血清降钙素原对慢性肾病患者细菌感染的诊断评价  

Effect of serum procalcitonin on diagnosis of bacterial infections in patients with chronic kidney disease

作　　者：韩颖敏 郑寿浩 肖达平[1] 任应鹏[2] 

机构地区：[1]台州市第一人民医院肾内科,浙江台州318020 [2]台州市第一人民医院检验科,浙江台州318020

出　　处：《中华医院感染学杂志》2017年第10期2190-2193,共4页Chinese Journal of Nosocomiology

基　　金：浙江省卫生厅医药科技计划基金资助项目(201522303)

摘　　要：目的探讨血清降钙素原(PCT)对慢性肾病患者细菌感染的诊断效果,为提升慢性肾病细菌感染患者的疗效提供科学依据。方法选取医院住院治疗的慢性肾病患者2 104例,根据是否发生院内细菌感染分为感染组116例和非感染组1988例,比较两组患者的血清PCT含量,计算PCT对慢性肾病患者细菌感染的灵敏度和特异性,分析感染组患者的病原菌分布以及相关病原菌的耐药性。结果两组患者的血清PCT含量差异有统计学意义(P<0.05),经治疗后,与感染组治疗前相比,差异有统计学意义(P<0.05);以PCT≥0.4ng/ml作为阳性标准,灵敏度80.2%(93/116),特异性97.6%(1941/1988);阳性预测值66.4%(93/140),阴性预测值98.8%(1941/1964);116例感染患者共培养出132株病原菌,感染单一菌株患者100例,混合感染患者16例,革兰阴性菌93株占70.5%,革兰阳性菌39株占29.5%;感染组患者革兰阴性菌中,铜绿假单胞菌对头孢唑林、红霉素、氧氟沙星、诺氟沙星、环丙沙星等耐药率较高,>85.0%,对亚胺培南和美罗培南敏感,耐药率<6.0%;大肠埃希菌对头孢唑林、红霉素、氧氟沙星、环丙沙星等耐药率较高,>70.0%,对阿米卡星、亚胺培南、美罗培南敏感,耐药率<13.0%;革兰阳性菌中,金黄色葡萄球菌对青霉素、替卡西林、阿莫西林、头孢曲松等耐药率较高,>80.0%,对苄卡西林、万古霉素敏感,耐药率为0;表皮葡萄球菌对青霉素、替卡西林、阿莫西林、头孢曲松等耐药率较高,>75.0%,对万古霉素敏感,耐药率为0。结论血清PCT的检测对于慢性肾病患者细菌感染早期的诊断指标具有较高的灵敏性和特异性,具有一定的临床诊断价值;慢性肾病患者感染以铜绿假单胞菌、大肠埃希菌为主,临床应根据药敏结果合理使用抗菌药物进行治疗,以提升感染患者的治疗效果和预后。OBJECTIVE To explore the effect of serum procalcitonin （PCT） on diagnosis of bacterial infections in patients with chronic kidney disease so as to provide scientific basis for improvement of effect on treatment of the chronic kidney disease patients with bacterial infections.METHODS A total of 2 104 patients with chronic kidney disease who were hospitalized for treatment were enrolled in the study and divided into the infection group with 116 cases and the non-infection group with 1988 cases according to the status of nosocomial bacterial infections.The serum PCT content was compared between the two groups of patients,the sensitivity and specificity of PCT in diagnosis of bacterial infections in the patients with chronic kidney disease were calculated,and the distribution of pathogens isolated from the patients in the infection group and the drug resistance of related pathogens were obserd RESULTS There was significant difference in the serum PCT content between the two groups of patients （P〈0.05）,and there was significant difference in the serum PCT content among the patients in the infection group before and after the treatment （P〈0.05）.When PCT no less than 0.4 ng/ml was set as the positive standard,the sensitivity was 80.2%（93/116）,the specificity 97.6%（1941/1988）,the positive predictive value 66.4% （93/140）,the negative predictive value 98.8% （1941/1964）.Totally 132 strains of pathogens were cultured from 116 patients with infection,of whom 100 had single infection,and 16 had mixed infections,including 93 （70.5%）strains of gram-negative bacteria and 39 （29.5 %） strains of gram-positive bacteria.Among the gram-negative bacteria isolated from the patients with infections,the drug resistance rates of Pseudomonas aeruginosa strains to cefazolin,erythromycin,ofloxacin,norfloxacin,and ciprofloxacin were more than 85.0%,while the drug resistance rates to imipenem and meropenem were less than 6.0 %.The drug resistance rates of Escherichia coli strains to cefazolin,erythromycin

关 键 词：PCT 慢性肾病 细菌 感染 诊断效果 

分 类 号：R446[医药卫生—诊断学]