血清降钙素原在诊断血液透析病人感染中价值的探讨

目的 评价血清降钙素原（PCT）对血液透析患者细菌感染的诊断价值.方法 选择进行血液透析治疗的52例患者,根据病原学和血清学诊断结果分组,细菌感染组26例,非细菌感染组26例,选用微量双夹心免疫发光法,定量检测PCT.对比两组患者的PCT浓度,并对细菌感染组患者,分别以1.0 ng/ml、1.5 ng/ml、2.0 ng/ml作为阳性判断标准,对其诊断敏感度、特异度、阳性预测值（PPV）、阴性预测值（NPV）、阳性似然比（＋LR）、阴性似然比（-LR）、Youden指数和诊断符合率进行评价.结果 细菌感染组血清PCT浓度为（6.15±2.63） ng/ml,非细菌感染组血清PCT浓度为（2.25± 1.32） ng/ml,两组血清PCT浓度比较差异有统计学意义（t=6.7579,P=0.0000）.阳性标准与血液透析感染诊断的敏感度在一定程度上成反比,与特异度成正比.Youden指数和诊断符合率在1.5 ng/ml作为阳性标准明显高于1 ng/ml和2 ng/ml时.结论 血清PCT水平与感染有着密切联系,有效控制感染能降低血清PCT水平,对临床治疗起到积极作用,其临床应用价值值得进一步探讨.

Value of serum procalcitonin in diagnosis of infection in hemodialysis patients

Objective To evaluate the value of serum procalcitonin （PCT） in diagnosis of bacteria infection in hemodial- ysis patients.Methods 52 patients undergoing hemodialysis treatment were divided into bacterial infection group（26 cases） and non-bacterial infection group（26 cases） according to diagnostic results of etiology and serology.PCT of two groups were quantitatively tested by immunoluminometric assay.Then, the PCT concentrations of two groups were compared. 1.0 ng/ml, 1.5 ng/ml and 2.0 ng/ml were respectively taken as positive critical standard to evaluate the diagnostic sensitivity,specificity, positive predictive value（ PPV）, negative predictive value （NPV）, positive likelihood ratio（ ＋LR）, negative likelihood ratio（- LR ） ,Youden index and diagnostic coincidence rate of the bacterial infection group.Results Serum PCT concentration of the bacterial infection group was （ 6.15 ± 2.63 ） ng/ml, and that of the non-bacterial infection group was （ 2.25 ± 1.32） ng/ml. There was statistical difference in the comparison of the serum PCT concentrations of two groups（ t = 6.7579 ,P= 0.0000）.Positive standard was inversely proportional to the sensitivity of hemodialysis infective diagnosis ,but it is proportional to specificity.When 1.5 ng/ml was taken as positive standard,Youden index and diagnostic coincidence were obviously higher than that when 1 ng/ml and 2 ng/ml were standard.Conclusion There is osculatory relationship between serum PCT level and infection.To control infection effectively can reduce the level of serum PCT, which will play an active role in clinical treatment. Thus, its value of clinical application is worthy of further study.