降钙素原 ROC曲线 

分 类 号：R515.3[医药卫生—内科学]