血清降钙素原联合C反应蛋白对血液透析导管相关性感染的早期诊断价值  

Early Diagnostic Value of Serum Procalcitonin and C-Reactive Protein in Central Venous Catheter-related Infection of Hemodialysis Patients

作　　者：庞玉洪[1] 赵建明[1] 陈抗侵[1] 牟爱华[1] 毛界 杨梅[1] 徐智会 

机构地区：[1]重庆市涪陵中心医院肾内科,408000 [2]重庆市綦江区人民医院重症医学科,401420

出　　处：《医学研究杂志》2016年第7期85-87,107,共4页Journal of Medical Research

基　　金：重庆市卫生与计划生育委员会医学科研计划项目(20143062)

摘　　要：目的探讨血清降钙素原(PCT)联合C反应蛋白(CRP)对血液透析导管相关感染的早期诊断价值。方法收集笔者医院2012年1月~2015年6月行中心静脉置管的血液透析患者380例临床资料,根据是否发生导管相关感染分为感染组(40例)与非感染组(340例)。采用酶联免疫吸附法(ELISA)检测各组血清PCT及CRP水平,分别比较两组治疗前后PCT及CRP水平的差异以及PCT与CRP水平的相关性,评价血清PCT及CRP水平对导管相关感染患者的早期诊断价值。结果治疗前感染组患者血清PCT及CRP水平明显高于非感染组患者(P<0.05);经过抗感染治疗后,感染组血清PCT和CRP水平较治疗前显著降低(P<0.05)。相关性分析显示,血清PCT与CRP水平呈显著正相关(r=0.52,P<0.01)。以PCT>1.78ng/ml为早期诊断导管相关感染界限,诊断导管相关感染的敏感度和特异性分别78.0%和92.6%;以CRP>13.2μg/ml为早期诊断导管相关感染界限,诊断导管相关感染的敏感度和特异性分别为85.0%和91.5%;两者指标串联诊断敏感度及特异性分别为90.0%和95.6%,ROC曲线下面积为0.904(95%CI:0.821~0.959)。结论血液透析导管相关感染早期PCT及CRP水平显著升高,联合检测血清PCT及CRP水平可作为诊断导管相关感染的早期敏感指标。Objective To study the clinical value of serum procalcitonin （PCT） level and and C reactive protein in the early diagno- sis of central venous catheter - related infection in hemodialysis patients. Methods A total of 380 hemodialysis patients, who underwent central venous catheter indwelling in our hospital from January 2012 to June 2015 were enrolled in the study. According to catheter - relat- ed infections, these patients were divided the infected group （40 cases） and non- infected group （340 cases）. Serum levels of PCT and CRP were measured by enzyme linked immunosorbent assay （ELISA）. The differences of serum PCT and CRP levels were compared and correlation with CRP were analyzed, and the relationship with the prognosis of catheter - related infection were also assessed. Results The serum PCT and CRP levels on infected group was significantly higher than non - infected groups （P 〈 0.05 ）. After the treatment, the levels of serum PCT and CRP were significantly decreased in infection group （P 〈 0.05）. The PCT and CRP levels were positive correla- ted （ r = 0.52, P 〈 0.01 ）. With PCT 〉 1.78ng/ml considered as the boundary for diagnosis of catheter - related infection, the sensitivity was 78.0% , the specificity was 92.6%. With CRP 〉 13.2p^g/ml considered as the boundary for diagnosis of catheter - related infection, the sensitivity was 85.0% , the specificity was 91.5%. The AUC was 0. 904 （95% C1：0. 821 - 0. 959）, and the sensitivity was 90.0% , specificity was 95.6% when the two cutoff values were both achieved. Conclusion The PCT and CRP levels of early catheter - related infection are significantly increased. The serum PCT and CRP levels can be used as an early diagnostic maker for catheter - related infection.

关 键 词：血液透析 C-反应蛋白 降钙素原 导管相关感染 

分 类 号：R692.5[医药卫生—泌尿科学]