降钙素原在念珠菌血流感染中的辅助诊断价值  

Diagnostic value of procalcitonin detection in Candida bloodstream infection

作　　者：唐洪影 岳娜[1] 田彬[1] 李静[1] 徐海茹[1] 蔡鲜[1] 胡志东[1] 

机构地区：[1]天津医科大学总医院医学检验科,天津300052

出　　处：《中华急诊医学杂志》2018年第3期254-258,共5页Chinese Journal of Emergency Medicine

摘　　要：目的 探讨血清降钙素原（procalcitonin, PCT）在念珠菌血流感染患者中的临床应用价值。方法 采用回顾性研究，对天津医科大学总医院共783例同时送检血液培养和血清PCT检测住院患者的结果进行分析，结合其临床资料，对血流感染念珠菌及细菌患者病例进行单因素及logistic 多因素回归分析，血培养结果各组间PCT差异比较采用Mann-Whitney U检验，并且根据受试者工作曲线（ROC）判断PCT的诊断性能。结果 510例血培养阴性患者PCT水平为0.21（0.06，1.02）ng/mL，121例念珠菌感染和152例细菌血流感染患者PCT水平分别为1.15（0.38，6.85）ng/mL和2.34（0.77，15.12）ng/mL，三组间PCT水平差异有统计学意义（P〈0.05）。根据ROC曲线，界值为0.355 ng/mL 时血清PCT诊断血流感染念珠菌的灵敏度为76.9%，特异度为60.8%，曲线下面积为0.726（P〈0.01）。结论 血清PCT水平对念珠菌血流感染有一定的辅助诊断价值。对于存在发生念珠菌血症相关因素的危重患者，应结合其临床症状、PCT等实验室检测指标，及时有效地给予抗真菌治疗。Objective To discuss the clinical application value of serum procalcitonin（PCT） in patients with Candida bloodstream infection. Methods The data of 783 hospitalized patients of Tianjin Medical University General Hospital including blood culture and serum PCT test were retrospectively analyzed, and the medical records of patients with Candida or bacterial bloodstream infection were evaluated by univariate and multivariate logistic regression analysis. The comparison of PCT value were carried out among the different blood culture groups using the Mann-Whitney U test. A receiver operating characteristic（ROC） curve was used to determine the diagnostic performance of the PCT. Results The PCT was 0.21 （0.06, 1.02） ng/mL in the 510 patients with negative blood culture, but in 121 patients with Candida infection and 152 patients with bacteria infections, the PCT levels were 1.15 （0.38, 6.85） ng/ mL and 2.34 （0.77, 15.12） ng/mL, respectively. There were statistically significant differences in PCT levels among three groups（P〈0.05）. According to ROC, when the value of PCT was 0.355 ng/mL, the sensitivity was 76.9%, and the specificity was 60.8% with 0.726 area under the curve （AUC） （P〈0.01） for the identification of Candida infection by blood cultures. Conclusions Serum PCT levels have a certain diagnostic value for Candida bloodstream infection. In critically ill patients with factors associated with candidemia, the combination of clinical symptoms with PCT as an adjuvant diagnostic marker and other laboratory findings can be used to make a prompt and effective initiation of antifungal therapy.

关 键 词：降钙素原 血培养 念珠菌 血流感染 

分 类 号：R446.6[医药卫生—诊断学] R519.3[医药卫生—临床医学]