降钙素原与不同菌种血流感染致脓毒症早期诊断价值的探讨  

Diagnostic value of procalcitonin in distinguishing Gram-negative bacterial blood stream infection from Gram-positive bacterial infection in early stage of sepsis

作　　者：邹秀丽[1] 吴铁军[1] 崔玉静[1] 田辉[1] 张喜红[1] 田锁臣[1] 

机构地区：[1]聊城市人民医院重症医学科,山东省聊城252000

出　　处：《中华急诊医学杂志》2017年第3期297-301,共5页Chinese Journal of Emergency Medicine

基　　金：聊城市科学技术发展计划项目（2013CJH23）

摘　　要：目的探讨降钙素原（PCT）、超敏C反应蛋白（hs—CRP）、白细胞计数（WBC）、中性粒细胞百分比（NEU％）在不同致病菌血流感染致脓毒症早期诊断的价值。方法回顾性分析2012年1月至2014年12月入住山东省聊城市人民医院重症医学科血流感染致脓毒症患者的临床资料，符合入选标准的患者124例入ICU24h内行PCT，hs—CRP，WBC，NEU％检测。应用SPSS17．0统计软件分析革兰阴性（G‘）菌组（41例）和革兰阳性（G’）菌组（83例）患者PCT、hs．CRP、WBC、NEU％的差异，根据受试者工作特征曲线（ROC）评价不同炎性指标不同菌种血流感染致脓毒症的诊断价值。结果与G’菌组比较，G-菌组PCT[55．32（22．01，97．11） vs．2．13（0．27，5．27）]（P〈0．01），hs—CRP[105．09（69．97，186．12） vs．70．54（42．37，138．63）]（P=0．508），NEU％[88．30（75．79，93．52）vs．55．32（22．01，97．11）]（P=0．302）相对较高，但WBC[13．59（10．74，17．58） vs．13．73（11．32，20．90）]（P=0．058）相对较高；PCT鉴别G‘菌和G’菌血流感染的ROC曲线下面积（AUC）为0．867（95％CI：0．789—0．946），当PCT截断值为17．48ng／mL时，Youden指数最大，为0．661，诊断G‘菌血流感染的敏感度为76．9％，特异度为89．2％。结论PCT较hs-CRP、WBC、NEU％在G。菌致血流感染早期升高更明显，对鉴别G‘菌和G’感染有一定诊断价值。Objective To investigate the diagnostic values of procalcitonin （PCT）, high sensitive C-reactive protein （hs-CRP）, white blood cell （WBC）and percentage of neutrocyte （NEU%）in Gram- negative and Gram-positive bacterial blood stream infection in early stage of sepsis in order to investigate the correlation between PCT and APACHE Ⅱ score as well as between PCT and SOFA score, and the prognostic value in assessment of Gram-negative and Gram-positive bacterial blood stream infection. Methods Clinical data of patients admitted to ICU from January 2012 through December 2014 were retrospectively analyzed. A total of 124 sepsis patients with blood stream infection were checked with PCT, hs-CRP, WBC and NEU% tests, and APACHE Ⅱ score and SOFA score were calculated. The differences in APACHE Ⅱ score and SOFA score were compared between Gram-negative group （n =41 ） and Gram-positive group （n = 83）. The correlation between PCT and APACHE Ⅱ score as well as between PCT and SOFA score was analyzed. The differences in diagnostic values of PCT, hs-CRP, WBC and NEU% between Gram-negative group and Gram- positive group were analyzed by using receiver operating characteristic （ROC） curve and it was plotted toassess the prognostic values of PCT, hs-CRP, WBC and NEU% for septic patients with blood stream infection. Results Compared with Gram-positive group, the levels of PCT [ 55.32 （22.01, 97.11 ） vs. 2.13 （0.27, 5.27）] （P 〈0.01）, hs-CRP [105.09 （69.97, 186.12） vs. 70.54 （42.37, 138.63）] （P=0.508）, NEU% [88.30 （75.79, 93.52） vs. 55.32 （22.01, 97.11）] （P=0.302） were higher but WBC was lower [13.59 （10.74, 17.58） vs. 13.73 （11.32, 20. 90）] （P=0.058） in Gram-negative group. The ROC curve analysis of PCT showed the area under the curve （AUC） was 0. 867 （95% CI： O. 789 -0. 946）. When the optimal cutoff point of PCT was 17.48 ng/mL, the largest Youden＇ s index was found to be 0. 661 with 76. 9% sensitivity and 89. 2% specificity. Between two g

关 键 词：降钙素原 革兰阴性菌 革兰阳性菌 血流感染 

分 类 号：R459.5[医药卫生—治疗学]