降钙素原识别早期血流细菌感染的临床价值研究  

Clinical Value of Plasma Procalcitonin in Identifying Bloodstream Infection

作　　者：刘厚强[1,2] 冉建民[2] 马永辉[1] 张锐[1] 尹海燕[1] 

机构地区：[1]暨南大学医学院附属广州红十字会医院重症医学科,广东广州510220 [2]暨南大学医学院附属广州红十字会医院内分泌科,广东广州510220

出　　处：《临床医学工程》2017年第6期788-790,共3页Clinical Medicine & Engineering

摘　　要：目的探讨血浆降钙素原(PCT)对识别早期细菌性血流感染及鉴别革兰氏阴性(G^-)菌、革兰氏阳性(G^+)菌血流感染的临床价值。方法以2014年1月至2016年12月167例细菌性血流感染患者作为观察组,同期134例血培养阴性患者作为对照组,对两组患者的血浆PCT进行统计分析;同时将观察组分为G^-菌亚组及G^+菌他组,分别为84例和83例,并对两亚组患者的PCT进行统计分析。结果观察组的血浆PCT阳性率为80.2%、中位数浓度为7.53 ng/mL,高于对照组的47.8%、0.47ng/mL(P<0.05);血浆PCT识别早期血流感染ROC曲线下面积为0.770,当截断点为1.25 ng/mL时,灵敏度为64.1%、特异度为76.9%。血培养阳性的两亚组中,G^-菌亚组患者的血浆PCT阳性率为88.1%、中位数浓度为17.54 ng/mL,高于G^+菌亚组患者的72.3%、1.60 ng/mL(P<0.05);血浆PCT鉴别G^-菌、G^+菌血流感染ROC曲线下面积为0.707,当截断点为6 ng/mL时,灵敏度为61.9%、特异度为68.7%。结论血浆降钙素原对识别早期血流细菌感染有一定的临床价值,并可在一定程度鉴别G^+菌或G^-菌血流感染,进而指导临床及时采取有效的治疗措施以改善患者预后。Objective To investigate the clinical value of plasma procalcitonin （PCT） in distinguishing early bacterial bloodstream infection and identifying Gram-negative （G-） bacteria bloodstream infection from Gram-positive （G＋） bacteria bloodstream infection. Methods 167 patients with bacterial bloodstream infection from January 2014 to December 2016 were enrolled as observation group, and 134 cases of patients with negative-blood culture at the same period were enrolled as control group; The PCT levels of two groups were statistically analyzed. Patients in the observation group were divided into the G- bacteria subgroup （n = 84） and G＋ bacteria subgroup （n = 83）, and the PCT levels of two subgroups were statistically analyzed. Results The positive rate of plasma PCT and median PCT concentration of observation group were 80.2% and 7.53 ng/mL respectively, significantly higher than 47.8% and 0.47 ng/mL of control group （P〈0.05）; The area under ROC curve using PCT distinguishing early bacterial bloodstream infection was 0.770; when the cut-offpoint was 1.25 ng/mL, the sensitivity was 64.1%, and the specificity 76.9%. The positive rate of ptasma PCT and median PCT concentration of G bacteria subgroup were 88.1% and 17.54 ng/mL respectively, significantly higher than 72.3% and 1.60 ng/mL ofG~ bacteria subgroup （P〈0.05）; The area under ROC curve using PCT identifying the G bacteria bloodstream infection from G＊ bacteria bloodstream infection was 0.707; when the cut-off point was 6 ng/mL, the sensitivity and specificity was 61.9% and 68.7% respectively. Conclusions Procalcitonin can distinguish early blood bacterial infection, and identify G- bacteria bloodstream infection from G＋ bacteria bloodstream infections, so effective measures can be taken to improve the prognosis of patients.

关 键 词：降钙素原 血流感染 革兰氏阴性菌 革兰氏阳性菌 

分 类 号：R446[医药卫生—诊断学]