血清降钙素原对血流感染早期诊断及预后评估的价值  

Value of procalcitonin in early diagnosis and prognostic evaluation of bloodstream infection

作　　者：冯丹丹 吴建浓[1] 汪仕栋 王妍妍 干铁儿[2] 邢茜[1] 江荣林[1] FENG Dandan;WU Jiannong;WANG Shidong(Department of Critical Care Medicine,the First Affiliated Hospital,Zhejiang Chinese Medical University,Hangzhou 310006,China)

机构地区：[1]浙江中医药大学附属第一医院重症医学科,杭州10006 [2]浙江中医药大学附属第一医院医院感染管理科,杭州310006 [3]浙江中医药大学第一临床医学院

出　　处：《浙江医学》2020年第7期704-708,共5页Zhejiang Medical Journal

基　　金：浙江省科技厅公益性技术应用研究计划项目(2013C33180);浙江省中医药科技计划青年人才基金项目(2019ZQ022)。

摘　　要：目的探讨血清降钙素原(PCT)对血流感染早期诊断及预后评估的价值。方法选取482例怀疑血流感染的住院患者为研究对象。根据血流感染诊断标准分为血流感染组207例和非血流感染组275例,比较两组患者血清PCT、白细胞计数(WBC)、C反应蛋白(CRP)水平,评估3者对血流感染的早期诊断效能;根据28d预后情况分为死亡组48例和存活组159例,比较两组患者上述指标,分析影响血流感染患者预后的因素,评估48h PCT降低率对血流感染患者预后的预测价值。结果血流感染组血清PCT、WBC、CRP水平均明显高于非血流感染组(均P<0.05)。PCT对血流感染早期诊断的AUC为0.83,高于WBC、CRP;其灵敏度为0.69,特异度为0.94。死亡组急性生理与慢性健康(APACHEⅡ)评分、首次及第3天PCT水平均高于存活组(均P<0.05),48h PCT降低率低于存活组(P<0.05);两组首次及第3天WBC、CRP水平比较,差异均无统计学意义(均P>0.05)。进一步作多因素logistic回归分析显示,首次PCT水平(OR=1.12,95%CI:1.04~1.20,P<0.05)、48hPCT降低率(OR=0.89,95%CI:0.85~0.94,P<0.05)、APACHEⅡ评分(OR=1.36,95%CI:1.22~1.51,P<0.05)是血流感染患者28d死亡的影响因素。48h PCT降低率预测血流感染患者预后的灵敏度为0.72,特异度为0.83,AUC为0.87,截断值为40.16%。结论血清PCT早期诊断血流感染的效能优于WBC、CRP。动态监测血清PCT水平有助于评估血流感染患者的预后。Objective To investigate the value of procalcitonin(PCT) in early diagnosis and prognostic evaluation of bloodstream infection. Methods A total of 482 inpatients with suspected bloodstream infection were enrolled in the study, among whom 207 cases were diagnosed as bloodstream infection(bloodstream infection group), and 275 cases were excluded from bloodstream infection(non-bloodstream infection group). The serum PCT, white blood cell count(WBC), C-reactive protein(CRP) levels of the two groups were compared, and their value for early diagnosis of bloodstream infection were evaluated. During the hospitalization, 48 patients died(fatal group) and 159 patients survived(survival group) within 28 days after admission. The risk factors of the poor short-term prognosis of bloodstream infection were analyzed. The predictive value of the 48 h PCT reduction rate in the prognosis for bloodstream infection patients was evaluated. Results The serum PCT, WBC and CRP levels in the bloodstream infection group were significantly higher than those in the non-bloodstream infection group(P<0.05). The area under the curve(AUC) of PCT for early diagnosis of bloodstream infection was 0.83, which was higher than that of WBC and CRP, its sensitivity was 0.69 and specificity was 0.94. Acute Physiology and Chronic Health Evaluation II score(APCHE II), PCT level at d1 and d3 in fatal group were higher than those of the survival group(both P<0.05), while the 48 h PCT reduction rate was lower than that of the survival group(P<0.05). There were no significant differences in WBC and CRP levels at d3 between the fatal and survival groups(all P >0.05). Multivariate logistic regression analysis showed that the initial PCT level(OR=1.12, 95%CI: 1.04~1.20, P<0.05), 48 h PCT reduction rate(OR=0.89, 95%CI: 0.85~0.94, P<0.05), APACHE II score(OR=1.36, 95%CI:1.22~1.51, P<0.05) were the independent risk factors of28-day fatality in patients with bloodstream infection. The 48 h PCT reduction rate predicts the prognosis of patients with bloodstream infect

关 键 词：降钙素原 血流感染 早期诊断 

分 类 号：R446.5[医药卫生—诊断学]