血清降钙素原对522例不同细菌类型和感染部位的全身性炎症反应患者的早期诊断差异分析  

The Analysis of the Diagnosis Differellce of PCT early Diagnosing 522 lases Patients with SIRS which Infected by Different type Bacteria and in Infection site

作　　者：刘远程[1] 刘欣[1] 

机构地区：[1]泸州医学院附属中医医院检验科,四川泸州646000

出　　处：《四川医学》2015年第5期711-715,共5页Sichuan Medical Journal

摘　　要：目的通过统计细菌感染患者的血清降钙素原(PCT)的表达和感染细菌的类型﹑部位,分析PCT对感染细菌类型和感染部位不同的全身性炎症患者的诊断差异,为PCT在临床细菌感染的早期诊断的准确应用提供可靠地临床观察数据。方法从6728例感染的患者中确认致病菌引起全身性炎症反应的患者522例,明确感染部位和致病菌类型,联合PCT临床诊断标准,分析在致病菌感染早期,不同致病菌类型和感染部位对PCT表达差异的影响。结果按照感染细菌类型,81例G+菌﹑441例G-菌;按照感染部位分析,无菌部位95例(血液﹑胸腹水﹑脑脊液﹑血液导管﹑胆汁﹑腹腔引流液)和有菌部位427例(尿液﹑呼吸道分泌物﹑创口分泌物等其他)。按照PCT细菌感染的阳性标准PCT≥0.1诊断,522细菌感染的全身性炎症患者的总诊断率为55.94%(292/522),无菌部位15.79%感染被剪除(15/95),有菌部位49.64%(212/427),G-菌57.05%(251/440)检出PCT阳性,G+菌48.78%(40/82)检出PCT阳性。考虑感染部位和细菌类型分析,PCT阳性检出率分别为:血液(G-95.24%,G+57.14%)﹑穿刺引流液(G-89.66%,G+40.0%)﹑尿液(G-52.84%,G+50%)﹑呼吸道分泌物(G-41.67%,G+58.33%)﹑创口分泌物等其他(G-41.03%,G+26.67%)。细菌及感染部位对PCT的诊断效能影响分析,细菌感染部位影响了PCT的检出效能,细菌感染的类型对于PCT的检出效能影响并不大,仅在血液细菌感染中的PCT对G-检出率高于G+。PCT全身性炎症标准方面,感染部位和细菌类型可能对PCT的值的升高程度有重要的影响。结论本研究的结果提示了,细菌感染的部位和细菌的类型可能影响PCT感染早期的预警性诊断的价值。对于PCT在细菌感染诱发的全身性炎症反应早期的监测应用,应联合不同感染部位和细菌类型开发PCT在全身性炎症诊断中更大的临床价值。Through Statistics of serum procalcitonin （PCT） expression and the types of bacteria, infection site in patients with bacterial infection , evaluation of differences Value of PCT in patients with systemic inflammation diagnostic , with bacterial in- fection type and the site of infection, promoted clinical and reliably for PCT in the accurate application of early diagnosis of bacterial infection and provide clinical observation data. Method 6728 cases of patients with infection from pathogens in 522 cases confirmed by systemic inflammatory response of patients, identify the site of infection and pathogenic bacteria types, combined with PCT clinical diagnosis standard, analysised that pathogens at early stage of infection, pathogen infection sites and different type bacterias affecting on PCT. Results By according to the type of bacterial infection, 81 cases of G＋ , 441 Cases of bacteria G- strain; analysis accord- ing to the site of infection, 95 cases of sterile site （ blood, pleural and ascitic fluid, cerebrospinal fluid, blood, bile duct, peritoneal fluid） and bacteria （part of 427 cases respiratory secretions, urine, wound secretion and other）. In accordance with the standard PCT, the positive predictive value PCT ≥0. 1 diagnosed that 522 patients with systemic inflammation rate was 55.94% （292/522）, aseptic part 15.79% infection was cut off （ 15/95）, bacteria parts of 49. 64% （212/427）, 57. 05% G- strains （251/440） detected PCT positive, 48.78% （ strain G＋ positive PCT 40/82）. Analysis of site of infection and bacterial types considered, PCT positive rate is respectively ： blood （ G95.24%, G＋ 57.14% ） and drainage fluid （ G-89. 66%, G＋ 40. 0% ） , urine （ G-52. 84% , G＋ 50% ） , respiratory secretions （G41.67% , G ~ 58.33% ） , wound secretion and other （G＇41.03% , G＋ 26. 67% ）. Analysis of the influence of diagnostic efficacy of bacterial type and infection sites on PCT, the site of bacterial infections affect the detection efficien- cy of P

关 键 词：降钙素原 全身性炎症反应 感染部位 细菌类型 

分 类 号：R459.7[医药卫生—急诊医学]