炎性指标在细菌性血流感染及自发性细菌性腹膜炎中的诊断价值

发布时间：2018-03-22 03:10

  本文选题：血流感染　切入点：自发性细菌性腹膜炎　出处：《山西医科大学》2017年硕士论文　论文类型：学位论文

【摘要】：目的:了解机体发生细菌性血流感染(BSI)及自发性细菌性腹膜炎(SBP)时病原菌的分布,并探讨白细胞计数(WBC)、中性粒细胞分类(NEU%)、C-反应蛋白(CRP)、降钙素原(PCT)等指标在细菌性血流感染(BSI)及自发性细菌性腹膜炎(SBP)中的诊断价值。方法:本论文采用诊断试验评价的研究方法,从细菌性血流感染和自发性细菌性腹膜炎两方面分别进行研究,选择2014年7月-2016年10月太原市第三人民医院住院患者为研究对象,以细菌培养阳性和有明显临床体征作为诊断标准分为病例组和对照组。血培养采集参照CLSIM47推荐指南执行,腹水培养采集参照欧洲肝脏学会相关指南执行,并在24小时内检测WBC、NEU%、CRP、PCT,最后进行以下统计分析:(1)描述细菌性血流感染、自发性细菌性腹膜炎时病原菌的分布;(2)采用wilcoxon秩和检验对病例组与对照组间的WBC、NEU%、CRP和PCT水平进行差异性比较;(3)采用wilcoxon秩和检验对革兰阳性菌(G+菌)组与革兰阴性菌(G-菌)组间的WBC、NEU%、CRP和PCT进行差异性比较;(4)描绘受试者工作特征曲线确定最佳临界值,利用ROC曲线下面积及试验的真实性,收益来评价WBC、NEU%、CRP和PCT单项及四项联合试验(并联)在细菌性血流感染和自发性细菌性腹膜炎诊断中的价值。结果:⑴血WBC、NEU%、CRP和PCT在诊断细菌性血流感染中的价值:选择经细菌病原学确诊的细菌性血流感染患者为细菌性BSI组,共128例,男88例,女40例,平均年龄(49.48±19.33)岁,选择未发生细菌性血流感染患者作为对照组,共290例,男191例,女99例,平均年龄(49.15±17.53)岁。细菌性BSI组与对照组均进行双侧双套血培养、wbc、neu%、crp和pct的检测,结果显示:(1)在细菌性bsi组,革兰阴性菌占74.22%,主要包括:大肠埃希菌(31.30%)、马耳他布鲁斯菌(21.90%)、肺炎克雷伯菌(12.50%)等,革兰阳性菌占25.78%,主要包括:表皮葡萄球菌(4.20%)、屎肠球菌(4.20%)等;(2)细菌性bsi组和对照组间neu%、crp、pct水平比较差异有统计学意义(p0.05),wbc差异无统计学意义(p0.05);(3)细菌性bsi组中g+菌与g-菌间wbc、neu%和crp水平比较差异无统计学意义(p0.05),pct水平比较差异有统计学意义(p0.05);(4)wbc、neu%、crp、pct及四项联合(并联)试验roc曲线下面积大小依次为:四项联合试验(0.820)、pct(0.793)、crp(0.666)、neu%(0.650)、wbc(0.546);反映真实性的指标:灵敏度、特异度、约登指数、阳性似然比、阴性似然比,结果分别为:wbc(33.06%,75.52%,0.0858,1.35,0.89)、neu%(38.71%,91.72%,0.3043,4.68,0.67)、crp(73.39%,54.48%,0.2787,1.61,0.49)、pct(70.16%,87.59%,0.557,5.65,0.34)、四项联合(并联)试验(67.7%,89.7%,0.574,6.57,0.36);收益性指标阳性预测值、阴性预测值,分别为:wbc(35.25%,71.28%)、neu%(65.79%,77.19%)、crp(39.58%,80.87%)、pct(70%,87.15%)、四项联合(并联)试验(74.14%,86.09%)。(5)roc曲线下面积按从大到小依次为:四项联合(并联)试验、pct、crp、neu%、wbc,roc曲线下面积大小相邻指标间通过z检验两两比较可见wbc与neu%、neu%与crp、crp与pct、pct与联合试验间差异均有统计学意义(p0.05)。⑵血wbc、neu%、crp和pct在诊断自发性细菌性腹膜炎中的价值:选择经细菌病原学确诊自发性细菌性腹膜炎的患者为sbp组,共50例,男39例,女11例,平均年龄(51.87±10.31)岁,选择未发生自发性细菌性腹膜炎患者为非sbp组,共232例,男157例,女75例,平均年龄(52.44±10.89)岁。sbp组和非sbp组均进行腹水培养、wbc、neu%、crp和pct的检测,结果显示:(1)在sbp组中,革兰阴性菌占62.00%,主要包括大肠埃希菌(40.00%)、肺炎克雷伯菌(12.00%)等,革兰阳性菌占38.00%,主要包括表皮葡萄球菌(10.00%)、科氏葡萄球菌(8.00%)、金黄葡萄球菌(2.00%)等;(2)sbp组和非sbp组间wbc、neu%、crp、pct水平比较差异有统计学意义(p0.05);(3)sbp组g+菌与g-菌间wbc、neu%和crp水平比较差异无统计学意义(p0.05),pct水平比较差异有统计学意义(p0.05);(4)wbc、neu%、crp、pct及四项联合(并联)试验roc曲线下面积大小依次为:pct(0.799)、四项联合(并联)试验(0.760)、crp(0.734)、neu%(0.606)、wbc(0.599);真实性指标包括灵敏度、特异度、约登指数、阳性似然比、阴性似然比,分别为:wbc(51.02%,68.97%,0.1999,1.64,0.71)、neu%(38.78%,85.34%,0.2412,2.65,0.72)、crp(77.55%,67.98%,0.4553,2.42,0.33)、pct(71.43%,73.71%,0.4514,2.72,0.387)、四项联合(并联)试验(61.2%,89.2%,0.504,5.67,0.43);收益包括阳性预测值、阴性预测值分别为,wbc(26.97%,86.53%)、neu%(45.45%,87.39%)、crp(35.85%,93.18%)、pct(35.79%,91.44%)、四项联合(并联)试验(54.55%,91.19%)。(5)roc曲线下面积按从大到小依次为:pct、四项联合(并联)试验、crp、neu%、wbc,roc曲线下面积大小相邻指标间通过z检验两两比较可见wbc与neu%、crp与联合试验、crp与pct、联合试验与pct间差异无统计学意义(p0.05),wbc、neu%与crp、联合试验、pct间差异有统计学意义(p0.05)。