血清降钙素原和C反应蛋白联合检测在ICU患者细菌感染诊断和治疗中的应用

目的评价降钙素原（procalcitonin，PCT）和C反应蛋白（C—reactiveprotein，CRP）联合检测对重症监护病房（ICU）细菌感染患者的诊断及疗效评估的价值。方法对ICU的70例细菌感染患者血清PCT、CRP的含量及动态变化进行检测，同时将70例细菌感染患者分为重症感染组（n=38）和局部感染组（n=32），并与35例非感染组患者进行比较。结果重症感染组血清PCT、CRP浓度分别为（15．3-4-7．3）μg／L和（20．5±6．8）mg／L，局部感染组血清PCT、CRP浓度分别为（2．5±1．1）μg/L和（10．1±4．6）mg／L，均明显高于非感染组PCT、CRP浓度分别为（0．4±0．2）μg／L和（3．5±2．2）mg／L]，差异有统计学意义（P〈0．01）。经有效抗菌药物治疗后，细菌感染患者的PCT、CRP浓度均下降，与治疗前相比差异有统计学意义（P〈0．01）。以PCT〉0．5μg/L、CRP〉8mg／L为界，PCT与CRP诊断细菌感染的敏感性均为92．9％，PCT的特异性（85．7％）高于CRP（62．9％）。结论血清PCT、CRP联合检测在细菌感染的早期诊断中有一定价值，PCT的特异性要优于CRP，动态监测PCT水平有助于评估疗效，协助判断疾病的转归。

Application of combined determination of serum procalcitonin and C - reactive protein in the diagnosis and treatment for ICU patients with bacterial infections

Objective To evaluate the clinical value of combined determination of serum procalcitonin （PCT） and C -reactive protein （CRP） in the diagnosis and assessment of therapeutic effect for ICU patients with bacterial infec- tions. Methods Serum PCT and CRP levels and their dynamic changes in 70 patients with bacterial infection in inten- sive care unit（ICU） were measured. The patients with bacterial infections were assigned to serious infection group （n = 38 ） and local infection group （ n = 32）. The results were analyzed and compared with those of non - infection group （ n = 35）. Results The levels of PCT and CRP were （15. 3 ±7. 3 ） μg/Land（20.5±6.8） mg/L respectively in serious infection group and （ 2.5 ±1.1 ） t.ug/L and （ 10.1 ± 4.6） rag/L, respectively in local infection group, which were all significantly higher compared with those in noninfection group the levels of PCT and CRP were （0.4 ± 0.2 ） μg/L and （3.5 ±2.2） mg/L, respectively, P 〈 0.01 ]. After antibiotic treatment, the levels of PCT and CRP in patients with bac- terial infections decreased significantly （ P 〈 0.01 ）. Based on the cut - off values of PCT 〉 0.5 txg/L and CRP 〉 8 mg/L for the diagnosis of bacterial infections, the sensitivity of PCT and CRP were all 92.9%, the specificity of PCT （ 85.7% ） was higher than that of CPR （62.9%）. Conclusions The combined determination of PCT and CPR assists the early di- agnosis of bacterial infections. The specificity of PCT is higher than that of CRP. Dynamic monitoring of PCT levels is helpful in the evaluation of therapeutic effect and prognosis of bacterial infections.