降钙素原在急性发热血流感染患者中的诊断意义  

Procalcitonin as an early diagnostic marker for bloodstream infection in patients with acute fever

作　　者：朱红[1] 王箴[2] 喻艳林[1] 侯为顺[1] 杨剑[1] ZHU Hong WANG Zhen YU Yanlin HOU Weishun YANG Jian(Department of Infectious Diseases ,The First Affiliated Hospital of Wannan Medical College, Wuhu 241001, China)

机构地区：[1]皖南医学院第一附属医院弋矶山医院感染性疾病科,安徽芜湖241001 [2]皖南医学院第一附属医院弋矶山医院重症医学科,安徽芜湖241001

出　　处：《皖南医学院学报》2017年第1期83-86,共4页Journal of Wannan Medical College

基　　金：芜湖市科技计划项目(2015hm02);皖南医学院中青年科研基金项目(WK2011F09)

摘　　要：目的:探讨血清降钙素原(PCT)对急性发热血流感染患者病情的诊断价值。方法:回顾性分析2013年1~12月弋矶山医院感染性疾病科157例急性发热患者临床资料,根据临床诊断结果将患者分成4组:血流感染组(Ⅰ组,n=35)、局部感染组(Ⅱ组,n=66)、其他疾病组(Ⅲ组,n=42)、不明原因发热组(FUO组,Ⅳ组,n=14)。比较各组患者间血培养、PCT、C反应蛋白(CRP)检验结果,绘制PCT及CRP诊断血流感染患者的受试者特征曲线(ROC曲线),并确定PCT的最佳临界值。结果:血流感染组(Ⅰ组)患者PCT、CRP均显著高于非血流感染组(Ⅱ、Ⅲ、Ⅳ组)(P<0.05);PCT、CRP诊断血流感染患者的ROC曲线下面积分别为0.732(95%可信区间:0.619~0.827)和0.700(95%可信区间:0.592~0.808);将诊断血流感染的PCT浓度的最佳临界值设定为0.41 ng/m L,排除血流感染的阴性预测值(NPV)达到94.8%。结论:在急性发热患者中,高水平PCT有助于血流感染的诊断,而PCT低于0.41ng/m L可作为排除血流感染的有效参考标准。Objective： To assess the diagnostic value of by measuring the serum procalcitonin（ PCT） level in bloodstream infectious patients with acute fever.Methods： Clinical data were obtained from 157 cases of acute fever treated in our critical care unit between January 2013 and December 2013.Then the cases were divided into bloodstream infection group（ group Ⅰ,n = 35）,localized infection（ group Ⅱ,n = 66）,other disorders（ group Ⅲ,n = 42）,and fever of unknown origin（ FUO; group Ⅳ,n = 14） according to the final diagnosis.Results of blood culture,PCT and C reactive protein（ CRP） were compared and statistically analyzed.Receiver operating characteristic（ ROC） curves were generated to determine the diagnostic value of PCT and CRP for the bloodstream infection.Results： Patients in group Ⅰ had significantly higher level of PCT and CRP than those in the other three groups.The areas under the ROC curves for PCT and CRP in predicting bloodstream infection were 0.732（ 95% CI： 0.619- 0.827） and 0.700（ 95% CI： 0.592- 0.808）. The optimal cut-off level of PCT for accurately differential diagnosis of blood infection was 0.41 ng / m L. Conclusion： In febrile patients,elevated PCT level may be accurate predictive value in differentiating bloodstream infection,and a cut-off value of 0. 41 ng / m L is optimal exclusive characteristic in differential diagnosis of such condition.

关 键 词：血流感染 降钙素原 C反应蛋白 

分 类 号：R446.11[医药卫生—诊断学]