降钙素原和血小板计数在血流感染中的临床意义  

The clinical significance of procalcitonin and platelet count in bloodstream infection

作　　者：申东翔[1] 林海焕 莫泽珣[1] 苏和毅 郭振辉[1] SHEN Dong-xiang, LIN Hai-huan, MO Ze-xun, SU He-yi, GUO Zhen-hu(General Hospital of Guaagzhou Military Command, Guangzhou 510010, Chin)

机构地区：[1]广州军区广州总医院,广东广州510010

出　　处：《现代医学》2018年第3期305-309,共5页Modern Medical Journal

基　　金：广东省科技计划项目(2012A061400010);广州市科技计划项目(20150820253);广州市科研条件建设项目(7411675081103);广州市科学研究专项(2014J4100033)

摘　　要：目的:检测血浆降钙素原(PCT)、C反应蛋白(CRP)、白细胞(WBC)、中性粒细胞(NEU)、中性粒细胞比值(Neut%)、血小板(PLT)计数在不同病原菌感染时的水平,探讨这些炎症指标在血流感染中的临床价值。方法:回顾性分析2012年1月至2015年12月入住MICU血培养阳性患者178例,根据血培养结果分为革兰阴性菌组(G-组,101例)和革兰阳性菌组(G+组,77例),比较两组患者6种炎症指标的差异,同时根据多因素Logistic回归分析和受试者工作特征(receiver operating characteristic,ROC)曲线下面积评价差异指标的鉴别诊断性能。再根据预后将血流感染患者分为生存组(79例)和死亡组(99例),对其预后的影响因素进行单因素分析和多因素逻辑回归分析(Logistic回归分析)。结果:G-组PCT、Neut%水平明显高于G+组,PLT水平明显低于G+组(P<0.01),而CRP、WBC和NEU在两组间差异无统计学意义;进一步的多因素回归分析显示:革兰阴性菌血流感染与PCT、PLT水平相关(P<0.05),ROC曲线分析显示:PCT、PLT、Neut%区分革兰阴性菌和革兰阳性菌ROC曲线下面积分别为0.76、0.68、0.64,最佳截断值分别为1.22 ng·ml-1、121×109L-1、87.8%。生存组PCT、CRP水平明显低于死亡组,PLT水平明显高于死亡组(P<0.05);WBC、NEU和Neut%在两组间差异无统计学意义。Logistic回归模型分析显示,急性生理与慢性健康评分(APACHEⅡ评分)与PLT计数是血流感染患者死亡的独立危险因素。结论:6种感染指标中同时检测PCT、PLT和Neut%有利于鉴别革兰阴性菌和革兰阳性菌血流感染,而APACHEⅡ评分和PLT可作为血流感染患者死亡的独立危险因素。Objective： To investigate the expression of procalcitonin（ PCT）,C-reactive protein（ CRP）,white blood cell（ WBC）,neutrophil（ NEU）,neutrophil ratio（ Neut%） and platelet（ PLT） count in bloodstream infection with different bacterium,and assess the clinical value of these inflammatory cytokines in bloodstream infection.Methods： 178 positive patients with blood culture enrolled in Medical Intensive Care Unit（ MICU） from January2012 to December 2015 were analyzed retrospectively. The patients were divided into G-group（ n = 101） and G ＋group（ n = 77） according to the result of blood culture. The six inflammatory markers were compared between the two groups. In addition,the patients were divided into survival group（ n = 79） and non-survival group（ n = 99）.Simple factor analysis and multivariate Logistic regression analysis were performed to assess the possible influence factors of prognosis. Results： The levels of PCT and Neut% in the G-group were significantly higher than those in the G ＋ group,while the level of PLT in the G ＋ group was significantly higher than that in the G-group. The expressions of CRP,WBC and NEU between the two groups had no significant differences. Multivariate regression analysis revealed that PCT and PLT were the relevant influence factors of G-bacterial bloodstream infection. The ROC curves showed that the area under ROC curve（ AUC） of PCT,PLT and Neut% for distin guishing G-and G ＋ bacterial were 0. 76,0. 68,0. 64 and the best cut-off value were 1. 22 ng · ml-1,121 × 109 L-1,87. 8%,respectively. The levels of PCT and CRP in the survival group were significantly lower than those in the nonsurvival group,while PLT showed conversely. There were no significant differences in WBC,NEU and Neut%between survival group and non-survival group. Multivariate regression analysis revealed that APACHE Ⅱscore and platelet count were the independent risk factors for the prognosis of the bloodstream infection patients. Conclusion：Among the six

关 键 词：血流感染 降钙素原 血小板计数 革兰阴性菌 革兰阳性菌 预后 

分 类 号：R515.3[医药卫生—内科学]