动态监测血清降钙素原水平对感染再发的诊断价值  

Diagnostic significance on the dynamic monitoring of serum procalcitonin level for recurrent infection

作　　者：慕月晶[1] 王伟佳[1] 徐胜男[1] 阚丽娟[1] 黄燕华[1] 欧阳能良[1] 徐全中[1] 严海忠[1] 张秀明[1] 

机构地区：[1]中山大学附属中山医院检验医学中心,广东中山528403

出　　处：《检验医学》2015年第9期881-885,共5页Laboratory Medicine

基　　金：中山市重大医学科研专项(2014A1FC005)

摘　　要：目的探讨血清降钙素原(PCT)动态水平对诊断感染再发的临床应用价值,并对感染再发患者的PCT诊断界值进行研究。方法收集中山大学附属中山医院细菌感染患者150例,动态监测其血清PCT水平,其中感染再发患者100例,治疗有效患者50例。观察细菌感染再发患者PCT回升水平及与其同期治疗有效患者PCT水平的差异情况。同时收集健康对照者60名,分析感染再发患者PCT水平回升拐点与健康成人PCT水平的差异。采用受试者工作特征(ROC)曲线分析PCT、白细胞(WBC)、白细胞介素6(IL-6)检测对感染再发的诊断性能,并初步设定PCT诊断感染再发的界值。结果 PCT水平动态监测结果显示感染再发与治疗有效呈不同的变化趋势,其中感染再发患者PCT水平出现回升现象,且明显高于治疗有效患者(P<0.05);感染再发患者PCT水平回升拐点仍高于健康人(P<0.05)。ROC曲线分析显示,PCT对于感染再发诊断的ROC曲线下面积为83.5%,其性能最佳[敏感性89.0%、特异性83.0%、阳性预测值84.0%和阴性预测值88.3%]处的界值为2.29 ng/m L,而WBC和IL-6诊断感染再发的ROC曲线下面积分别为55.1%和61.0%。结论动态监测血清PCT水平对诊断及鉴别诊断细菌引起的感染再发具有重要的临床应用价值。Objective To investigate the clinical application significance of serum procalcitonin （ PCT ） level dynamic monitoring for diagnosing recurrent infection, and to investigate the PCT cut-off value for recurrent infection. Methods The retrospective study enrolled 150 patients with bacterial infection in Zhongshan Hospital, Sun Yat-sen University, and the change of serum PCT level was monitored dynamically.Among them,100 patients suffered from recurrent infection, while the other 50 patients acquired effective treatment.The PCT levels of recurrent infection group and effective treatment group in the same period were observed, and the difference between them was analyzed.A total of 60 blood samples from healthy subjects were also collected, and the difference between recurrent turning points of PCT and PCT levels of healthy subjects was analyzed.The diagnostic performance of PCT, white blood cell （ WBC ） and interleukin 6 （IL-6） for recurrent infection with receiver operating characteristic （ROC） curve was evaluated, and a primary diagnostic cut-off value of PCT was established for recurrent infection.Results In recurrent infection group and effective treatment group, the serum PCT levels showed different trends.The recurrent infection group showed an obvious rebound, and the level was higher than that in effective treatment group （P〈0.05）.The rebound turning points of serum PCT level in recurrent infection group were still higher than those in healthy subjects（ P〈0.05） .The diagnostic significance of PCT for recurrent infection was confirmed by ROC curve analysis, and the area under the ROC curve for PCT was 83.5%.The most appropriate cut-off value was 2.29 ng/mL, and the sensitivity was 89.0%, the specificity was 83.0%, the positive predictive value was 84.0%, and the negative predictive value was 88.3%.The areas under the ROC curves of WBC and IL-6 for recurrent infection were 55.1%and 61.0%, respectively.Conclusions It was of great clinical application significance to monitor serum PCT

关 键 词：降钙素原 感染再发 白细胞 白细胞介素6 

分 类 号：R446.62[医药卫生—诊断学]