降钙素原、白介素6、超敏C反应蛋白及中性粒细胞比值在急性肾盂肾炎血流感染临床诊断中的应用研究  

Procalcitonin,interleukin 6,high-sensitivity C-reactive protein,and neutrophil ratio in the clinical diagnosis of bloodstream infection in acute pyelonephritis

作　　者：申欣 刘喜旺 杨绍明[1] SHEN Xin;LIU Xiwang;YANG Shaoming(Department of Political Science and Engineering,Rizhao Center for Disease Control and Prevention,Rizhao,Shandong 276826,China;Department of Clinical Laboratory,Rizhao Central Hospital,Rizhao,Shandong 276800,China)

机构地区：[1]日照市疾病预防控制中心政工科,山东日照276826 [2]日照市中心医院检验科,山东日照276800

出　　处：《社区医学杂志》2024年第12期410-414,共5页Journal Of Community Medicine

摘　　要：目的评价血液中降钙素原(PCT)、白细胞介素6(IL-6)、超敏C反应蛋白(hs-CRP)、中性粒细胞比值(NEU%)在早期诊断急性肾盂肾炎(APN)患者发生血流感染(BSI)的临床应用价值。方法选取2021-01-01-2023-03-31日照市中心医院住院治疗的APN单一病原菌血流感染患者67例,设为血流感染组;选择同期在日照市中心医院住院治疗的APN血培养阴性患者61例,设为非血流感染组;收集患者血培养当天的血液标本,检测PCT、IL-6、hs-CRP、NEU%4项指标,分析比较2组各指标水平差异有无统计学意义,绘制受试者工作特征(ROC)曲线,评价各指标单独检测和联合检测在APN血流感染中的诊断价值。结果67例血流感染病原菌中革兰阴性菌54株(80.60%),以大肠埃希菌、肺炎克雷伯菌为主;革兰阳性菌13株(19.40%),以金黄色葡萄球菌、粪球菌属为主。血培养阳性组与血培养阴性组感染指标比较采用Mann-Whitney U检验,血培养阳性组患者血清PCT水平明显高于血培养阳性组,差异有统计学意义,P<0.001;血培养阳性组患者血清IL-6水平明显高于血培养阴性组,差异有统计学意义,P<0.001;血培养阳性组患者血液NEU%水平明显高于血培养阴性组,差异有统计学意义,P<0.001;血培养阳性组患者血清hs-CRP水平与血培养阴性组的差异无统计学意义,P=0.074。ROC曲线分析PCT诊断APN血流感染的曲线下面积(AUC)为0.821(P<0.001),最佳诊断界限值2.06 ng/mL,灵敏度为67.2%,特异度为85.2%,约登指数为0.524;IL-6诊断APN血流感染的AUC为0.718(P<0.001),最佳诊断界限值为43.76 pg/mL,灵敏度为88.1%,特异度为55.7%,约登指数为0.438;NEU%诊断APN血流感染的AUC为0.751(P<0.001),最佳诊断界限值为82.40%,灵敏度为71.6%,特异度为73.8%,约登指数为0.458。PCT、IL-6及NEU%联合检测的AUC为0.867(P<0.001)。结论hs-CRP不能有效区分APN是否发生BSI;PCT检测辅助诊断价值最高;多指标联合检测可提高APN患者中发生BSI的诊�Objective To evaluate the clinical application value of procalcitonin(PCT),interleukin 6(IL-6),high-sensitivity C-reactive protein(hs-CRP),and neutrophil percentage(NEU%)in blood for early diagnosis of bloodstream infection(BSI)in patients with acute pyelonephritis(APN).Methods A total of 67 patients with APN and single-pathogen bloodstream infection hospitalized in Rizhao Central Hospital from January 1,2021,to March 31,2023,were selected as the bloodstream infection group.Additionally,61 APN patients with negative blood cultures hospitalized in the same period were selected as the non-bloodstream infection group.Blood samples collected on the day of blood culture were tested for PCT,IL-6,hs-CRP,and NEU%.The differences in these indicators between the two groups were analyzed using the Mann-Whitney U test.Receiver operating characteristic(ROC)curves were plotted to evaluate the diagnostic value of each indicator individually and in combination for APN with BSI.Results Among the 67 cases of bloodstream infection pathogens,there were 54strains(80.60%)of Gram-negative bacteria,mainly Escherichia coli and Klebsiella pneumoniae;13strains(19.40%)of Gram-positive bacteria,mainly Staphylococcus aureus and Streptococcus faecalis.The comparison of infection indicators between the blood culture positive group and the blood culture negative group showed that the serum PCT level in the blood culture positive group was significantly higher than that in the blood culture negative group,with a statistically significant difference,P<0.001.The serum IL-6level in the blood culture positive group was significantly higher than that in the blood culture negative group,with a statistically significant difference,P<0.001.The blood NEU%level in the blood culture positive group was significantly higher than that in the blood culture negative group,with a statistically significant difference,P<0.001.There was no statistically significant difference in serum hs-CRP levels between the blood culture positive group and the blood culture negat

关 键 词：降钙素原 白介素6 中性粒细胞比值 急性肾盂肾炎 血流感染 

分 类 号：R692.3[医药卫生—泌尿科学]