不同感染性指标在血流感染早期诊断中的应用价值

发布时间：2018-05-13 08:31

本文选题：血流感染 + 降钙素原　；参考：《中国感染与化疗杂志》2016年05期

【摘要】：目的探讨降钙素原(PCT)、C反应蛋白(CRP)、白细胞(WBC)计数、中性粒细胞(NEU)绝对数、NEU比率在早期辅助诊断血流感染(BSI)中的临床应用价值。方法回顾性分析2013年1月-2015年5月安徽医科大学第一附属医院的住院患者中送检血培养并同时检测PCT、CRP和血常规的患者1 835例。按血培养结果将患者分为血培养阳性组和血培养阴性组,比较两组中PCT、CRP、WBC、NEU和NEU比率的水平变化,并绘制受试者工作特征(ROC)曲线评价各指标的诊断价值。结果血培养阳性患者189例,革兰阴性菌109株(57.7%),革兰阳性菌60株(31.7%),念珠菌20株(10.6%)。血培养阳性组PCT、CRP、WBC、NEU和NUE比率的中位数分别为6.04 ng/mL、90.00 mg/L、10.00×10~9/L、8.22×10~9/L、0.857 1;血培养阴性组PCT、CRP、WBC、NEU和NUE比率的中位数分别为0.31 ng/mL、38.52 mg/L、8.96×10~9/L、6.33×10~9/L、0.769 8。血培养阳性组的各项结果均明显高于血培养阴性组(P0.05)。革兰阴性细菌组患者血清PCT 9.12(1.57~32.38)ng/mL明显高于革兰阳性细菌组2.62(1.00~12.90)ng/mL(P0.05)和念珠菌组1.40(0.67~12.88)ng/mL(P0.05),且肠杆菌科细菌患者的PCT值11.45(2.20~37.58)ng/mL明显高于不发酵糖革兰阴性杆菌1.93(0.70~13.37)ng/mL(P0.05)。细菌组的CRP 92.17(45.11~151.08)mg/L明显高于念珠菌组56.65(23.32~101.05)mg/L(P0.05),且革兰阳性细菌组CRP 93.93(46.67,147.86)mg/L高于念珠菌组(P0.05)。以血培养阳性为阳性标准绘制ROC曲线,PCT、CRP、WBC、NEU和NUE比率的AUC分别为0.793、0.662、0.555、0.591和0.665(P0.05),对BSI均有一定诊断价值,其中PCT、CRP和NUE比率的诊断价值最大。结论 PCT、CRP可作为BSI的辅助诊断指标,PCT水平对BSI的早期诊断价值更高。早期检测PCT和CRP可以及时帮助BSI患者判断病原菌类型,及早治疗改善预后。
[Abstract]:Objective to evaluate the clinical value of calcitonin (PCT) C-reactive protein (CRPU) count, neutrophil neutrophils (neu) absolute count and neutrophils (neu) ratio in the early diagnosis of blood flow infection (BSI). Methods from January 2013 to May 2015, 1 835 inpatients in the first affiliated Hospital of Anhui Medical University were examined for PCT CRP and blood routine test. According to the results of blood culture, the patients were divided into two groups: the positive group and the negative group. The changes of the ratio of NEU and WBCU were compared between the two groups, and the diagnostic value of each index was evaluated by drawing the operating characteristics of the subjects. Results there were 189 patients with positive blood culture, 109 Gram-negative bacteria, 60 Gram-positive bacteria, and 20 Candida. The median ratios of NUE and NUE in positive blood culture group were 6.04 ng / mL / L 10.00 脳 10 ~ (9) / L ~ (8.22) 脳 10 ~ (9) / L ~ (-1) / L ~ (0.857) 1, respectively, and the median of PCT / CRP / WBC ~ (NEU) and NUE ratio were 0.31 ng / m ~ (-1) ~ 38.52 mg / L ~ (8.96) 脳 10 ~ (9) / L ~ (-1) 6.33 脳 10 ~ (9) L / L = 0.769 8 / L respectively. The results of blood culture positive group were significantly higher than that of blood culture negative group (P 0.05). The serum PCT 9.12(1.57~32.38)ng/mL of patients with Gram-negative bacteria was significantly higher than that of patients with Gram-positive bacteria (2.621.00 ~ 12.90ng / mL P0.05) and Candida (1.400.670.670.88ng / mL P0.05N), and the 11.45(2.20~37.58)ng/mL of Enterobacteriaceae patients was significantly higher than that of non-fermentative gram-negative bacteria (1.930.70ng / L). The CRP 92.17(45.11~151.08)mg/L of bacterial group was significantly higher than that of Candida group (56.65 ~ 23.32 ~ 101.05 mg / L), and the CRP 93.93(46.67147.86)mg/L of Gram-positive bacteria group was higher than that of Candida group. The AUC of ROC curve drawn with positive blood culture as positive standard was 0.793U 0.662U 0.555U 0.591 and 0.665U P 0.05g, respectively, which had certain diagnostic value for BSI, and the diagnostic value of PCTV-CRP and NUE ratio was the greatest. Conclusion the level of PCT can be used as an auxiliary diagnostic index for BSI, and it is more valuable in the early diagnosis of BSI. Early detection of PCT and CRP can help BSI patients to judge pathogen types and improve prognosis.
【作者单位】：安徽医科大学第一附属医院检验科;
【基金】：国家自然科学基金项目(81171618)
【分类号】：R446.5

【相似文献】