血清降钙素原在成人细菌性血流感染中的早期预测价值

摘要：目的 探讨血清降钙素原(procalcitonin，PCT)水平在成人细菌性血流感染中的早期预测价值。方法 选取2018年1 月至2019年12月云南省第二人民医院收治的339例成人细菌性血流感染患者(＞18岁)，按病原菌形态分为革兰阴性菌组231例， 与革兰阳性菌组108例，对两组PCT的测定结果进行统计分析，并绘制受试者工作特征(ROC)曲线找到适宜的PCT临界值(Cut-off 值)。结果 革兰阴性菌组PCT水平6.93(1.70~38.63)ng/mL明显高于革兰阳性组PCT水平1.03(0.30~4.54)ng/mL，差异具有统计学 意义(P＜0.05)；在革兰阴性菌组中，肺炎克雷伯菌PCT水平高于大肠埃希菌(P=0.007)和其他革兰阴性菌(P=0.006)，差异有统 计学意义；在革兰阳性组中，各细菌之间的PCT水平均无统计学差异(P＞0.05)；ROC曲线下面积为0.770(95%CI：0.718~0.823，P ＜0.01)，以1.97ng/mL为临界值时，血清PCT区分革兰阴性菌、革兰阳性菌所致血流感染的敏感度为70.56%，特异度为62.04%。结 论 PCT水平对革兰阴性菌和革兰阳性菌所致血流感染的鉴别具有一定临床应用价值；可结合PCT结果对病原菌做出初步判断，为 成人细菌性血流感染的抗感染治疗提供参考。

Value of procalcitonin in early predictive of bacterial bloodstream infections in adults

Objective To explore the early predictive value of procalcitonin (PCT) level between Gram positive and Gram-negative bacteria bloodstream infections in adults. Methods A total of 339 adult patients with bacterial bloodstream infections (>18 years old) treated in the second people's Hospital of Yunnan Province from January 2018 to December 2019 were divided into a Gram-negative bacteria group (n=231) and a Gram-positive bacteria group (n=108). Statistical analysis of PCT results of two groups and a ROC curve was used to find the appropriate cut-off value. Results Gram-negative bacteria PCT level of 6.93 (1.70~38.63)ng/mL was significantly higher than Gram-positive bacteria PCT level of 1.03 (0.30~4.54)ng/mL(P<0.05). Among Gram-negative bacteria group, the PCT level of Klebsiella pneumoniae was higher than those of Escherichia coli (P=0.007) and other Gram negative bacteria (P=0.006), and the difference was statistically significant. There was no significant difference in PCT level among Gram-positive bacteria group(P>0.05). The area under the ROC curve was 0.770(95%CI: 0.718~0.823, P<0.01). When 1.97ng/mL was used as the critical value, the sensitivity of bloodstream infections of Gram-negative bacteria was 70.56% and the specificity was 62.04%. Conclusion The level of PCT has a certain clinical value in the differentiation of bloodstream infections caused by Gram-positive bacteria and Gram-negative bacteria. The results of PCT can be combined with other tests to make a preliminary judgment of pathogens, which provides a reference for early anti-infection treatment of bacterial bloodstream infection in adults.