本文選題：血流感染 + 降鈣素原�。� 參考：《中國(guó)感染與化療雜志》2016年05期

【摘要】：目的探討降鈣素原(PCT)、C反應(yīng)蛋白(CRP)、白細(xì)胞(WBC)計(jì)數(shù)、中性粒細(xì)胞(NEU)絕對(duì)數(shù)、NEU比率在早期輔助診斷血流感染(BSI)中的臨床應(yīng)用價(jià)值。方法回顧性分析2013年1月-2015年5月安徽醫(yī)科大學(xué)第一附屬醫(yī)院的住院患者中送檢血培養(yǎng)并同時(shí)檢測(cè)PCT、CRP和血常規(guī)的患者1 835例。按血培養(yǎng)結(jié)果將患者分為血培養(yǎng)陽(yáng)性組和血培養(yǎng)陰性組,比較兩組中PCT、CRP、WBC、NEU和NEU比率的水平變化,并繪制受試者工作特征(ROC)曲線評(píng)價(jià)各指標(biāo)的診斷價(jià)值。結(jié)果血培養(yǎng)陽(yáng)性患者189例,革蘭陰性菌109株(57.7%),革蘭陽(yáng)性菌60株(31.7%),念珠菌20株(10.6%)。血培養(yǎng)陽(yáng)性組PCT、CRP、WBC、NEU和NUE比率的中位數(shù)分別為6.04 ng/mL、90.00 mg/L、10.00×10~9/L、8.22×10~9/L、0.857 1;血培養(yǎng)陰性組PCT、CRP、WBC、NEU和NUE比率的中位數(shù)分別為0.31 ng/mL、38.52 mg/L、8.96×10~9/L、6.33×10~9/L、0.769 8。血培養(yǎng)陽(yáng)性組的各項(xiàng)結(jié)果均明顯高于血培養(yǎng)陰性組(P0.05)。革蘭陰性細(xì)菌組患者血清PCT 9.12(1.57~32.38)ng/mL明顯高于革蘭陽(yáng)性細(xì)菌組2.62(1.00~12.90)ng/mL(P0.05)和念珠菌組1.40(0.67~12.88)ng/mL(P0.05),且腸桿菌科細(xì)菌患者的PCT值11.45(2.20~37.58)ng/mL明顯高于不發(fā)酵糖革蘭陰性桿菌1.93(0.70~13.37)ng/mL(P0.05)。細(xì)菌組的CRP 92.17(45.11~151.08)mg/L明顯高于念珠菌組56.65(23.32~101.05)mg/L(P0.05),且革蘭陽(yáng)性細(xì)菌組CRP 93.93(46.67,147.86)mg/L高于念珠菌組(P0.05)。以血培養(yǎng)陽(yáng)性為陽(yáng)性標(biāo)準(zhǔn)繪制ROC曲線,PCT、CRP、WBC、NEU和NUE比率的AUC分別為0.793、0.662、0.555、0.591和0.665(P0.05),對(duì)BSI均有一定診斷價(jià)值,其中PCT、CRP和NUE比率的診斷價(jià)值最大。結(jié)論 PCT、CRP可作為BSI的輔助診斷指標(biāo),PCT水平對(duì)BSI的早期診斷價(jià)值更高。早期檢測(cè)PCT和CRP可以及時(shí)幫助BSI患者判斷病原菌類(lèi)型,及早治療改善預(yù)后。
[Abstract]:Objective to evaluate the clinical value of calcitonin (PCT) C-reactive protein (CRPU) count, neutrophil neutrophils (neu) absolute count and neutrophils (neu) ratio in the early diagnosis of blood flow infection (BSI). Methods from January 2013 to May 2015, 1 835 inpatients in the first affiliated Hospital of Anhui Medical University were examined for PCT CRP and blood routine test. According to the results of blood culture, the patients were divided into two groups: the positive group and the negative group. The changes of the ratio of NEU and WBCU were compared between the two groups, and the diagnostic value of each index was evaluated by drawing the operating characteristics of the subjects. Results there were 189 patients with positive blood culture, 109 Gram-negative bacteria, 60 Gram-positive bacteria, and 20 Candida. The median ratios of NUE and NUE in positive blood culture group were 6.04 ng / mL / L 10.00 脳 10 ~ (9) / L ~ (8.22) 脳 10 ~ (9) / L ~ (-1) / L ~ (0.857) 1, respectively, and the median of PCT / CRP / WBC ~ (NEU) and NUE ratio were 0.31 ng / m ~ (-1) ~ 38.52 mg / L ~ (8.96) 脳 10 ~ (9) / L ~ (-1) 6.33 脳 10 ~ (9) L / L = 0.769 8 / L respectively. The results of blood culture positive group were significantly higher than that of blood culture negative group (P 0.05). The serum PCT 9.12(1.57~32.38)ng/mL of patients with Gram-negative bacteria was significantly higher than that of patients with Gram-positive bacteria (2.621.00 ~ 12.90ng / mL P0.05) and Candida (1.400.670.670.88ng / mL P0.05N), and the 11.45(2.20~37.58)ng/mL of Enterobacteriaceae patients was significantly higher than that of non-fermentative gram-negative bacteria (1.930.70ng / L). The CRP 92.17(45.11~151.08)mg/L of bacterial group was significantly higher than that of Candida group (56.65 ~ 23.32 ~ 101.05 mg / L), and the CRP 93.93(46.67147.86)mg/L of Gram-positive bacteria group was higher than that of Candida group. The AUC of ROC curve drawn with positive blood culture as positive standard was 0.793U 0.662U 0.555U 0.591 and 0.665U P 0.05g, respectively, which had certain diagnostic value for BSI, and the diagnostic value of PCTV-CRP and NUE ratio was the greatest. Conclusion the level of PCT can be used as an auxiliary diagnostic index for BSI, and it is more valuable in the early diagnosis of BSI. Early detection of PCT and CRP can help BSI patients to judge pathogen types and improve prognosis.
【作者單位】： 安徽醫(yī)科大學(xué)第一附屬醫(yī)院檢驗(yàn)科;
【基金】：國(guó)家自然科學(xué)基金項(xiàng)目(81171618)
【分類(lèi)號(hào)】：R446.5

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