血清降钙素原定量检测对血培养预测价值的研究  

Value of quantitative detection of serum procalcitonin in prediction of blood culture

作　　者：王露霞[1] 曾海燕[2] 胡塔[3] 郭振辉[4] 李薇[1] 黄晓燕[1] 李建勋[1] 李理[5] 石凌波[6] 

机构地区：[1]广州军区广州总医院检验科,广东广州510010 [2]深圳市光明新区人民医院检验科,广东深圳518106 [3]广东省妇幼保健院检验科,广东广州510010 [4]广州军区广州总医院MICU-广东省老年感染与器官功能支持重点实验室,广东广州510010 [5]广州军区广州总医院呼吸科,广东广州510010 [6]广州中医药大学祈福医院检验科,广东广州510049

出　　处：《中华医院感染学杂志》2015年第6期1227-1229,1241,共4页Chinese Journal of Nosocomiology

基　　金：广东省科技计划基金资助项目(2012A061400010);广州市科研基金资助项目(穗科信字2012-224-5)

摘　　要：目的探讨血清降钙素原(PCT)定量检测在血流感染中的应用价值,为临床合理应用PCT指标正确解释结果提供依据。方法回顾性研究医院2012年1-12月同时进行血培养与PCT检测且结果有效的979例患者临床资料,应用ROC曲线分析PCT在不同分界值对血培养的敏感性、特异性、阳性预测值、阴性预测值,并对其假阳性、假阴性结果可能出现的原因进行归纳总结。结果 979例血培养患者中血培养阳性172例,PCT阳性率75.0%,且PCT水平明显高于血培养阴性组(P<0.05),PCT为0.5ng/ml时对血培养的敏感性、特异性、阳性预测值、阴性预测值分别为75.0%、59.0%、28.1%和91.7%,血培养采血不规范、患者局部感染未导致血源播散或非感染因素诱导的PCT升高是导致PCT对血培养阳性预测值偏低的主要原因。结论在缺乏对患者的了解和临床关系时,PCT水平与微生物检测证据(血培养阳性)的相关性无实际意义,但可以用于排除血流感染,PCT水平必须结合临床情况进行判读,应避免脱离患者具体病情而进行分析,并应考虑假阳性和假阴性的可能性。OBJECTIVE To explore the value of quantitative detection of serum procalcitonin （PCT ） in diagnosis of bloodstream infections so as to provide guidance for reasonable clinical use of the PCT indicator for correct defini -tion of results .METHODS From Jan 2012 to Dec 2012 ,the clinical data of 979 patients for whom the blood culture and PCT detection were performed and the results were eligible were retrospectively analyzed ;the ROC analysis was conducted to observe the sensitivity ,specificity ,positive predictive value ,and negative predictive value of the PCT at different cut-off points on the blood culture ;the causes of the false positive or negative results were de-fined .RESULTS Of the 979 patients for whom the blood culture was performed ,172 were positive for the blood culture ,the positive rate of PCT was 75 .0% ,and the level of PCT of the patients with positive blood culture was significantly higher than that of the patients with negative blood culture （P＆lt; 0 .05） .When the level of PCT was 0 .5ng/ml ,the sensitivity on the blood culture was 75 .0% ,the specificity 59 .0% ,the positive predictive value 28 .1% ,the negative predictive value 91 .7% .The unreasonable blood sampling ,blood-borne transmission of local infections ,or the elevated level of PCT induced by the non-infection factors were the major causes of low positive predictive value of blood culture .CONCLUSION The correlation between the PCT level and the evidence of detec-tion of microorganisms （blood culture positive） has no practical significance in the absence of understanding the pa-tient and clinical relationships ,but it can be used to exclude the bloodstream infections .The level of PCT should be interpreted in the combination with clinical condition ,and it is necessary to analyze on the basis of the specific condition of the patients and to consider the possibility of false positives and false negatives .

关 键 词：降钙素原 血培养 感染 预测价值 

分 类 号：R446[医药卫生—诊断学]