炎症指标鉴别血流感染致病菌类型的临床意义  

Diagnostic Value of Biomarkers in Bloodstream Infection Caused by Either Gram Positive/Negative Bacteria or Fungi

作　　者：戴莉[1] 李道学[1] 杨炯[1] 

机构地区：[1]武汉大学中南医院呼吸内科,湖北武汉430071

出　　处：《武汉大学学报（医学版）》2016年第3期488-492,共5页Medical Journal of Wuhan University

摘　　要：目的:探讨降钙素原(PCT)等炎症指标鉴别血流感染致病菌类型的临床意义。方法:回顾性分析2013年1月至2014年9月武汉大学中南医院收治的血培养阳性且为单一致病菌的血流感染患者的临床资料。统计并分析血清PCT、C-反应蛋白(CRP)、血沉(ESR)、白细胞(WBC)计数等炎症指标在革兰阴性菌(G^-菌)组、革兰阳性菌(G^+菌)组和真菌组间的差异。绘制炎症指标鉴别致病菌类型的受试者工作特征(ROC)曲线,评价其对鉴别致病菌类型的临床价值。结果:1 G^-菌组血清PCT与CRP水平均明显高于G^+菌组及真菌组。PCT水平在G^-菌组、G^+菌组及真菌组分别为5.01(0.59-29.84),0.50(0.13-2.94)和0.91(0.17-2.18)ng/ml(P<0.001);CRP水平在3组中分别为(69.2±33.6),(46.0±32.5)和(30.0±26.8)mg/L(P<0.001)。2 ROC曲线结果:当设定最佳诊断临界值为2.59ng/ml,PCT鉴别G^-菌与G^+菌所致血流感染的灵敏度与特异度分别为51.0%和85.7%(P<0.001)。当设定最佳诊断临界值为3.11ng/ml,鉴别G^-菌与真菌所致血流感染的灵敏度与特异度分别为65.4%和87.2%(P<0.001)。3血清PCT、CRP与WBC计数三项联合可提高鉴别血流感染致病菌类型的准确性:三项联合鉴别G^-菌与G^+菌所致血流感染的灵敏度与特异度分别为70.8%和82.9%(P<0.001);鉴别G^-菌与真菌所致血流感染的灵敏度与特异度分别为78.4%和100%(P<0.005)。结论:与G^+菌及真菌所致血流感染相比,G^-菌所致的血流感染患者血清PCT水平明显升高;血清PCT水平可用于鉴别血流感染致病菌类型,而PCT、CRP及WBC计数三项指标联合可提高鉴别血流感染的准确性。Objective：To investigate the diagnostic value of biomarkers,such as procalcitonin（PCT）,for distinguishing gram-negative/positive bacteria or fungi in bloodstream infection（BSI）.Methods：This retrospective study was performed in Zhongnan Hospital of Wuhan University during Jan.2013 to Sep.2014.Patients with BSI were divided into gram-negative bacterial infection（G^-）group,gram-positive bacterial infection（G~＋）group and fungal infection group（fungi group）according to the results of blood culture.The biomarkers,including PCT,C-reaction protein（CRP）,erythrocyte sedimentation rate（ESR）and white blood cells（WBC）count,in all groups were compared.Diagnostic values of biomarkers were calculated via receiver operating characteristic（ROC）curves.Results：1The levels of PCT and CRP in G^-group were significantly higher than that of in G~＋and fungi groups.Serum PCT concentrations were 5.01（0.59-29.84）,0.50（0.13-2.94）and 0.91（0.17-2.18）ng/ml in G^-,G~＋and fungi groups,respectively（P〈0.001）.2The results of ROC curves：PCT was used to distinguish gram-negative bacterial infection from gram-positive bacterial infection with a sensitivity,specificity and optimal cut-off value of 51.0%,85.7% and 2.59ng/ml,respectively（P〈0.001）;PCT for distinguishing gram-negative bacterial infection from fungal infection with a sensitivity,specificity and optimal cut-off value of 65.4%,87.2% and 3.11ng/ml,respectively（P〈0.001）.3Combined serum PCT and CRP with WBC count for discriminating gram-negative bacterial infection from grampositive bacterial infection with a sensitivity and specificity of 70.8%and 82.9%,respectively（P〈0.001）.All of three biomarkers for distinguishing gram-negative bacterial infection from fungal infection with a sensitivity and specificity of 78.4% and 100%,respectively（P〈0.005）.Conclusion：Serum PCT levels in patients with gram-negative bacterial infection are significantly higher than those in patients with gram-positive bacterial or f

关 键 词：降钙素原 C-反应蛋白 革兰阴性菌 血流感染 

分 类 号：R378[医药卫生—病原生物学]