血清超敏C反应蛋白、降钙素原及白细胞计数检测对维持性血液透析合并感染的诊断价值  

Diagnostic value of serum high-sensitivity C-reactive protein,procalcitonin,and white blood cell count for infection in maintenance hemodialysis patients

作　　者：龙颂 李甫良 杨金有 邓富文 LONG Song;LI Fu-liang;YANG Jin-you;DENG Fuwen(Department of Pharmacy,The First People's Hospital of Honghe Prefecture,Honghe 661100,China;School of Pharmacy,Dali University,Dali 671000,China)

机构地区：[1]红河州第一人民医院药学部,红河661100 [2]大理大学药学院,大理671000

出　　处：《中国血液净化》2024年第8期601-604,共4页Chinese Journal of Blood Purification

基　　金：云南省第一人民医院临床药学中心2023年度开放课题(2023YJZX-YX25)。

摘　　要：目的分析血清超敏C反应蛋白(hs-CRP)、降钙素原(PCT)及白细胞计数(WBC)对维持性血液透析(maintenance hemodialysis,MHD)合并感染患者的诊断价值。方法选取2022年1月1日—2023年12月31日红河州第一人民医院血液净化中心行MHD治疗的住院患者,按其是否存在感染分为感染组及非感染组。检测血清hs-CRP、PCT及WBC水平并进行比较,同时采用受试者工作特征曲线评价各项指标对MHD患者合并感染的诊断效能。结果共纳入136例患者,其中感染组70例,非感染组66例。感染组住院天数(t=-6.706,P<0.001)、住院费用(t=-5.592,P≤0.001)高于非感染组。感染组血清hs-CRP(t=-7.021,P<0.001)、PCT(t=-6.063,P<0.001)及WBC(t=-3.218,P=0.001)表达水平高于非感染组。单项指标诊断MHD合并感染时,hs-CRP的诊断效能高于PCT及WBC,截断值为16.25 mg/L时,最大约登指数对应AUC为0.849,灵敏度为83.33%,特异性为75.71%;hs-CRP、PCT及WBC联合诊断MHD合并感染时,hs-CRP联合PCT诊断效能高于其他指标联合诊断,最大约登指数对应AUC为0.882,灵敏度和特异性分别为89.39%、74.29%。hs-CRP、PCT及WBC三者联合诊断时,诊断效能较好,AUC为0.878,其灵敏度和特异性为83.33%、80.00%。结论hs-CRP、PCT及WBC联合检测对MHD合并感染的诊断价值较好。Objective To explore the diagnostic value of high-sensitivity C-reactive protein(hs-CRP),procalcitonin(PCT),and white blood cell count(WBC)in maintenance hemodialysis(MHD)patients combined with infection.Methods The MHD patients hospitalized in the Blood Purification Center of Honghe First People's Hospital from January 1,2022 to December 31,2023 were enrolled in this study.They were divided into infected group and non-infected group.Serum hs-CRP,PCT and WBC count were measured and compared between the two groups.The efficacy of the three indexes for the diagnosis of infection in MHD patients was evaluated by receiver operator characteristic(ROC)curve.Results A total of 136 patients were included in this study(70 patients in infected group,and 66 patients in non-infected group).Hospitalization day(t=-6.706,P<0.001)and hospitalization expenses(t=-5.592,P<0.001)were higher in the infected group than in the non-infected group.Serum hs-CRP(t=-7.021,P<0.001),PCT(t=-6.063,P<0.001)and WBC(t=-3.218,P=0.001)were higher in the infected group than in the non-infected group.The diagnostic value of hs-CRP was higher than that of PCT and WBC for the infection in MHD patients.If the cutoff value of hs-CRP was set at 16.25 mg/L,the area under the curve(AUC)corresponding to the maximum entry index was 0.849,with the sensitivity of 83.33%,and the specificity of 75.71%.Serum hs-CRP combined with PCT had the best diagnostic efficacy,with the AUC corresponding to the maximum boarding index of 0.882,the sensitivity of 89.39%,and the specificity of 74.29%;serum hs-CRP combined with PCT and WBC had a better diagnostic efficacy,with the AUC of 0.878,the sensitivity of 83.33%,and the specificity of 80.00%.Conclusion Combined use of hs-CRP,PCT and WBC have a better diagnostic value,and can be used as a clinical reference to initiate antimicrobial treatment in MHD patients complicated with infection.

关 键 词：维持性血液透析 感染指标 诊断价值 感染 超敏C反应蛋白 

分 类 号：R446[医药卫生—诊断学]