PCT、CRP、WBC在辅助诊断革兰阴性杆菌脓毒血症中的价值探讨

Discussion on the value of PCT,CRP and WBC in assisting diagnosis of gram-negativebacilli bacterial sepsis

目的探讨血清降钙素原(PCT)、C-反应蛋白(CRP)、白细胞(WBC)在革兰阴性杆菌脓毒血症病原菌的辅助诊断价值。方法回顾性分析2019年1月—2019年12月在吉林大学第一医院住院的革兰阴性杆菌脓毒血症患者479例,根据血培养报告的致病菌进行分组,大肠埃希菌(eco)组230例、肺炎克雷伯菌(kpn)组173例、铜绿假单胞菌(pae)组30例、鲍曼不动杆菌(aba)组29例和阴沟肠杆菌(ecl)组17例;比较各组间外周血PCT、CRP、WBC的差异,通过受试者工作特征曲线(ROC)评价上述指标对不同致病菌脓毒症的辅助诊断价值。结果(1)PCT在eco组升高的程度最低,且明显低于kpn、pae、aba和ecl组(P<0.05);CRP在eco组升高的程度最低,且明显低于kpn、pae、aba和ecl组(P<0.05);CRP在ecl组升高的程度最高,且明显高于eco和kpn二组(P<0.05);WBC增高,在各组间无明显差异(P>0.05);(2)PCT、CRP、WBC对革兰阴性杆菌脓毒血症的辅助诊断价值:PCT的cutoff值为时0.63 ng/mL时,其敏感度71.4%,特异度76.9%,其AUC为0.848(95%CI:0.816~0.880);CRP的cutoff值为33.58 mg/L时,其敏感度83.3%,特异度71.2%,AUC为0.782(95%CI:0.731~0.833);WBC的cutoff值为10.75×10^(9)/L时,其敏感度41.8%,特异度64.4%,ROC曲线下面积(AUC)为0.494(95%CI:0.432~0.556);PCT、CRP联合诊断的敏感度69.1%,特异度86.5%,AUC为0.9(95%CI:0.874~0.927)。结论不同革兰阴性杆菌脓毒血症患者PCT、CRP组间存在统计学差异;CRP和PCT对革兰阴性杆菌感染具有较高的诊断价值。PCT和CRP联合诊断效能优于单个指标的诊断效能。

Objective To investigate the value of serum procalcitonin(PCT),C-reactive protein(CRP)and leukocyte(WBC)in the diagnosis of gram-negative(G~-)bacillibacterial sepsis.Methods Retrospective analysis was performed on 479 cases of gram-negativebacillibacteria sepsis hospitalized in the First Hospital of Jilin University from January to December 2019,according to the pathogenic bacteria reported in blood culture,230 cases of Escherichia coli(eco)group,173 cases of Klebsiella pneumoniae(kpn)group,30 cases of Pseudomonas aeruginosa(pae)group,29 cases ofAcinetobacter baumannii(aba)group and 17 cases of Enterobacter cloacae(ecl)group were grouped;The differences of PCT,CRP,WBC in peripheral blood of each group were compared,and the auxiliary diagnostic value of the above indexes for different pathogenic sepsis was evaluated by the Receiver operating Characteristic curve(ROC).Results(1)PCT was the lowest in the eco group,and was significantly lower than the kpn,pae,aba,and ecl groups(P<0.05);CRP was the lowest in the eco group,and was significantly lower than the kpn,pae,aba,and ecl groups(P<0.05);CRP was the highest in the ecl group,and was significantly higher than the eco and kpn groups(P<0.05).WBC was increased,and there was no statistically significant difference between the groups(P>0.05);(2)The value of PCT,CRP and WBC in auxiliary diagnosis of gram-negative bacillibacterial sepsis:When the cutoff value of PCT is 0.63 ng/mL,its sensitivity is 71.4%,specificity is 76.9%,and AUC is 0.848(95%CI:0.816~0.880);When the cutoff value of CRP was 33.58 mg/L,its sensitivity was 83.3%,specificity was 71.2%,and AUC was 0.782(95%CI:0.731~0.833);When cutoff value of WBC is 10.75×10^(9)/L,its sensitivity is 41.8%,specificity is 64.4%,and area under ROC curve(AUC)is 0.494(95%CI:0.432~0.556);The combined sensitivity,specificity and AUC of PCT and CRP were 69.1%,86.5%and 0.9(95%CI:0.874~0.927).Conclusion There were statistically significant differences between the PCT and CRP groups of patients with different gram-negative bacillibacteria sepsis.CRP and PCT have high diagnostic value for gram-negativebacilli bacterial infection.The combined diagnostic efficacy of PCTand CRP was superior to that of a single index.