肝素结合蛋白对维持性血液透析患者导管相关感染的诊断价值

目的探讨肝素结合蛋白(HBP)在维持性血液透析患者导管相关感染诊断中的价值。方法选取该院收治的维持性血液透析患者75例为研究对象,根据是否发生导管相关性感染分为观察组(n=45)和对照组(n=30);检测两组患者血清HBP、降钙素原(PCT)和C反应蛋白(CRP)水平,采用ROC曲线分析各指标对导管相关性感染及革兰阴性菌感染的鉴别诊断价值。结果观察组病原菌培养检出革兰阳性菌感染34例,占75.6%,革兰阴性菌感染11例,占24.4%。观察组患者血清HBP、PCT和CRP水平显著高于对照组,且革兰阴性菌感染患者血清HBP、PCT水平也明显高于革兰阳性菌感染患者,差异均有统计学意义(P0.05)。HBP、PCT、CRP对细菌感染的曲线下面积分别为0.955、0.890、0.871,灵敏度为86.7%、88.9%、62.2%,特异度为93.3%、73.3%、93.3%。HBP对革兰阴性菌感染的鉴别诊断价值优于PCT和CRP,其ROC曲线下面积为0.818,最佳临界值为HBP27.52μg/L,灵敏度为100.0%,特异度为61.8%。结论血清HBP、PCT和CRP可作为诊断维持性血液透析导管相关细菌感染的重要检测指标,其中HBP对鉴别革兰阴性菌感染具有一定参考价值。

Value of HBP in diagnosis of catheter-related infections in maintenance hemodialysis patients

Objective To investigate the diagnostic value of Heparin-binding protein (HBP) in maintenance hemodialysis patients in catheter-related infections.Methods 75 patients with maintenance hemodialysis were enrolled in the study and divided into observation group(n=45,with catheter-related infections) and control group(n=45,without catheter-related infections).The serum HBP,procalcitonin (PCT) and C-reactive protein (CRP) levels were detected.The values in diagnostic of catheter-related infections and Gram-negative bacterial infections were analyzed by receiver operating characteristic(ROC) curve.Results There were 34 cases of patients infected by Gram-positive bacterial with the rate of 75.6% and 11 cases of patients infected by Gram-negative bacterial with rate of 24.4%.The serum HBP,PCT and CRP levels in observation group were significantly higher than those in control group and the serum HBP,PCT levels of patients infected by Gram-negative bacterial were higher than those of patients infected by Gram-positive bacterial (P<0.05).The area under curves of HBP,PCT,CRP in diagnosis of catheter-related infections were 0.955,0.890,0.871 with sensitivity of 86.7%,88.9%,62.2% and specificity of 93.3%,73.3%,93.3%.The value of HBP in diagnosis of Gram-negative bacteria infections was better than PCT and CRP.The area under ROC was 0.818 and the cut off value was HBP>27.52 μg/L with sensitivity of 100.0% and specificity of 61.8%.Conclusion Serum HBP,PCT and CRP may be the effective indicators for diagnosis of catheter-related infections,and the HBP has important reference value for diagnosis of Gram-negative bacterial infections.