血清降钙素原作为菌血症预示因子临床价值的研究  

Research on the clinical significance of serum procalcitonin in predicting bacteremia

作　　者：侯伟伟[1] 肖倩茹[1] 江涟[1] 万海英[1] 

机构地区：[1]上海市同济医院检验科,上海200065

出　　处：《检验医学》2014年第8期802-805,共4页Laboratory Medicine

摘　　要：目的探讨血清降钙素原（PCT）与菌血症之间的关系,评价血清PCT在预测血培养确证的菌血症方面的诊断价值。方法采用回顾性研究,以同时进行血培养及PCT检测的1 690例患者为研究对象,对其结果进行分析。研究对象分为3组,即血培养阳性组（129例）、血培养阴性组（1 463例）和血培养污染组（98例）,比较3组之间PCT浓度的差异,并将血培养阳性组分为革兰阴性菌组、革兰阳性菌组和假丝酵母菌组,从而进一步比较PCT浓度在阳性组内的差异。结果血培养阳性组PCT浓度高于血培养阴性组和血培养污染组[中位数（四分位数）分别为2.62（0.37-12.80）、0.17（0.07-0.62）和0.20（0.09-0.72）ng/mL,P〈0.000 1]。革兰阴性菌组、假丝酵母菌组和革兰阳性菌组PCT阳性率分别为74.5%、37.5%和66.7%,PCT浓度[中位数（四分位数）]分别为6.24（0.43-16.09）、0.47（0.22-3.18）和1.09（0.24-4.05）ng/mL,革兰阴性菌组PCT浓度明显高于革兰阳性菌组和假丝酵母菌组（P〈0.05）。结论除临床其他指标外,PCT作为一种可靠的检测指标,可用于排除血培养的污染和非感染性疾病情况,为菌血症提供早期的预示信息,从而改善和提高菌血症诊断的准确性,避免非必需的抗菌药物治疗,对临床诊疗具有很大的临床意义。Objective To investigate the relationship of serum procalcitonin（ PCT） and bacteremia,and to evaluate the diagnosis significance of serum PCT to predict bacteremia determined by blood cultures. Methods A total of 1 690 patients undergoing blood cultures and PCT were concurrently enrolled for detecting bacteremia by retrospective analysis. The patients were classified into blood culture positive group（ 129 cases）,blood culture negative group（ 1 463cases） and contaminated blood culture group（ 98 cases）. According to the difference of PCT concentration,the blood culture positive group was subclassified into 3 groups,gram-negative bacterium group,gram-positive bacterium group and Candida mycoderma group. The difference of PCT concentration in the blood culture positive group was further analyzed comparatively. Results The concentration of PCT in blood culture positive group was higher than those of blood culture negative group and contaminated blood culture group [medians（ quartiles） were 2. 62（ 0. 37-12. 80）,0. 17（ 0.07-0.62） and 0.20（ 0.09-0.72） ng/mL,P〈0.000 1]. In gram-negative bacterium group,Candida mycoderma group and gram-positive bacterium group,the positive rates of serum PCT were 74. 5%,37. 5% and 66. 7%,respectively,while the PCT concentrations [medians（ quartiles） were 6. 24（ 0. 43-16. 09）,0. 47（ 0. 22-3. 18） and 1.09（ 0. 24-4. 05） ng /mL. PCT concentration in gram-negative bacterium group was higher than those in gram-positive bacterium group and Candida mycoderma group（ P〈0. 05）. Conclusions In addition to other clinical parameters,PCT is a reliable parameter for ruling out blood culture contamination and non-bacterial conditions. PCT is effective as a parameter for predicting early bacteremia,and is able to improve the accuracy of diagnosis and avoid the unnecessary antimicrobial usage. PCT has great clinical significance for the clinical diagnosis and treatment.

关 键 词：降钙素原 菌血症 血培养 

分 类 号：R446.1[医药卫生—诊断学]