降钙素原和白细胞介素-6水平在细菌性血流感染鉴别诊断中的价值

目的探讨血清降钙素原(PCT)和白细胞介素-6(IL-6)水平对鉴别革兰阳性(G+)菌、革兰阴性(G-)菌血流感染的价值。方法将2017年12月至2019年12月于广东省人民医院治疗的血流感染患者195例纳入研究,其中G-菌感染者90例作为G-组,G+菌感染者105例作为G+组。另外,选取同期就诊的非血流感染者100例作为对照组。回顾性分析上述人群的PCT和IL-6检测结果,比较这两项指标在G-组、G+组、对照组间的差异。采用受试者工作特征曲线(ROC)分析PCT和IL-6的诊断效能。结果195例血流感染患者中,G-菌感染90例(占46.15%)、G+菌感染105例(占53.85%),G-组、G+组、对照组PCT水平中位数分别为4.2、0.8、0.1 pg/mL,IL-6水平中位数分别为247.9、47.0、11.9 ng/mL,各组间PCT和IL-6水平比较差异有统计学意义(P<0.05)。IL-6的ROC曲线下面积(AUC)为0.723,诊断界值为105.9 ng/mL,灵敏度为73.6%,特异度为65.3%;PCT的AUC为0.652,诊断界值为0.255 pg/mL,灵敏度68.1%,特异度57.4%。结论PCT和IL-6水平变化在G+菌、G-菌血流感染的诊断中有一定的临床参考价值。

The significance of procalcitonin and interleukin-6 levels in differential diagnosis of bacterial bloodstream infection

Objective To investigate the value of serum procalcitonin(PCT)and interleukin-6(IL-6)levels in differentiating gram positive(G+)bacteria and gram negative(G-)bacteria bloodstream infection.Methods A total of 195 patients with bloodstream infection who were treated in Guangdong Provincial People′s Hospital from December 2017 to December 2019 were enrolled in the study,including 90 patients with G-bacteria infection as G-group and 105 patients with G+bacteria infection as G+group.In addition,100 patients without bloodstream infection during the same period were enrolled as the control group.The results of PCT and IL-6 tests were analyzed retrospectively,and compared among G-group,G+group and control group.The diagnostic efficacy of PCT and IL-6 were analyzed by receiver operating characteristic(ROC)curve.Results In the 195 patients with bloodstream infection,90 cases(46.15%)were infected by G-bacteria and 105 cases(53.85%)were infected by G+bacteria.The median levels of PCT in G-,G+and control groups were 4.2,0.8 and 0.1 pg/mL,and IL-6 were 247.9,47.0 and 11.9 ng/mL,respectively.There were significant differences in the levels of PCT and IL-6 among the three groups(P<0.05).The area under the curve(AUC)of IL-6 was 0.723,the diagnostic cut-off value was 105.9 ng/mL,the sensitivity was 73.6%,the specificity was 65.3%;the AUC of PCT was 0.652,the diagnostic cut-off value was 0.255 pg/mL,the sensitivity was 68.1%,the specificity was 57.4%.Conclusion The changes of PCT and IL-6 levels have certain reference value in the diagnosis of G+bacteria and G-bacteria bloodstream infection.