血清降钙素原联合血培养对重症医学科血流感染患者病原菌的早期预测价值

The early predictive value of serum procalcitonin combined blood culture in the early stage of pathogenic bacteria infection

目的探讨血清降钙素原(procalcitonin,PCT)联合血培养对重症医学科(intensive care unit,ICU)血流感染患者病原菌的早期预测价值。方法回顾性分析2012年1月至2015年6月我院ICU病房血培养阳性患者的临床资料,检测所有患者PCT水平,对检测结果进行统计学分析。结果107例血培养阳性患者中,革兰阴性菌感染者62例,占57.94%(62/107),革兰阳性菌感染者40例,占37.38%(40/107);真菌感染者5例,占4.68%(5/107)。革兰阴性菌、革兰阳性菌及真菌感染患者血清PCT检测结果差异有统计学意义(H=9.378,P=0.000)。革兰阴性菌感染患者血清PCT检测结果高于革兰阳性菌和真菌感染患者,真菌感染患者血清PCT检测结果高于革兰阳性菌感染患者,且差异均有统计学意义(P均<0.05)。107例感染者中,PCT的阳性率为78.50%(84/107)。革兰阴性菌、革兰阳性菌及真菌感染患者血清PCT检测阳性率差异有统计学意义(χ2=12.635,P=0.020)。革兰阴性菌感染患者血清PCT检测阳性率高于革兰阳性菌和真菌感染患者,革兰阳性菌感染患者血清PCT检测阳性率高于真菌感染患者,且差异均有统计学意义(P均<0.05)。当临界值为3.15 ng/m L时,血清PCT检测用于判断革兰阴性菌感染的受试者工作特征曲线下面积为0.895,灵敏度为84.0%,特异性为92.0%,阳性预测值为91.0%,阴性预测值为85.0%,阳性拟然比为10.50,阴性拟然比为0.17,约登指数为0.76。结论血清PCT与血培养联合检测对ICU感染患者病原菌的早期诊断有较高的预测价值。

Objective To investigate the early predictive value of serum procalcitonin（PCT） combined blood culture in intensive care unit（ICU） patients with blood infection. Methods Retrospective analysis the clinical data of ICU patients whose blood culture were positive from January 2012 to June 2015 in our hospital. The serum PCT levels of all the patients were detected, and the results were analyzed statistically.Results In 107 cases patients, 62 cases [57.94%（62 / 107）] patients were gram negative bacterial infection,40 cases[37.38%（40 / 107）] patients were gram positive bacterial infection, and 5 cases[4.68%（5 / 107）] patients were fungi infection. There were statistical significance in the difference of PCT levels among gram negative bacterial infection patients, gram positive bacterial infection patients and fungi infection patients（H =9.378,P= 0.000）. The PCT level of gram negative bacterial infection patients was higher than that of gram positive bacterial infection patients and fungi infection patients, and PCT level of fungi infection patients was higher than that of gram positive bacterial infection patients, and the differences all had statistical significance（Pall〈 0.05）. The positive rate of 107 cases of infection patients was 78.50%（84 / 107）. There were statistical significance in the difference of PCT positive rate among gram negative bacterial infection patients, gram positive bacterial infection patients and fungi infection patients（χ2= 12.635,P= 0.020）. The PCT positive rate of gram negative bacterial infection patients was higher than that of gram positive bacterial infection patients and fungi infection patients, and PCT positive rate of gram positive bacterial infection patients was higher than that of fungi infection patients, and the differences all had statistical significance（Pall 〈 0.05）. When the cutoff value was 3.15 ng / m L, the area under receiver operating characteristic curve was 0.895, sensitivity was84.0%, specificity was 92.0%, positive predictive value was 91.0%, negative predictive value was 85.0%,positive likelihood ratio was 10.50, negative likelihood ratio was 0.17, Youden index number was 0.76 of PCT level for diagnosing gram negative bacterial infection. Conclusion Serum PCT has high value in the early predict of pathogenic bacteria in ICU patients with blood infection.