PCT、IL-6、CRP、NLR在ICU细菌性血流感染患者革兰氏阳性菌和阴性菌中的鉴别作用及对死亡风险的预测价值  

The Differential Role of PCT,IL-6,CRP and NLR in Gram-Positive and Negative Bacteria and the Predictive Value of the Risk of Death in Patients with Bacterial Bloodstream Infection in ICU

作　　者：杨翔[1] 余维丽 储雯雯[2] 鹿中华[1] 黎命娟 陈虎[1] 曹利军[1] 张新城 孙昀[1] YANG Xiang;YU Wei-li;CHU Wen-wen;LU Zhong-hua;LI Ming-juan;CHEN Hu;CAO Li-jun;ZHANG Xin-cheng;SUN Yun(First Department of Critical Medicine,The Second Affiliated Hospital of Anhui Medical University,Hefei,Anhui,230601,China;Department of Clinical Laboratory,The Second Affiliated Hospital of Anhui Medical University,Hefei,Anhui,230601,China)

机构地区：[1]安徽医科大学第二附属医院重症医学一科,安徽合肥230601 [2]安徽医科大学第二附属医院检验科,安徽合肥230601

出　　处：《现代生物医学进展》2022年第15期2926-2931,共6页Progress in Modern Biomedicine

基　　金：安徽省高校优秀拔尖人才培育资助项目(gxyq2021171)。

摘　　要：目的:探讨降钙素原(PCT)、白细胞介素-6(IL-6)、C反应蛋白(CRP)、中性粒细胞/淋巴细胞比值(NLR)在重症加强护理病房(ICU)细菌性血流感染(BSI)患者革兰氏阳性菌(G+菌)和阴性菌(G-菌)中的鉴别作用及对死亡风险的预测价值。方法:选取2019年2月~2021年12月我院收治的99例细菌性BSI患者,根据细菌革兰氏染色培养鉴定结果分为G-菌感染组和G+菌感染组,检测并比较两组PCT、IL-6、CRP、NLR水平,并以受试者工作特征(ROC)曲线分析上述指标对G+菌和G-菌感染的鉴别价值。比较G+菌、G-菌不同病原菌类型的PCT、IL-6、CRP、NLR水平差异。此外,将所有患者根据28 d预后差异分为死亡组和存活组,比较两组PCT、IL-6、CRP、NLR水平,以ROC曲线分析上述指标对ICU细菌性BSI患者死亡的预测价值。结果:(1)99例细菌性BSI患者中,病原菌类型为G-菌的70例(70.71%),G+菌29例(29.29%)。(2)G-菌感染组PCT、NLR水平均高于G+菌感染组(P<0.05),而两组IL-6及CRP水平对比差异不明显(P>0.05)。联合检测PCT、NLR水平鉴别G+菌和G-菌的ROC-AUC(0.95CI)为0.855(0.770~0.912),鉴别效能较好。(3)肺炎克雷伯菌PCT、IL-6、CRP水平均高于大肠埃希菌、鲍曼不动杆菌、铜绿假单胞菌以及其他G-菌,NLR水平则低于大肠埃希菌、鲍曼不动杆菌、铜绿假单胞菌以及其他G-菌(P<0.05)。链球菌属PCT、IL-6、CRP、NLR水平均高于凝固酶阴性葡萄球菌、金黄色葡萄球菌以及肠球菌属(P<0.05)。(4)死亡组患者的PCT、IL-6、NLR水平均高于存活组(P<0.05),而两组CRP水平对比差异不明显(P>0.05)。联合检测PCT、IL-6、NLR水平预测ICU细菌性BSI患者死亡的ROC-AUC(0.95CI)为0.871(0.787~0.937),预测效能较好。结论:联合检测PCT、NLR在鉴别ICU细菌性BSI患者G-菌和G+菌方面具有一定价值,而联合检测PCT、IL-6、NLR对患者死亡风险具有一定预测价值。Objective:To investigate the differential role of procalcitonin(PCT),interleukin-6(IL-6),C-reactive protein(CRP)and neutrophil/lymphocyte ratio(NLR)in Gram-positive bacteria(G+bacteria)and Gram-negative bacteria(G-bacteria)in patients with bacterial bloodstream infection(BSI)in intensive care unit(ICU)and its predictive value for the risk of death.Methods:99 patients with bacterial BSI who were treated in our hospital from February 2019 to December 2021 were selected,and they were divided into G-bacteria infection group and G+bacteria infection group according to the identification results of bacterial Gram staining culture.The levels of PCT,IL-6,CRP and NLR in the two groups were detected and compared,and the differential value of the above indexes for G+bacteria and G-bacteria infection was analyzed according to the receiver operating characteristic(ROC)curve.The difference of levels of PCT,IL-6,CRP and NLR of different pathogen types of G+bacteria and G-bacteria were compared.In addition,all patients were divided into death group and survival group according to the 28 d prognosis difference.The levels of PCT,IL-6,CRP and NLR in the two groups were compared.The predictive value of the above indexes for the death of patients with bacterial BSI in ICU was analyzed by ROC curve.Results:(1)Among 99 patients with bacterial BSI,the pathogen type were G-bacteria with 70 cases(70.71%),and G+bacteria with 29 cases(29.29%).(2)The levels of PCT and NLR in G-bacteria infection group were higher than those in G+bacteria infection group(P<0.05),but there was no significant difference in the levels of IL-6 and CRP between the two groups(P>0.05).The ROC-AUC(0.95CI)of combined detection of levels of PCT and NLR to identify G+bacteria and G-bacteria was 0.855(0.770~0.912),the identification efficiency was good.(3)The levels of PCT,IL-6 and CRP of Klebsiella pneumoniae were higher than those of Escherichia coli,Acinetobac ter baumannii,Pseudomonas aeruginosa and other G-bacteria,while the level of NLR was lower than that of Esche

关 键 词：细菌性血流感染 PCT IL-6 CRP NLR 鉴别价值 预后 

分 类 号：R446.11[医药卫生—诊断学] R63[医药卫生—临床医学] R45