血清降钙素原对革兰阴性或革兰阳性菌血流感染的诊断价值  

Diagnostic value of serum procalcitonin measurement for identification of gram-negative and gram-positive bacterial bloodstream infection

作　　者：刘坤贺 张春美[1] LIU Kun-he;ZHANG Chun-mei(the First people's Hospital of Hefei,Hefei,Anhui 230001,China)

机构地区：[1]合肥市第一人民医院呼吸内科,安徽合肥230001

出　　处：《临床肺科杂志》2018年第4期663-665,共3页Journal of Clinical Pulmonary Medicine

摘　　要：目的探讨血清降钙素原(PCT)对革兰阴性(G^-)或革兰阳性(G^+)菌血流感染的鉴别诊断价值。方法回顾性分析从2015年11月至2017年11月入院的血流感染患者116例,所有患者血培养为单一菌株且检测了血清PCT、C-反应蛋白(CRP),同期血培养阴性的局部感染患者56例为对照组。比较PCT、CRP水平在G^-菌、G^+菌血流感染患者之间的差异,同时根据受试者工作特征(ROC)曲线判断PCT、CRP的诊断效能。结果纳入血流感染患者116例,其中G^-菌感染60例,G^+菌感染56例。G^-菌组、G^+菌组和对照组PCT水平中位数分别为8.47ng/m L、2.24ng/m L和0.23ng/m L,CRP水平分别为:114.60±44.24mg/L、109.82±44.21mg/L、49.02±25.20mg/L。血培养阳性组与局部感染组PCT、CRP水平差异均有统计学意义(P<0.05),G^-菌组与G^+菌组之间PCT水平存在明显统计学差异(P<0.05),而CRP水平无统计学差异(P=0.78)。根据ROC曲线,当PCT界值设定为4.62ng/m L时,血清PCT水平鉴别G^-与G^+菌血流感染的灵敏度为71.7%,特异度为75%。结论血清PCT对鉴别G^-菌与G^+菌血流感染有较高的临床应用价值,CRP无鉴别诊断意义。当PCT>4.62ng/m L时,G^-菌感染可能性大。Objective To evaluate the diagnostic value of serum procalcitonin(PCT)for identification of gram-negative(G-)and gram-positive(G+)bacterial bloodstream infection.Methods The clinical data of 116 patients with bloodstream infections admitted from November 2015 and November 2017 were analyzed retrospectively.All patients had a single strain in blood culture and their serum PCT and C-reactive protein(CRP)levels were detected.Meanwhile,56 patients with local infection of negative blood cultures were recruited as the control group.PCT and CRP levels were compared between the patients with G-and G+bacteria bloodstream infection.The diagnostic efficacy of PCT and CRP were determined by receiver operating characteristic(ROC)curve analysis.Results There were 116 patients with bloodstream infection,including 60 cases of G-bacterial infection and 56 cases of G+bacterial infection.The median levels of PCT were 8.47ng/mL,2.24ng/mL and 0.23ng/mL in the G-bacteria infection group,the G+bacteria infection group and the control group.The level of CRP was 114.60±44.24mg/l,109.82±44.21mg/l and 49.02±25.20mg/l in the G-bacteria infection group,the G+bacteria infection group and the control group.The difference of PCT and CRP level in the blood culture positive group and the local infection group was statistically significant(P<0.05).The difference in the CRP level between G-bacteria and the G+bacteria had no significance(P=0.78),but the PCT level had statistical significance(P<0.05).According to ROC curve,PCT level at 4.62ng/mL could distinguish G-bacteria infection from G+bacteria infection with a sensitivity of 71.7%and a specificity of 75%.Conclusion Serum PCT has diagnostic value in differentiating G-and G+bacteria bloodstream infections,and CRP has no diagnostic value.The risk of G-bacteria bloodstream infection is increased when PCT is higher than 4.62ng/mL.

关 键 词：血流感染 降钙素原 C-反应蛋白 革兰阴性菌 革兰阳性菌 

分 类 号：R446.5[医药卫生—诊断学] R515[医药卫生—临床医学]