结论:(1)细菌性血流感染时,革兰阴性菌约占74.22%,以大肠埃希菌、马耳他布鲁斯菌、肺炎克雷伯菌为主,革兰阳性菌约占25.78%,以表皮葡萄球菌、屎肠球菌、人葡萄球菌为主;自发性细菌性腹膜炎时,革兰阴性菌约占62.00%,以大肠埃希菌、肺炎克雷伯菌为主,革兰阳性菌约占38.00%,以表皮葡萄球菌、科氏葡萄球菌、金黄葡萄球菌等为主。(2)细菌性血流感染时neu%、crp、pct三项指标在有诊断意义;自发性细菌性腹膜炎时,wbc、neu%、crp、pct四项指标均有诊断意义。(3)细菌性血流感染和自发性细菌性腹膜炎时,pct水平在阴性菌感染时显著高于阳性菌感染,而wbc、neu%、crp水平在阳性菌菌、阴性菌间无明显差别。(4)细菌性血流感染时,通过roc曲线下面积对各指标进行评估,诊断价值从大到小依次为:四项联合(并联)试验、pct、crp、neu%、wbc;四项联合(并联)试验诊断显著优于单项试验,pct、crp、neu%、wbc单项试验间差异有显著意义。四项联合试验(并联)与pct在真实性,收益等方面显著优于血wbc、neu%、crp等检测方法;(5)自发性细菌性腹膜炎时,通过roc曲线下面积对各指标进行评估,诊断价值从大到小依次为:PCT、四项联合(并联)试验、CRP、NEU%、WBC;四项联合试验(并联)、PCT、CRP(三者间无差异)诊断价值显著优于WBC、NEU%(二者间无差异);PCT在真实性方面优于四项联合试验(并联)、CRP、NEU%和WBC;四项联合(并联)试验在阳性预测值优于单项试验,而CRP阴性预测值优于四项联合(并联)试验、PCT、NEU%和WBC。
[Abstract]:Objective: to understand the body of bacterial bloodstream infection (BSI) and spontaneous bacterial peritonitis (SBP) distribution of pathogenic bacteria, and to investigate the white blood cell count (WBC), neutrophil classification (NEU%), C- reactive protein (CRP), procalcitonin (PCT) and other indexes in bacterial bloodstream infection (BSI) and spontaneous bacterial peritonitis (SBP) in the diagnosis. Methods: This paper adopts the research methods of diagnostic test evaluation, study from two aspects of bacterial bloodstream infection and spontaneous bacterial peritonitis respectively, July 2014 -2016 year in October Third People's Hospital of Taiyuan city were selected as the research object, the bacterial culture positive and there are obvious clinical signs as diagnostic criteria were divided into case group and control group. Blood culture collection is recommended by CLSIM47 guidelines, referring to the European Association for the study of liver ascites culture acquisition related guidelines, and WBC detection in 24 hours, NEU%, CRP, PCT, and finally the following statistical analysis: (1) description of bacterial bloodstream infection, pathogen distribution of spontaneous bacterial peritonitis; (2) using the Wilcoxon rank test NEU% on between case group and control group, WBC, CRP and PCT levels were compared; (3) the Wilcoxon rank and the test of gram positive bacteria (G+ bacteria) and Gram-negative bacteria (G- bacteria) between the groups of WBC, NEU%, CRP and PCT were compared; (4) receiver operating characteristic curve to determine the optimal threshold, the authenticity and the test area under ROC curve, return to the evaluation of WBC, NEU%, CRP and PCT single and four joint test (parallel) in bacterial bloodstream infection and spontaneous bacterial peritonitis diagnosis. Results: the blood WBC, NEU%, CRP and PCT value in the diagnosis of bacterial bloodstream infections: bacterial bloodstream by pathogenic bacteria confirmed infection in patients with bacterial BSI 缁，

本文编号：1646785