降钙素原在细菌感染中临床应用的研究

Clinical study on diagnostic value of serum procalcitonin applied in patients with sepsis

目的探讨血清降钙素原(PCT)在细菌感染中的临床应用价值。方法选取2007年8月-2008年10月入院疑为细菌感染患者共63例,健康体检人员21例,根据ACCP/SCCM共识会议及临床相关表现将入选病例分为脓毒血症组、细菌感染性SIRS组、局部细菌感染组及正常对照组各21例,对其进行血清降钙素原(PCT)、超敏C-反应蛋白(hsCRP)及外周血白细胞计数(WBC)水平的测定及比较;全部病例于入院治疗前、使用抗菌药物24 h、5、9 d及出院前测定血清PCT,hsCRP,WBC水平。结果在抗菌药物治疗前,血清PCT在细菌感染性SIRS组中轻度升高,为(1.19±0.31)ng/ml,在脓毒血症组中显著升高为(29.88±9.38)ng/ml;脓毒血症组中血清PCT水平明显高于细菌感染性SIRS组和局部细菌感染组,两两比较差异有统计学意义(P<0.01);动态监测脓毒血症组发现,在抗菌药物治疗后血清PCT可快速下降,由(24.52±5.02)ng/ml降至(0.49±0.14)ng/ml,而hsCRP、WBC在细菌感染被控制后仍维持在高水平,分别为(72.3±20.4)～(33.2±9.7)ng/ml、(17.4±10.6)～(12.4±4.1)×109/L,其回落速度慢于血清PCT。结论血清PCT检测可作为全身细菌感染早期诊断的指标,对全身细菌感染诊断具有良好的敏感性和特异性;血清PCT检测能动态监测脓毒血症患者病情变化,能反映细菌感染的严重程度,为临床医师评估病情转归提供客观依据;血清PCT检测的结果可反映抗菌药物的疗效,能为临床医师及时调整抗菌药物提供依据。

OBJECTIVE To investigate the clinical application value of the serum PCT in bacterial infection.METHODS A total of 63 hospitalized patients with suspected bacterial infections from Aug 2008 to Oct 2009 were selected in hospital.All patients were determined the level of serum PCT,HSCRP,and WBC before treatment,after the use of antibiotics for 24h,5 days,10 days and before discharge.RESULTS In pre-antibiotic treatment,serum PCT didn′t increase in the local bacterial infection group（N group）,mildly increase in the bacterial infectious SIRS group（1.19±0.31）ng/ml（N group） and significantly increased in sepsis group（29.88±9.38）ng/ml.while the hsCRP and WBC are significantly increased in the bacterial infectious SIRS group（NS group） and sepsis group（S group）.In pre-antibiotic treatment,Serum PCT levels of sepsis group（S group） were significantly higher than that of bacterial infectious SIRS group（NS group） and there existed the significant differences between the two groups（P〈0.01）.dynamic observate PCT,hsCRP and WBC of Sepsis group（S groups）,serum PCT can rapidly increase at the early infection.hsCRP,WBC remain higher after controlling the infection（72.3±20.4）～（33.2±9.7）ng/ml,（17.4±10.6）～（12.4±4.1）×109/L,and they decline slower than serum PCT.PCT has a good sensitivity（95.2%） and specificity（100%） in sepsis group（S group）,and they were all higher than those of hsCRP and WBC.CONCLUSIONS Detection of serum PCT can serve as the early diagnosis indicator of bacterial infection.Serum PCT for the diagnosis of sepsis has a high sensitivity and specificity.Detection of serum PCT can dynamically monitor the state of an illness in patients with sepsis,reflect the severity of bacterial infection,and provide objective evidence for clinicians to assess the disease prognosis.The results are superior to hsCRP and WBC.The results of serum PCT test can reflect the efficacy of antibiotics,and provide guidelines for clinicians to adjust the antibiotics in time.