Utilidad de las determinaciones analíticas en sangre y líquido cefalorraquídeo para predecir meningitis bacterianas en el servicio de urgencias

Introduction

The classic clinical presentation of bacterial meningitis (BM) is observed in less than half of the cases in adults, and symptoms are less specific in children, the elderly or immunocompromised, and other chronic patients. The usual signs and symptoms do not provide optimal sensitivity and specificity for distinguishing possible BM from viral meningitis (VM), which may lead to a delay in the appropriate antimicrobial therapy. Society therefore stands to benefit from the development of effective, objective, and rapid tools able to predict and identify patients with BM. These tools include laboratory tests for blood and cerebrospinal fluid (CSF). The aim of this review is to summarise recently published scientific evidence in order to clarify existing controversies and compare the usefulness and diagnostic ability of the different parameters used to predict BM.

Value of procalcitonin as a marker of surgical site infection following spinal surgery

Aim

To compare the value of Procalcitonin (PCT) as a marker of surgical site infection to other inflammatory markers, including C-Reactive Protein (CRP), White Cell Count (WCC) and Erythrocyte Sedimentation Rate (ESR) in patients undergoing a number of spinal procedures. This study also aims to describe the biokinetic profile of the above-named markers in patients developing surgical site infection and those remaining infection-free post-operatively.

颈髓损伤术后医院获得性肺炎影响因素及PCT与CRP的诊断价值

目的探究颈髓损伤术后医院获得性肺炎(HAP)的影响因素,分析降钙素原(PCT)、C-反应蛋白(CRP)的诊断价值。方法回顾性分析2017年2月-2019年2月河北医科大学第三医院239例行颈髓损伤术患者的病例资料,根据有无发生HAP进行分组,分为HAP感染组(61例)和非HAP感染组(178例)。单因素及多因素Logistic回归分析颈髓损伤术后HAP的感染因素,观察患者PCT、CRP水平的诊断价值。结果行颈髓损伤术后HAP发生率为25.52%(61/239);两组颈髓损伤术后患者的年龄、颈髓损伤节段、日本骨科协会(JOA)评分、住院时间,差异有统计学意义(P<0.05);Logistic回归分析结果,颈髓损伤节段(OR=1.236)、JOA评分(OR=3.214)、住院时间(OR=1.317)为颈髓损伤术后HAP的影响因素;术后,HAP感染组患者PCT、CRP水平高于非HAP感染组(P<0.05);PCT曲线下面积(AUC)大于CRP,特异度高于CRP(P<0.05)。结论颈髓损伤术后患者HAP发生率较高,颈髓损伤节段、JOA评分、住院时间为颈髓损伤术后HAP的影响因素,同时PCT可作为HAP的首选诊断指标,CRP可作为辅助诊断指标,为临床预防诊断HAP提供参考依据。     

杂合式血液净化序贯治疗联合丹参注射液对重症急性胰腺炎患者症状及血清AMY、PCT的影响

目的:探讨杂合式血液净化序贯治疗联合丹参注射液对重症急性胰腺炎(SAP)患者症状改善及血清淀粉酶(AMY)、降钙素原(PCT)水平变化的影响。方法:将SAP患者82例按随机数字表法分为对照组与研究组各41例。对照组采取杂合式血液净化序贯治疗(血液灌流结合连续性静脉-静脉血液滤过),研究组在对照组基础上联合丹参注射液治疗。对比治疗效果。结果:研究组体温恢复正常及呕吐恶心消失、腹痛腹胀、首次排便用时短于对照组(P<0.05)。治疗后,2组血清AMY及PCT水平较治疗前降低(P<0.05),且研究组低于对照组(P<0.05)。结论:丹参注射液联合杂合式血液净化序贯治疗SAP,可有效改善患者临床症状,降低血清AMY、PCT水平。     

Diagnostic and prognostic role of procalcitonin (PCT) and MR‐pro‐Adrenomedullin (MR‐proADM) in bacterial infections

Rapid diagnosis of bacterial infections is crucial for adequate antibiotic treatment. Serum molecules such as Procalcitonin (PCT) have been used as biomarkers of infection. Recently, the mid‐regional pro‐Adrenomedullin (MR‐proADM) has been evaluated in combination with PCT for sepsis diagnosis. The diagnostic role of PCT and MR‐proADM both in sepsis and in localized infections together with their contribution to effective antibiotic therapy has been evaluated. One hundred and eighty‐two patients with bacterial infection has been enrolled: PCT and MR‐proADM were measured at admission (T = 0), at 12–24 h (T = 1) and in the third or fifth day of antibiotic therapy (T = 3–5). ROC curve (receiver operating characteristic) and post‐test probability were calculated. MR‐proADM increased with the severity of the infection. PCT resulted significantly higher in sepsis than localized infection. After antibiotic therapy, PCT significantly decreased in localized respiratory infections and in sepsis, while MR‐proADM decreased significantly after antibiotic therapy only in patients with severe sepsis/septic shock. The threshold values of PCT and MR‐proADM were >0.1 ng/mL and >0.8 nmol/L, respectively. The combined use of PCT and MR‐proADM increased the post‐test probability of the diagnosis of bacterial infections compared to PCT alone. In conclusion, PCT and MR‐proADM combination improves the diagnosis of bacterial infection and contribute to prognosis and antibiotic therapy effectiveness.     

