降钙素原对ICU发热患者血流感染的诊断及预测价值

发布时间：2018-03-15 10:33

本文选题：降钙素原　切入点：C反应蛋白　出处：《中国药房》2016年32期 　论文类型：期刊论文

【摘要】：目的:探讨与评价降钙素原(PCT)对重症监护病区(ICU)发热患者血流感染(BSI)的诊断及预测价值。方法:回顾性分析2012年3月-2014年12月我院ICU 233例发热患者的病历资料,比较不同血培养结果、不同病原菌类型和不同细菌种类感染患者血清PCT和C反应蛋白(CRP)水平的差异,采用受试者工作特征(ROC)曲线评价和比较PCT、CRP对BSI的诊断及预测价值。结果:233例发热患者中,血培养阳性患者有74例,阳性率为31.76%;血培养阳性患者血清PCR、CRP水平均高于血培养阴性和污染患者,差异均有统计学意义(P0.001);而血培养阴性患者与污染患者血清PCR、CRP水平比较,差异均无统计学意义(P0.05)。74例血培养阳性患者中,革兰氏阴性菌感染患者45例,占60.81%;革兰氏阳性菌感染患者18例,占24.32%;真菌感染患者11例,占14.86%;革兰氏阴性菌感染患者血清PCT水平显著高于革兰氏阳性菌和真菌感染患者,革兰氏阳性菌感染患者血清PCT水平也显著高于真菌感染患者,差异均有统计学意义(P0.05);但3种病原菌感染患者血清CRP水平比较,差异无统计学意义(P0.05)。发热患者感染的主要细菌包括不动杆菌、金黄色葡萄球菌、铜绿假单胞菌、大肠埃希菌和肺炎克雷伯菌;各细菌感染患者血清PCT水平比较,差异均有统计学意义(P0.05);而其血清CRP水平比较,差异无统计学意义(P0.05)。ROC曲线分析结果显示,PCT和CRP对区分血培养阳性与阴性均有统计学意义(P0.001),ROC曲线下面积(AUROC)分别为0.789[95%置信区间(CI)(0.732,0.845)]和0.629[95%CI(0.568,0.690)],截断值分别为1.2 ng/ml和81.4 mg/L;PCT和CRP对区分血培养阳性与血培养污染亦均有统计学意义(P0.001),AUROC分别为0.805[95%CI(0.711,0.899)]和0.673[95%CI(0.540,0.805)],截断值分别为0.5 ng/ml和73.4 mg/L。结论:PCT有助于ICU发热患者BSI的诊断及血培养结果的判定,且其预测效能优于CRP;监测患者血清PCT水平可指导BSI早期经验性抗感染治疗。
[Abstract]:Objective: to investigate and evaluate the diagnostic and predictive value of procalcitonin (ICU) in patients with fever in intensive care ward. Methods: the medical records of ICU patients with fever from March 2012 to December 2014 were retrospectively analyzed. The levels of serum PCT and C-reactive protein (CRP) in patients with different pathogen types and different bacterial types were compared. The diagnostic and predictive value of BSI was evaluated and compared by using the operating characteristics of the subjects. Results among the 233 febrile patients, 74 were positive for blood culture. The positive rate was 31.76. The levels of serum PCR- CRP in the patients with positive blood culture were higher than those in the patients with negative and contaminated blood culture, and the differences were statistically significant (P 0.001), while the levels of serum PCR- CRP in the patients with negative blood culture were compared with those in the patients with contamination. Of the 74 patients with positive blood culture, 45 were Gram-negative bacteria (60.81%), 18 were Gram-positive bacteria (24.32%), and 11 were fungal infections. The level of serum PCT in patients with Gram-negative bacteria infection was significantly higher than that in patients with Gram-positive bacteria and fungal infection, and the level of serum PCT in patients with Gram-positive bacteria infection was significantly higher than that in patients with fungal infection. The differences were statistically significant (P 0.05), but there was no significant difference in serum CRP levels among the three pathogens. The main bacteria infected in fever patients included Acinetobacter, Staphylococcus aureus, Pseudomonas aeruginosa. Escherichia coli and Klebsiella pneumoniae, the levels of serum PCT in patients with bacterial infection were significantly different (P 0.05), while the levels of serum CRP in patients with bacterial infection were compared. There was no significant difference in P0.05U. ROC curve analysis. The results showed that there were significant differences between positive and negative blood culture by CRP and the area under the P0.001ROC curve were 0.789 [95% confidence interval 0.732n 0.845] and 0.629 [95CI0.5680.690], the truncation values were 1.2 ng/ml and 81.4 mg / L PCT and CRP respectively. There were significant differences between positive blood culture and contamination of blood culture. The AUROC was 0.805 [95CI0.7110.899] and 0.673 [0.5400.805]. The truncation values were 0.5 ng/ml and 73.4 mg / L. conclusion the results of BSI and blood culture in patients with ICU fever can be determined by the use of VPCT. Monitoring the serum PCT level can guide the early empirical anti-infective therapy of BSI.
【作者单位】：珠海市人民医院药学部;珠海市人民医院检验科;珠海市人民医院重症医学科;珠海市人民医院肿瘤科;
【基金】：珠海市社会发展领域医疗卫生类项目(No.2012093)
【分类号】：R459.7

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