血清降钙素原在尿路感染诊断中的应用价值  

Diagnostic value of serum procalcitonin in urinary tract infection

作　　者：张成龙[1,2] 王玉宝[1] 郇娟[1] 师伟[1] 韩双羽 王哲[1] 郭文学[1] 贾宇驰 

机构地区：[1]天津医科大学第二医院感染性疾病研究所,300211 [2]天津医院风湿免疫科

出　　处：《中华医学杂志》2015年第44期3614-3616,共3页National Medical Journal of China

摘　　要：目的分析尿路感染患者中合并尿路梗阻者或合并菌血症者血清中降钙素原（PCT）的水平，探讨PCT在尿路感染诊断中的应用价值。方法将2013年1至12月天津医科大学第二医院感染内科住院治疗的尿路感染患者102例，分为尿路梗阻组（60例）和无尿路梗阻组（42例），比较组间血清PCT的差异，绘制PCT诊断尿路梗阻的受试者工作特征（ROC）曲线。102例患者中做过血培养的44例，根据培养结果分成血培养阳性组（13例）和血培养阴性组（31例），比较组间血清PCT的差异，绘制PCT诊断菌血症的ROC曲线。结果尿路梗阻组中位PCT为1．71（0．10—53．20）mg／L，高于无尿路梗阻组的0．21（0．10～10．00）mg／L（P〈0．001）；血培养阳性组PCT为2．73（0．10—41．60）mg／L，高于血培养阴性组的0．42（0．10～53．20）mg／L（P=0．030）。PCT诊断尿路梗阻的ROC曲线下面积是0．80（95％置信区间0．71—0．89），诊断菌血症的ROC曲线下面积是0．71（95％置信区间0．53～0．88）；PCT诊断菌血症和尿路梗阻的阴性预测值（NPV）最大时分别是0．90和0．87，对应的PCT值分别是0．51mg／L和0．35mg／L。结论PCT对判断尿路感染患者合并尿路梗阻或菌血症具有一定的参考价值。Objective To analyze the serum level of procalcitonin （PCT） in urinary tract infection （UTI） patients with urinary obstruction or bacteremia, and to investigate the value of PCT in diagnosing UTI. Methods A total of 102 patients with UTI hospitalized from January to December 2013 in the Second Hospital of Tianjin Medical University were categorized into obstructed UTI （n =60） and non-obstructed UTI （n = 42 ）, whose serum PCT concentrations were compared. Blood cultures were implemented in 44 patients, including 13 with positive findings （bacteremia） and 31 with negative findings （non-bacteremia）. Serum PCT levels were also compared between the bacteremia and non-bacteremia groups. Receiver operating characteristic （ROC） curves were constructed to illustrate the performance of PCT in diagnosing urinary obstruction and bacteremia. Results The median serum concentration of PCT in the obstructed UTI group（ 1.71 （0. 10 -53.20） mg/L）was higher than that in the non-obstructed UTI group（O. 21 （0. 10 - 10. 00） rag/L, P 〈0. 001 ） ; the serum concentration of PCT in the bacteremia group（2. 73 （0. 10 -41.60） mg/L）was higher than that in the non-bacteremia group（0. 42 （0. 10 -53.20） mg/L, P =0. 030）. The area under ROC curve of PCT in diagnosing urinary obstruction and bacteremia was 0. 80 （95% C10. 71 - 0. 89） and 0. 71 （ 95% CI 0. 53 - 0. 88 ）. The maximum negative predictive value （NPV） was 0.90 and 0.87, respectively, when the serum concentrations of PCT diagnosing bacteremia and urinary obstruction was 0. 51 mg/L and 0. 35 mg/L. Conclusion PCT may be of some value in diagnosing UTI with urinary obstruction or bacteremia.

关 键 词：泌尿道感染 菌血症 尿路梗阻 降钙素原 

分 类 号：R691.3[医药卫生—泌尿科学]