超声结合C反应蛋白及降钙素原在妇科急腹症诊治中的临床意义

目的探讨超声检查结合C反应蛋白（C reactive protein）及降钙素原（procalcitonin,PCT）在妇科急腹症诊断、鉴别诊断中的临床应用价值及意义。方法前瞻性研究2011年1月～2012年12月重庆东华医院收治的50例妇科急腹症患者,分别在入院后24h内检测C反应蛋白及降钙素原,并深入分析并与超声检测及病理结果的相关性。结果与超声检测及术后病理结果对照,超声检测异位妊娠、不全流产患者的准确性是91%,降钙素原无明显升高,但是C反应蛋白有升高,盆腔炎症的超声检测准确性是87%,C反应蛋白及降钙素原都明显升高;超声检测卵巢肿瘤破裂、卵巢肿瘤蒂扭转的准确性是89%,C反应蛋白及降钙素原也有升高,但程度明显低于盆腔炎症的患者,并且以CRP升高为主。结论 C反应蛋白及降钙素原在炎症性妇科急腹症明显升高,其次为肿瘤性疾病,超声诊断妇科急腹症有重要的作用,但是结合该2项检测可进一步提高鉴别诊断准确性,可作为超声等影像学检查的协同方法。     

202例儿童肺炎静脉血C-反应蛋白和降钙素原的变化特点及意义

目的观察儿童肺炎时两个炎性指标C-反应蛋白(CRP)、降钙素原(PCT)在不同病原感染时的血液表达水平及变化规律,以指导抗生素的临床应用,减少抗生素滥用。方法回顾性研究2015年1月～2017年9月期间在我院儿科住院治愈的202个肺炎病例,将其分为四组:病毒感染性肺炎组、细菌感染性肺炎组、支原体感染性肺炎组、支原体+病毒感染性肺炎组。收集这些病例的全血CRP、PCT实验室检查数据,去掉CRP、PCT的最大值和最小值,采用SAS 9.4统计学软件进行统计学分析,对比CRP、PCT在四组肺炎的表达水平。结果①病毒感染性肺炎组CRP表达水平最低,同细菌感染性肺炎组、支原体感染性肺炎组、支原体+流感病毒感染性肺炎组比较,差异有统计学意义(P0.05);其余三组间CRP表达水平无统计学差异。②细菌感染性肺炎组PCT表达水平最高,同病毒感染性肺炎组、支原体感染性肺炎组、支原体+病毒感染性肺炎组比较,差异有统计学意义(P0.05),其余三组间PCT无统计学差异。③CRP与PCT水平整体具有相关性,相关系数0.34(P0.001)。结论 PCT作为一个新型炎性指标对于预测细菌感染性肺炎较CRP具有更大的优势。     

脓毒血症患儿血浆肝素结合蛋白、降钙素原和C-反应蛋白与病情严重程度的关系

目的探讨腺毒血症患儿血装肝素结合蛋白(heparin-binding protein,HBP)、血清降甸素原(procalcitonin,PCT)和C反应蛋白(C-reactive protein,CRP)与病情严重程度的关系。方法选取2017年1月-2019年3月在西安交通大学医学院第一附属医院接受治疗的113例脓毒血症患儿为观察组,选取同期在本院体检的健康志愿者35例为对照组。根据病情程度将观察组分为脓毒症组,严重脓毒症组,感染性休克脓毒症组。根据预后情况不同分为存活组和死亡组。比较各组HBP、PCT、CRP、慢性健康状况评分Ⅱ(APACHEⅡ)、序贯器官衰竭估计评分(SOFA),并分析其与病情严重程度和预后的关系。分析HBP、PCT和CRP与APACHEⅡ、SOFA的相关性。采用受试者工作曲线(ROC)分析血浆HBP、PCT和CRP诊断膝毒血症的临床效能。结果①113例脓毒血症患儿,脓毒症34例,严重脓毒症36例,感染性休克脓毒症43例;经规范治疗后,生存82例,死亡31例。②观察组患儿入院时血浆HBP、血清PCT和CRP水平比对照组显著升高(P<0.05)。感染性休克脓毒症组患儿入院时血浆HBP、血清PCT和CRP水平最高,严重脓毒症组次之,脓毒症最低(P<0.05)。Pearson分析表明,入院时血浆HBP、血清PCT和CRP水平与脓毒血症严重程度均呈正相关(r分别为0.804、0.732、0.605,均P<0.05)。③存活组患儿入院时血浆HBP、血清PCT和CRP水平均低于死亡组(P<0.05)。Pearson分析显示:入院时血浆HBP、血清PCT和CRP水平均与预后呈正相关(r分别为0.813、0.756,、0.674,均P<0.05)。④血浆HBP、血清PCT和CRP水平与APACHEⅡ评分、SOFA评分显著相关,均呈正相关。其中血浆HBP水平与APACHEⅡ评分及SOFA评分的相关性较好(r分别为0.741和0.811,均P<0.001)。⑤入院时血浆HBP的评估脓毒血症的曲线下面积(AUC)和95%CI分别为0.885和(0.854~0.973),当截断点为27.99ng/mL时,灵敏度、特异度分别为80.4%和88.5%。血清PCT的评估脓毒血症的AUC和95%CI分别为0別5和(0.749~0.882),当截断点为0.16ng/mL时,灵敏度、特异度分别为81.9%和68.7%。血清CRP的评估脓毒血症的AUC和95%CI分别为0.731和(0.653~0.809),当截断点为2.3 mg/L时,灵敏度、特异度分别为54.3%和87.0%。结论脓毒血症患儿血浆HBP、PCT和CRP显著上升,与患儿病情严重程度和预后有关,用于早期监测和评估脓毒症患者的病情具有重要临床意义。