血清白细胞介素-6检测对血流感染诊断价值的探讨  

Diagnostic Value of Serum IL-6 for Identification of Bacterial Bloodstream Infections

作　　者：时宇[1] 董瑾[2] 李少增[1] 李兆岩[1] 张静[1] 张冬青[1] 王海滨[1] 

机构地区：[1]解放军总医院第一附属医院检验科,北京100048 [2]解放军306医院检验科,北京100048

出　　处：《标记免疫分析与临床》2016年第11期1246-1250,共5页Labeled Immunoassays and Clinical Medicine

摘　　要：目的探讨血清白细胞介素-6（IL-6）水平对鉴别革兰阴性菌（G-）、革兰阳性菌（G＋）及真菌血流感染在临床中的诊断价值。方法收集从2015年1月至2016年3月入院血流感染患者的资料,所有患者血培养为单一菌株并于采血当天检测血清IL-6水平,同时选取血培养阴性的局部感染患者30例作为对照组,比较IL-6水平在G-菌、G＋菌及真菌血流感染患者之间的差异,并根据受试者工作特征（ROC）曲线判断IL-6诊断效能。结果 170例血流感染患者中,G-菌感染75例（占44%）、G＋菌感染67例（占40%）及真菌感染28例（占16%）;G-菌组、G＋菌组、真菌组及对照组IL-6水平中位数分别为221.3pg/m L、37.4 pg/m L、111.0 pg/m L和3.87 pg/m L,各组间IL-6水平差异有统计学意义（P57.585pg/m L时,G-菌感染可能性大;IL-6对鉴别真菌所致血流感染患者无临床参考价值,有待相关新指标的发现及评估。Objective To investigate the clinical value of serum IL-6 levels for differentiating Gram-negative（ G-）,Gram-positive（ G＋） and fungus bloodstream infections. Methods The clinical data of 170 patients with bloodstream infections admitted between January 2015 and March 2016 who had a single strain infection in blood culture and IL-6 levels results were analyzed retrospectively. Patients with local infection with negative blood cultures were recruited as control. The serum IL-6 levels were compared between the patients with G-,G＋and fungus bloodstream infections. The cut-off value of IL-6 was determined by receiver operating characteristic（ ROC） curve analysis. Results Out of 170 patients with bloodstream infections,75 cases were infected with G-bacteria,67 cases with G＋bacteria,28 cases with fungus. Median levels of IL-6were 221. 3pg / m L,37. 4 pg / m L,111. 0pg / m L and 3. 87 pg / m L in the G-bacteria infection group,the G＋bacteria infection group,fungus infection group and the control group,respectively. There was a statistical difference among four groups. According to ROC curve,IL-6 level at 57. 585 pg / m L could distinguish G-bacteria infection from G＋bacteria infection with a sensitivity of 81. 3% and a specificity of 56. 7%,AUC was 0. 7,95% CI was 0. 613-0. 788（ P 0. 001）. Conclusion Serum IL-6 has diagnostic value in differentiating G-and G＋bacteria bloodstream infections. The risk of G-bacteria bloodstream infection is increased when IL-6 is greater than 57. 585 pg / m L. IL-6 has no clinical value in differentiating patients with bloodstream infections caused by fungi.

关 键 词：白细胞介素-6 革兰阴性菌 革兰阳性菌 真菌 血流感染 

分 类 号：R446.1[医药卫生—诊断学]