降钙素原对中心ICU患者血流感染诊断作用的探讨  

Discussion about Procalcitonin in the Diagnosis of Blood Stream Infection

作　　者：景小莹 汪婷[1] 谢国明[1] 

机构地区：[1]重庆医科大学检验医学院教育部临床检验诊断学重点实验室,重庆400016

出　　处：《生物工程前沿（中英文版）》2015年第1期50-55,共6页Biotechnology Frontier

摘　　要：目的比较不同降钙素原（procalcitonin，PCT）诊断分界点（cut．offpoint）对中心ICU病人血流感染的诊断作用。方法对重庆医科大学附属第一医院2011年6月-2014年2月中心ICU同时进行血培养与降钙素原检测患者的资料进行回顾性分析，应用全自动连续性检测系统BacT／Alert3D血培养仪器进行血培养，Vitek2微生物全自动鉴定仪对病原菌进行鉴定，VIDAS全自动免疫分析仪检测降钙素原，IBMSPSSStatistics19软件对病人血培养和PCT检测结果进行统计分析。结果当以1．075为cut-off值来界定中心ICU病人是否血流感染时，PCT结果阳性率为57.3％，诊断灵敏度为93.3％，特异性为50．6％，阳性预测值和阴性预测值分别为26．1％和97．6％；当以O．5为cut-off值来界定中心ICU病人是否血流感染时，PCT结果阳性率为69．6％，诊断灵敏度为97．8％，特异性为35．7％，阳性预测值和阴性预测值分别是22．1％和98．8％；当以0．05为cut-off值来界定中心ICU病人是否血流感染时，PCT结果阳性率为93．0％，诊断灵敏度为97．7％，特异性为7．8％，阳性预测值和阴性预测值分别是15．8％和95％．结论PCT检测具有一定的敏感性和特异性，但不宜用同一个cut-off值来作为所有病人的诊断水平。本实验显示对于中心ICU病人，用同科室病人的PCT指标统计所得的cut-off值来进行诊断，诊断效率比用不分病种病人的PCT指标统计所得的cut-off值来进行诊断要高，因此前者更适宜用于中心ICU病人血流感染的诊断。Objective Compare different cut-off points of procalcitonin （PCT） in diagnosis of blood stream infection with patients in centre ICU. Methods Data about patients with blood stream infection diagnosed with PCT and blood culture in first affiicated hospital of Chongqing medical university from June 2011 to February 2014 were respectively analyzed. Blood was cultured in Bact/Alert 3D, a fully automatic consecutive detection system. Pathogens were indentified using VETEK 2, a fully automatic microorganism identifier. PCT was detected with VIDAS, a fully automatic immunal analyzer. Results When cut-offpoint of PCT in diagnosis of blood stream infection with patients in centre ICU is 1.075, the positive rate of PCT was 57.3%. The sensitivity and specificity of PCT were 93.3% and 50.6% respectively with a positive and negative predictive value of 26.1% and 97.6%.When cut-off point of PCT in diagnosis of blood stream infection with patients in centre ICU is 0.5, the positive rate of PCT was 69.6%. The sensitivity and specificity of PCT were 97.8% and 35.7%respectivelywith a positive and negative predictive value of 22.1% and 98.8%.When cut-off point of PCT in diagnosis of blood stream infection with patients in centre ICU is 0.05, the positive rate of PCT was 93.0%. The sensitivity and specificity of PCT were 97.7% and 7.8% respectivelywith a positive and negative predictive value of 15.8% and 95%. Conclusion The detection of PCT has a certain sensitivity and specificity in diagnosis of blood stream infection, but we shouldn＇t diagnose all patients with the same one cut-offpoint of PCT. This test shows that for patients in centre ICU, when diagnosed with cut-off point resulted with analysis of PCT values of patients in the same department, the efficiency was higher than diagnosed with cut-off point resulted with analysis of PCT values of patients in various departments. So, the frst cut-off point is better in diagnosis of blood stream infection of patients in centre ICU.

关 键 词：降钙素原 血培养 中心ICU 血流感染 比较 

分 类 号：Q[生物学]