降钙素原、高敏C反应蛋白和白介素6对导管相关血流感染早期诊断的价值

目的研究降钙素原(PCT)、高敏C反应蛋白(hs-CRP)、白介素6(IL-6)对重症监护病房(ICU)患者导管相关血流感染(CRBSI)早期诊断的临床价值。方法选择某院2013年4月—2015年4月ICU留置中心静脉导管(CVC)疑诊CRBSI的78例患者,患者入住ICU及疑诊CRBSI当日采集患者血液标本,同时行血培养和静脉导管尖端培养,根据血培养和静脉导管尖端培养结果将患者分为CRBSI组与非CRBSI组,比较PCT、hs-CRP、IL-6对CRBSI诊断的价值。结果 28例疑诊患者最终诊断为CRBSI。疑诊CRBIS当日,CRBSI组患者的PCT、hsCRP、IL-6和血白细胞(WBC)水平分别为(3.35±1.52)μg/L、(32.90±11.10)mg/L、(423.20±171.70)ng/L、和(12.70±2.70)×109/L,均高于非CRBSI组分别为(1.22±0.44)μg/L、(23.50±6.00)mg/L、(257.90±81.40)ng/L、和(11.20±1.90)×109/L],差异均有统计学意义(均P0.05)。ROC曲线分析:PCT、hs-CRP、IL-6和血白细胞(WBC)水平曲线下面积(AUC)及95%CI分别为0.92(0.85,0.99)、0.75(0.62,0.88)、0.80(0.67,0.92)和0.64(0.50,0.72);灵敏度分别为0.82、0.64、0.71和0.46;特异度分别为0.92、0.94、0.92和0.88。结论 PCT和IL-6对ICU患者CRBSI的早期诊断具有较高的价值,对及早诊断CRBSI具有一定的预测作用。

Early diagnostic value of procalcitonin, high sensitivity C reactive protein and interleukin 6 in catheter related bloodstream infection

ObjectiveTo study the early diagnostic value of procalcitonin（PCT）, high sensitivity C reactive protein（hs CRP） and interleukin 6（IL 6） in catheter related bloodstream infection (CRBSI) in patients in intensive care unit(ICU).Methods78 ICU patients with suspected CRBSI between April 2013 and April 2015 were selected, blood specimens of patients on the first day of admission and being suspected CRBSI were taken, blood and venous catheter tips were performed culture, patients were divided into CRBSI group and non CRBSI group according to culture results of blood and venous catheter tips, diagnostic values of PCT, hs CRP, and IL 6 were compared. Results28 patients were diagnosed CRBSI. On the day of being suspected with CRBSI, levels of PCT, hs CRP, IL 6, and white blood cell(WBC) in CRBSI group were significantly higher than non CRBSI group respectively(［3.35±1.52］μg/L vs ［1.22±0.44］μg/L; ［32.90±11.10］mg/L vs ［23.50±6.00］mg/L; ［423.20±171.70］ng/L vs ［257.90±81.40］ng/L; ［12.70±2.70］×109/L vs ［11.20±1.90］×109/L］，P＜0.05 ). The receiver operating characteristic curve(ROC) analysis showed that area under the curve (AUC) and 95% CI of PCT, hs CRP, IL 6, and WBC were 0.92（0.85，0.99）,0.75（0.62, 0.88）,0.80（0.67, 0.92）, and 0.64（0.50, 0.72）respectively；sensitivity were 0.82,0.64,0.71, and 0.46 respectively；specificity were 0.92,0.94, 0.92,and 0.88 respectively. ConclusionPCT and IL 6 have high effectiveness for early diagnosis of CRBSI in ICU patients, and have certain predictive value for early diagnosis of CRBSI.