降钙素原对重症患者抗感染治疗指导价值的临床研究

目的 研究重症患者抗感染治疗前及过程中血清降钙素原(PCT)、C反应蛋白(CRP)及白细胞计数(WBC)的变化对指导抗菌药物的选择和疗效判断的价值。方法 选取2013年1月至2014年12月收治的200例住院患者,在明确感染的前提下结合细菌培养结果分为细菌感染组130例和非感染组70例,对其进行血清PCT、CRP和WBC检测,比较两组患者治疗前和治疗过程中PCT、CRP及WBC计数之间的差别,并计算PCT、CRP和WBC诊断细菌感染的敏感度和特异度。结果 细菌感染组患者PCT和CRP检测值高于非感染组患者(P < 0.05),而WBC两组间差异无统计学意义(P > 0.05);PCT升高诊断细菌感染的敏感性(95.4%)和特异性(91.4%)要高于CRP和WBC(P < 0.05);在使用抗菌药物治疗前,革兰阴性菌(G^-菌)感染组患者的PCT高于革兰阳性菌(G⁺菌)感染组(P < 0.05)。抗菌药物治疗后,PCT水平下降幅度较CRP大(P < 0.05),WBC变化幅度较小(P < 0.05)。结论 PCT可作为感染性疾病初步诊断的指标之一,并可用于初步判断病原体及指导判断抗菌药物的疗效。

Clinical study of procalcitonin in guiding anti-infection treatment in critically ill patients

Objective To study the value of serum procalcitonin (PCT), C-reactive protein (CRP), white blood cell count (WBC) changes before and during the anti-infection treatment in guiding choice of antimicrobial drugs and therapeutic evaluation in critically ill patients. Methods On the premise of identified infection, together with the results of bacterial culture, 200 cases of hospitalized patients ever treated from Jan 2013 to Dec 2014 were divided into bacterial infection group (130 cases) and non-bacterial infection group (70 cases). The serum levels of PCT, CRP and WBC were detected and then their differences between the two groups before and during treatment were compared. The sensitivity and specificity of PCT, CRP and WBC for diagnosis of bacterial infections were calculated. Results The estimated values of PCT and CRP of bacterial infection patients were significantly higher than those of non-bacterial infection patients (P < 0.05), but the WBC difference between the two groups was not statistically significant (P > 0.05). Elevated PCT level resulted in higher sensitivity (95.4%) and specificity (91.4%) for diagnosis of bacterial infection than those of increased CRP and WBC. Before use of antimicrobial drugs, the PCT level in G^- bacterial infection patients was significantly higher than that in G⁺ bacterial infection patients (P < 0.05). But after antibiotic therapy, the decline of PCT level was significantly larger than that of CRP (P < 0.05), while the WBC level changed slightly. Conclusion Serum PCT level could be applied as an indicator of preliminary diagnosis of infectious diseases, and used to initially determine the pathogens and the efficacy of antibiotics.