降钙素原在局部感染及败血症早期临床诊断的价值评价

Clinical diagnostic value of procalcitonin detection in local infection and sepsis

目的评价血清PCT浓度在败血症早期诊断中的临床价值。方法检测不同感染病例的PCT、CRP、WBC、neu%和lym%,以SPSS软件进行ROC曲线分析,并采用binary logistc回归建立预测概率模型,获得新的统计量,计算各曲线下面积(AUC),获得最佳诊断点。结果PCT在血培养阳性、阴性组之间具有显著性差异(χ2=52.52,P<0.001),ROC曲线诊断标准选择为>2处的Youden指数最大,灵敏度为63.3%,特异性为86.8%;PCT、CRP、WBC、neu%和lym%的AUC分别为:0.700、0.765、0.636、0.618和0.648;PCT联合CRP、lym%检测的AUC为0.776,在0.566处的Youden指数结果最大,其诊断灵敏度为63.8%,特异性为84.7%。结论PCT在败血症早期鉴别诊断中有一定价值,PCT联合WBC、CRP和lym%等指标可提高败血症早期诊断的灵敏度和特异性。

Objective To evaluate the value of procalcitonin （PCT） detection in the diagnosis of local infection and sepsis. Methods PCT, C-reactive protein （CRP）, white blood cell count （WBC）, neutrophil ratio （neu% ） and lymphocyte ratio （lym%） were measured in patients with negative or positive blood culture test. The receiver operating characteristic （ROC） curves were constructed for PCT CRP, WBC, neu%, lym%, and the diagnostic model using SPSS software. Based on the binary logistic regression model, the predictors or probabilities were obtained and applied to establish the empirical and binormal model of the ROC curves to compare the area under the curve （AUC）. Results A highly significant difference in PCT concentrations was noted between the two groups （χ2=52.52, P0.001）, and the diagnostic criteria at 2 of the ROC curves resulted in the greatest Youden index with a sensitivity of 63.3% and specificity of 86.8%. The AUC of PCT, CRP, WBC, neu% and lym% were 0.700, 0.765, 0.636, 0.618 and 0.648, respectively; the combined predicted ROC AUC was 0.776. The maximum Youden index was acquired at the optimal cutoff point of 0.566 with a diagnosis sensitivity and specificity of 63.8% and 84.7%, respectively. Conclusions The PCT level is a valuable predictor for a rapid and reliable early diagnosis of sepsis. The diagnostic model based on the laboratory parameters, using the combined predictors of PCT, CRP and lym%, can be a useful means for predicting early-onset sepsis.