PCT、NLR、PLR在细菌所致血流感染中的临床应用价值  

Clinical application value of PCT,NLR and PLR in bloodstream infection caused by bacteria

作　　者：莫丽玲 林发全[1] 梁宏洁[1] 廖林[1] 韦贵将[2] 黄莎圆子 杨溢 MO Liling;LIN Faquan;LIANG Hongjie;LIAO Lin;WEI Guijiang;HUANG Shayuanzi;YANG Yi(Department of Clinical Laboratory,the First Affiliated Hospital of Guangxi Medical University/Key Laboratory Diagnostics of Clinical Laboratory Medicine of Guangxi Universities,Nanning 530021,Guangxi,China;Department of Medical Laboratory,the Affiliated Hospital of Youjiang Medical University for Nationalities,Baise 533000,Guangxi,China;Department of Medical Laboratory,Guangxi Hospital of the First Affiliated Hospital of Sun Yat-sen University,Nanning 530028,Guangxi,China)

机构地区：[1]广西医科大学第一附属医院检验科/广西高校临床检验诊断学重点实验室,广西南宁530021 [2]右江民族医学院附属医院检验科,广西百色533000 [3]中山大学附属第一医院广西医院检验科,广西南宁530028

出　　处：《右江医学》2025年第1期14-19,共6页Chinese Youjiang Medical Journal

基　　金：广西高校中青年教师科研基础能力提升项目(2024KY0098)。

摘　　要：目的探讨革兰阳性菌(G+)和革兰阴性菌(G-)所致的血流感染患者血中降钙素原(PCT)、白细胞介素-6(IL-6)、白细胞(WBC)、中性粒细胞/淋巴细胞比值(NLR)、血小板/淋巴细胞比值(PLR)的变化及其临床意义。方法选取2021年4月—2023年4月在中山大学附属第一医院广西医院住院的血流感染患者101例,其中G+菌40例,G-菌61例,采用流式细胞技术测定WBC、中性粒细胞(N)、血小板(PLT)、淋巴细胞(L)水平,计算NLR和PLR。采用电化学发光方法检测PCT、IL-6,干式免疫荧光法检测CRP。利用非参数检验比较不同组间两项指标的差异,采用ROC曲线分析模型预测价值,采用Hosmer-Lemeshow检验分析模型拟合效果。结果血流感染患者中G+菌占39.60%,包括肠球菌(22.77%)、血浆凝固酶阴性葡萄球菌(8.91%)、金黄色葡萄球菌(7.92%);G-菌占60.40%,包括肺炎克雷伯菌(22.77%)、大肠埃希菌(13.86%)、鲍曼不动杆菌(4.95%)、其他病原菌(18.81%)。G-菌组PCT、NLR与PLR高于G+菌组(P<0.05),G-菌组与G+菌组的组间IL-6、WBC水平比较差异无统计学意义(P>0.05);血浆凝固酶阴性葡萄球菌的PCT、IL-6、NLR、PLR水平高于金黄色葡萄球菌与肠球菌(P<0.05),WBC水平低于金黄色葡萄球菌(P<0.05),与肠球菌比较差异无统计学意义(P>0.05);G-菌组中肺炎克雷伯菌的PCT、IL-6、WBC、PLR水平高于大肠埃希菌、鲍曼不动杆菌、其他病原菌(P<0.05),NLR水平低于大肠埃希菌、鲍曼不动杆菌、其他病原菌(P<0.05)。Hosmer-Lemeshow检验分析可知,χ^(2)=3.093,P>0.05,模型拟合效果较好。ROC曲线结果显示,预测模型最佳临界值为0.089,PCT、NLR、PLR单一检测及三项联合检测的ROC曲线下面积(AUC)分别为0.692(0.645~0.751)、0.794(0.656~0.816)、0.733(0.687~0.821)、0.837(0.697~0.916)。结论PCT、NLR、PLR在G+菌和G-菌所致的血流感染中表现具有差异性,PCT、NLR、PLR联合检测优于单个指标在G+菌与G-菌所致血流感染中的鉴别价值�Objective To investigate the changes and clinical significance of procalcitonin(PCT),interleukin-6(IL-6),white blood cells(WBC),neutrophil/lymphocyte ratio(NLR),and platelet/lymphocyte ratio(PLR)in patients with bloodstream infections caused by Gram positive and Gram negative bacteria.Methods 101 patients with bloodstream infections admitted to Guangxi Hospital of the First Affiliated Hospital of Sun Yat-sen University from April 2021 to April 2023 were selected,including 40 cases of G+bacteria and 61 cases of G-bacteria.Flow cytometry was used to measure the levels of WBC,neutrophils(N),platelets(PLT),and lymphocytes(L)in patients,and then NLR and PLR were calculated.Electrochemiluminescence method was used to detect PCT and IL-6 indicators in the two groups,and dry immunofluorescence method was used to detect CRP indicators.Non-parametric tests were used to compare differences between two indicators between different groups,and ROC curve analysis was used to predict the value of the model,and Hosmer-Lemeshow test was used to analyze the fitting effect of the model.Results Among patients with bloodstream infection,G+bacteria accounted for 39.60%,including Enterococcus(22.77%),plasma coagulase negative Staphylococcus(8.91%),and Staphylococcus aureus(7.92%);G-bacteria accounted for 60.40%,including Klebsiella pneumoniae(22.77%),Escherichia coli(13.86%),Acinetobacter baumannii(4.95%),and other pathogens(18.81%).The PCT,NLR and PLR of the G-bact erial group were higher than those of the G+bacterial group(P<0.05),and there was no statistically significant difference in IL-6 and WBC levels between the G-bacterial group and the G+bacterial group(P>0.05);the levels of PCT,IL-6,NLR,and PLR in plasma coagulase negative Staphylococcus were higher than those in Staphylococcus aureus and Enterococcus aureus(P<0.05),while the WBC in plasma coagulase negative Staphylococcus aureus was lower than that in Staphylococcus aureus(P<0.05),but there was no statistically significant difference compared with Enterococcus aureus(P>0.05)

关 键 词：降钙素原 中性粒细胞/淋巴细胞比值 血小板/淋巴细胞比值 血流感染 

分 类 号：R515.3[医药卫生—内科学]