重症监护病房细菌性血流感染监测中C反应蛋白和降钙素原的临床意义

目的探讨C反应蛋白（CRP）和降钙素原（PCT）在重症监护病房细菌性血流感染监测中的临床意义。方法回顾性分析北京世纪坛医院重症监护病房进行血液培养的154例患者临床资料，根据血培养结果分为阳性组（n=78）和阴性者（n=76）；血培养采血当日测定CRP和PCT结果，并对两组数据进行比较。血培养阳性组按革兰阳性菌（n=17）与阴性菌（n=61）再次分组，并对两小组患者的CRP和PCT水平进行比较。结果血培养阳性组CRP中位数124（11-217）mg／L]显著高于阴性组中位数62．3（7．39-200）mg／L，Z=-5．394，P〈0．01]；阳性组PCT中位数6．59（0．21～100）μg／L]亦显著高于阴性组中位数0．44（0．07-60．34）μg／L，Z=-8．896，P〈0．01]。革兰阳性菌组CRP中位数119（34．8～217）mg／L]与革兰阴性菌组中位数126（11～205）mg／L]差异无统计学意义；但革兰阴性菌组PCT中位数6．99（1．55～100）μg／L]显著高于革兰阳性菌组中位数2．04（0．21～46．69）μg／L，Z=-2．663，P〈0．053。结论在重症监护病房细菌性血流感染的监测CRP和PCT具有一定参考价值；与革兰阳性菌血流感染相比，革兰阴性菌血流感染的PCT值更高。

Clinical implication of C-reactive protein and procalcitonin in bloodstream bacte-rial infection in intensive care unit

Objective To evaluate the clinical implication of C-reactive protein and procalcitonin in bloodstream bacterial infec-tion in ICU. Methods The data of C-reactive protein and procalcitonin were analyzed retrospectively in 78 patients with positive blood culture and 76 patients with negative blood culture. C-reactive protein and procaleitonin were compared between these two patient groups. The C-reactive protein and procalcitonin values were also compared between the patients with gram-positive bloodstream infection （n = 17） and those with gram-negative bloodstream infection （n = 61）. Results The median （range） C-reac-tive protein level 124 （11-217） mg/L] was significantly higher in the patients with positive blood culture than in those with negative blood culture 62.3 （7.39-200） mg/L, Z = - 5. 394, P〈0.01 ）]. The procalcitonin level was significantly higher in the patients with positive blood culture -6. 59 （0.21-100） μg/L] than in those with negative blood culture （0.44 （0. 07-60.34） μg/L） （Z= - 8. 896, P〈0.01）]. C-reactive protein level did not show significant diference between the patients with gram-positive bloodstream infection 119 （34.8-217） mg/L] and those with gram-negative bloodstream infection 126 （11-205） mg/L]. However, the procalcitonin level was significantly higher in the patients with gram-negative bloodstream infection 6.99 （1.55-100） μg/L] than in those with gram-pos-itive bloodstream infection 2.04 （0. 21-46.69） μg/L, Z = - 2.663, P〈0. 05]. Conclusions C-reactive protein and procalcitonin show clinical implications in monitoring bloodstream bacterial infection in ICU. Procalcitonin level is higher in the patients with gram-negative bloodstream infection than in those with gram-positive bloodstream infection.