降钙素原及C反应蛋白联合肾盂积液CT值对尿源性脓毒血症的早期诊断价值  

Value of procalcitonin and C-reactive protein combined with CT value of renal pelvis effusion in the early diagnosis of urinary sepsis

作　　者：胡晶 木群 徐涛 董铮 万典 柳琦[2] 张长升 HU Jing;MU Qun;XU Tao;DONG Zheng;WAN Dian;LIU Qi;ZHANG Changsheng(Anesthesia Department;Urinary Surgery Department,Huanggang Central Hospital,Huanggang 438000,China)

机构地区：[1]黄冈市中心医院麻醉科,湖北黄冈438000 [2]黄冈市中心医院泌尿外科,湖北黄冈438000

出　　处：《临床医学研究与实践》2024年第22期48-51,共4页Clinical Research and Practice

基　　金：2022年湖北省自然科学基金项目(No.2022CFB799)。

摘　　要：目的探讨降钙素原(PCT)及C-反应蛋白(CRP)联合肾盂积液CT值对尿源性脓毒血症的早期诊断价值。方法回顾性选取2020年7月至2022年10月我院收治的137例上尿路感染患者,其中确诊为脓毒血症或脓毒性休克者94例(研究组),急性肾盂肾炎者43例(对照组)。测定两组的实验室指标及肾盂积液CT值。比较两组患者的白细胞计数(WBC)、肌酐(Cr)、尿素氮(BUN)、PCT、CRP水平及肾盂积液CT值;绘制受试者工作特征(ROC)曲线并计算曲线下面积(AUC),判断血清PCT、CRP、肾盂积液CT值及三者联合检测对尿源性脓毒血症的诊断效能。结果研究组的WBC低于对照组,差异具有统计学意义(P<0.05);两组的Cr、BUN水平比较,差异无统计学意义(P>0.05)。研究组的PCT、CRP水平及肾盂积液CT值高于对照组,差异具有统计学意义(P<0.05)。ROC曲线分析结果显示,三者联合诊断尿源性脓毒血症的AUC为0.894,明显高于血清PCT、CRP及肾盂积液CT值单一诊断(AUC=0.731、0.625、0.778,P<0.05);三者联合诊断的灵敏度为74.90%,特异度为90.68%。结论血清PCT、CRP及肾盂积液CT值三者联合诊断尿源性脓毒血症的效能较高,可作为尿源性脓毒血症早期诊断的有效参考指标,指导临床早期干预,改善患者预后。Objective To investigate the value of procalcitonin(PCT)and C-reactive protein(CRP)combined with CT value of renal pelvis effusion in the early diagnosis of urinary sepsis.Methods The clinical data of 137 patients with upper urinary tract infection admitted in our hospital from July 2020 to October 2022 were retrospectively selected.Among them,94 patients were diagnosed as sepsis or septic shock(study group)and 43 patients were diagnosed as acute pyelonephritis(control group).The laboratory indexes and CT value of renal pelvis effusion were measured in the two groups.The levels of white blood cell count(WBC),creatinine(Cr),blood urea nitrogen(BUN),PCT,CRP and CT value of renal pelvis effusion were compared between the two groups of patients;the receiver operating characteristic(ROC)curve was drawn and the area under the curve(AUC)was calculated to determine the diagnostic efficacy of serum PCT,CRP,CT value of renal pelvis effusion and combined detection for urinary sepsis.Results The WBC of the study group was lower than that of the control group,and the difference was statistically significant(P<0.05);there were no significant differences in Cr and BUN levels between the two groups(P>0.05).The levels of PCT,CRP and CT value of renal pelvis effusion in the study group were higher than those in the control group,and the differences were statistically significant(P<0.05).ROC curve analysis results showed that the AUC of combined diagnosis of urinary sepsis was 0.894,which was significantly higher than that of single diagnosis of serum PCT,CRP and CT value of renal pelvis effusion(AUC=0.731,0.625,0.778,P<0.05).The sensitivity of the combined diagnosis of the three was 74.90%,and the specificity was 90.68%.Conclusion The combination of serum PCT,CRP and CT value of renal pelvis effusion has a high efficiency in the diagnosis of urinary sepsis,which can be used as an effective reference index for the early diagnosis of urinary sepsis,guide early clinical intervention and improve the prognosis of patients.

关 键 词：降钙素原 C-反应蛋白 肾盂积液CT值 尿源性脓毒血症 上尿路感染 

分 类 号：R692.2[医药卫生—泌尿科学]