降钙素原、C-反应蛋白在鉴别血流感染菌属中的应用价值

目的:探讨降钙素原(PCT)、C-反应蛋白(CRP)在鉴别血流感染不同菌属的临床应用价值,评价PCT 及CRP水平在肠杆菌科、非发酵菌、葡萄球菌属及肠球菌属中的差异。方法:选取2015 年1 月~2017 年1 月中血培养阳性并同时进行PCT、CRP 测定的患者作为研究对象,PCT 及CRP 检测分别采用电化学发光法和免疫比浊法,数据分析采用SPSS21.0 软件,比较不同菌属间PCT 及CRP 水平是否存在差异。采用Sigma 软件,建立ROC 曲线,计算最佳临界值。结果:PCT 水平在革兰阳性菌与革兰阴性菌中差异具有统计学意义,U 值为4 420.00,P 值为0.004,最佳临界值为1.105 ng/ ml;PCT 水平在凝固酶阳性葡萄球菌与凝固酶阴性葡萄球菌中差异具有统计学意义,U 值为79.00,P 值<0.001,最佳临界值为0.870 ng/ ml;PCT水平在肠杆菌科与非发酵菌中差异具有统计学意义,U 值为681.50,P 值为0.005,最佳临界值3.310 ng/ ml;葡萄球菌属与肠球菌属间PCT 水平无统计学意义;CRP 水平在以上各分组中差异均无统计学意义。结论:PCT 在鉴别血流感染不同菌属中有一定价值,可在早期对怀疑菌血症患者合理用药提供依据,与血培养联合检测以降低重症患者的抗感染失败风险,提高治疗效率。

Value of procalcitonin and C-reactive protein in discriminating bloodstream infection bacterial species

Objective: To investigate the value of procalcitonin (PCT), C-reactive protein (CRP) in discriminating the bloodstream infection bacterial species ,and to analyze the levels of PCT and CRP in sepsis caused by different pathogens.Methods:Patients with blood culture and PCT,CRP detection were collected in the study ,from January 2015 to January 2017.The levels of PCT and CRP were detected with electrochemiluminescence and immunoturbidimetric,respectively.The levels of PCT in gram positive bacteria and gram negative bacteria,different bacterial species were compared by SPSS21.0 statistical software.Receiver operating characteristic(ROC) curve was established by Sigma software,calculating the optimal cutoff value.Results: The difference in the levels of PCT between gram positive bacteria and gram negative bacteria was statistically significant,and the value of U was 4 420.00,(P = 0.004).ROC analysis showed the optimal cut-off value was 1.105 ng/ ml.The levels of PCT had statistically significant difference in coagulase.positive staphylococci and coagulase-negative staphylococci,and the value of U was 79.00(P<0.001).ROC analysis revealed the optimal cut-off value of 0.870 ng/ ml.There was a significant difference in the levels of PCT in Enterobacteriaceae and non fermentative bacteria and the value of U was 681.50(P=0.005).ROC analysis showed the optimal cutoff value was 3.310 ng/ ml.There was no significant difference in PCT between Staphylococcus and Enterococcus.The levels of CRP was no significant difference between the groups.Conclusion:Detection of PCT has certain value in discriminating of bloodstream infection by different bacterial species,which can provide the basis for the early rational use of drugs in patients with suspected bacteremia.The detection of PCT combined with the blood culture,can reduce the risk of failure in patients with severe infection,and improve the efficiency of treatment.