血清降钙素原在儿童血流感染诊断中的价值

发布时间：2018-01-26 06:31

本文关键词： 血流感染降钙素原血培养 ROC曲线分析儿童　出处：《山东医药》2017年04期 　论文类型：期刊论文

【摘要】：目的探讨血清降钙素原(PCT)诊断儿童血流感染的价值。方法回顾性分析323例血培养阳性的血流感染患儿及120例血培养阴性患儿(血培养阴性组)的临床资料。观察血培养及血清PCT检测结果,通过受试者工作特征(ROC)曲线评价PCT对血流感染的诊断价值,并计算最佳临界值。结果 323例血培养阳性患儿分离出G-菌149株(GN组),G+菌153株(GP组),真菌21株(真菌组);血清PCT水平由高到低依次为不动杆菌属、肠杆菌属、大肠埃希菌感染。GN组、GP组、真菌组与血培养阴性组PCT水平分别为5.080(0.725~35.085)、0.270(0.120~0.700)、0.350(0.330~2.090)、0.245(0.090~0.560),GN组与GP组、真菌组、血培养阴性组比较差异均有统计学意义(P均0.01)。GN组和GP组不同PCT水平(0.5、0.2~2、2~10、10~50、50 ng/m L)G-菌感染率、G+菌感染率比较差异均有统计学意义(χ~2分别为29.538、22.365,P均0.01),且GN组高于GP组(χ~2=26.663,P0.01);真菌组不同PCT水平血流感染率比较差异无统计学意义(χ~2=0.850,P0.05)。PCT鉴别G-菌血流感染的ROC曲线下面积(AUC)为0.810,GP组为0.624;以1.03 ng/m L为最佳临界值,PCT诊断G-血流感染的灵敏性为60.7%,特异性为78.6%,阳性预测值为89.7%,阴性预测值为39.3%,约登指数为39.3%。结论血清PCT水平对儿童革兰阴性菌血流感染的诊断价值较高,1.03 ng/m L为其诊断的最佳临界值。
[Abstract]:Objective to evaluate the value of serum procalcitonin (PCT) in the diagnosis of blood flow infection in children. Methods 323 children with positive blood culture and 120 children with negative blood culture were analyzed retrospectively. To observe the results of blood culture and serum PCT detection. The diagnostic value of PCT for blood stream infection was evaluated by the operating characteristics of the subjects. Results 149 strains of GN and 21 strains of fungi (fungi group) were isolated from patients with GN group, 153 strains of GN group and 21 strains of fungi (fungi group). The serum levels of PCT from high to low were Acinetobacter, Enterobacter, Escherichia coli infection and GP group. The levels of PCT in fungi group and blood culture negative group were 5.080, 0.725, 35.085, 0.270, 0.120 and 0.700, respectively. The GN group, GP group and fungus group were 0.350, 0.330, 2.090, 0.245, 0.090, 0.560, respectively. The difference of blood culture negative group was statistically significant (P < 0.01). GN group and GP group had different PCT levels of 0.5 ~ 0.2U ~ (2) ~ (2) ~ (10) ~ (10) ~ (10) ~ (50). There were statistically significant differences in the infection rates of 50 ng/m G- bacteria and G bacteria (蠂 ~ 2 = 29.538 ~ 22.365, P = 0.01). And the GN group was higher than GP group (蠂 2 + 26.663 P 0.01). There was no significant difference in blood flow infection rate between different PCT levels in fungal group (蠂 2 + 0.850). The area under ROC curve of P0.05. PCT for differentiating G- bacteria blood stream infection was 0. 810% GP group was 0. 624; Using 1.03 ng/m L as the best critical value, the sensitivity, specificity and positive predictive value were 60.7 and 78.6, respectively. Negative predictive value was 39.3 and Yorden index was 39.3. Conclusion Serum PCT level is of high diagnostic value in children with Gram-negative bacterial blood flow infection. 1.03 ng/m L was the best critical value for diagnosis.
【作者单位】：首都医科大学附属北京儿童医院;
【分类号】：R725.1
【正文快照】： 菌血症和败血症是由细菌、真菌等病原微生物入侵血流所致的全身性炎症反应综合征,统称为血流感染。血流感染病死率高,患者往往发生多个器官的急性转移性感染,因此早期诊断和治疗至关重要[1]。血培养是实验室诊断血流感染的“金标准”,但培养时间长,阳性率低。近年来,血清降钙

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