发热患者血流感染与血清PCT、CRP、IL-6和内毒素的临床应用评价  

Clinical evaluation of serum PCT,CRP,IL-6 and endotoxin in fever patients with bloodstream infection

作　　者：李星军[1] 钱敏健 邓桂胜 郁淼[1] 张莉[1] Xingjun;QIAN Mingjian;DENG Guisheng;YU Miao;ZHANG Li(Department of Laboratory Medicine;Respiratory Department,Chongmling Branch of Xinhua Hospital Affiliated to School of Medicine of Shanghai ]iaotong University,Shanghai 202150,China)

机构地区：[1]上海交通大学医学院附属新华医院崇明分院检验科,上海202150 [2]上海交通大学医学院附属新华医院崇明分院呼吸内科,上海202150

出　　处：《国际检验医学杂志》2018年第22期2782-2785,2789,共5页International Journal of Laboratory Medicine

基　　金：上海市崇明县科学技术发展基金项目(CKY2016-16)

摘　　要：目的探讨发热患者血清中降钙素原(PCT)、C-反应蛋白(CRP)、白细胞介素-6(IL-6)、内毒素等生物指标在血流感染中的诊断意义及临床应用评价。方法收集2016年5月至2017年3月入住该院的成年发热患者共278例患者的临床资料,根据血培养结果将患者分为3组:第一组为血培养阳性的菌血症患者(141例);第二组为血培养阴性,但临床诊断为细菌感染(95例);第3组为无细菌感染(42例)。其中第一组又分为革兰阴性(G-)菌血流感染(98例)和革兰阳性(G+)菌血流感染(43例)。比较发热患者各组间的白细胞计数(WBC)、中性粒细胞比例(Neut%)、PCT、CRP、IL-6和内毒素水平的差异;分别绘制各组发热患者诊断的受试者工作特征曲线(ROC曲线),根据曲线下面积(AUC)和最佳诊断临界值来分别评价各炎性因子对血流感染所致发热患者的诊断价值及其诊断的灵敏度和特异度。结果 3组间PCT、CRP、IL-6、内毒素水平比较差异有统计学意义(P<0.01),WBC和Neut%水平在各组间差异无统计学意义(P>0.05)。G-菌组患者的血PCT、CRP、IL-6和内毒素水平均明显高于G+菌组(P<0.01);感染性发热患者各炎性标志物诊断效率由大到小依次为PCT、CRP、IL-6,灵敏度依次为CRP、PCT、IL-6,特异度依次为PCT、内毒素、CRP、IL-6。结论 G-菌感染的发热患者血中PCT、CRP、IL-6和内毒素水平显著高于G+菌感染者。生物标志物PCT、CRP、IL-6和内毒素可用于细菌感染所致发热患者的细菌类型判别和临床早期的诊断,帮助临床医生经验性使用抗菌药物提供重要的参考依据。Objective To investigate the diagnostic value and clinical application of serum procalcitonin （PCT）, C reactive protein （CRP） ,interleukin- 6 （IL- 6） and endotoxin in patients with fever. Methods A total of 278 adults patients with fever from May 2016 to March 2017 in hospital were enrolled in this study. The fe vet patients were divided into three groups according to the blood culture results. The first group was patients with positive result of blood culture （141 cases）,the second group was patients with nagetive result of blood culture,whose clinical diagnosis was bacterial infection （95 cases）,and the third group was patients with no bacterial infection （42 cases）. The first group was divided into gram negative （G ） bacteria blood infection group （98 cases） and gram positive （G＋ ） bacteria blood infection group （43 cases）. The biomarkers such as leukocyte count （WBC） , neutropbil proportion （Neut % ） , PCT, CRP, IL-6 and endotoxin levels were compared between the groups of fever patients in 24 h. The receiver operating characteristic curve （ROC curve） of fever patients were drawn. The diagnostic value, sensitivity and specificity of each inflammatory factor were evalua ted according to the area under the curve （AUC） and the optimal diagnostic threshold. Results The difference of PCT,CRP,IL 6 and endotoxin between the three groups was statistically significant （P〈0.01）. There was no significant difference between the WBC and Neut% of the three groups （P〉0. 05）. The levels of PCT, CRP,IL-6 and endotoxin in the O group were significantly higher than those in the Q＋ group （P〈0.01）.The diagnostic efficiency of inflammatory markers in patients with infectious fever from high to low is PCT, CRP,IL-6,and CRP , PCT , IL-6 for sensitivity,PCT , endotoxin , CRP , IL-6 for specificity. Conclusion The levels ofPCT,CRP,IL-6 andendotoxin in the blood of the fever patients with G bacterial infection were significantly higher than those in the blood

关 键 词：血流感染 降钙素原 白细胞介素-6 C-反应蛋白 内毒素 发热 

分 类 号：R441.3[医药卫生—诊断学]