C-反应蛋白及降钙素原在血流细菌感染诊断中的应用价值

Value of C-reactive protein and procalcitonin in diagnosis of bloodstream infection

目的探讨c-反应蛋白（CRP）和降钙素原（PCT）在血流细菌感染诊断中的临床意义，为血流感染的早期诊断提供依据。方法回顾性分析123例血培养阳性患者及112例血培养阴性患者血培养采血当FtCRP和PCT测定结果，并对两组数据进行比较；血培养阳性组按革兰阳性菌与革兰阴性菌再次分组，数据采用SPSS16．O软件进行统计分析，血培养阳性组与阴性组间CRP、PCT的比较，阳性组内CRP、PCT的比较采用秩和检验。结果112例血培养阴性患者与123例血培养阳性患者其CRP阳性率分别为97．3oA和100．0％，PCT阳性率分别为31．3％和100．0％；血培养阳性组CRP测定值为18．9～217mg／L，显著高于血培养阴性组测定值3．5～138．8mg／L，差异有统计学意义（P〈0．01）；阳性组PCT测定值0．21～100ng／ml亦显著高于阴性组测定值0．02～1．76ng／ml（P〈0．01）；血培养阳性革兰阳性菌与革兰阴性菌组间CRP测定结果差异无统计学意义，而PCT测定结果差异有统计学意义（P〈0．05）。结论PCT与CRP可作为血流细菌感染的监测指标；革兰阴性菌血流感染的PCT较阳性菌血流感染的PCT值更高。

OBJECTIVE To evaluate the clinical significance of C-reactive protein （CRP） and procaleitonin （PCT） in diagnosis of bacterial bloodstream infections so as to provide basis for early diagnosis of blood stream infections. METHODS Totally 123 cases of patients with positive blood culture and 112 cases of patients with negative blood culture were enrolled in the study , then the blood specimens were collected to determine the CRP and PCT on the survey day, and the data were compared between the two groups; the patients with positive blood culture were divided into the gram-positive bacteria group and the gram negative bacteria group, the statistical analysis of the data was performed with the use of SPS 16.0 software, and the CRP and PCT were compared between the positive blood culture group and the negative blood culture group as well as within the positive blood culture group. RESULTS The positive rate of CRP of the 112 patients with negative blood culture was 97.3% , the 123 patients with positive blood culture 100.0% ; the positive rates of PCT were 31.3% and 100.0% , respectively. The CRP determination value of the positive blood culture group was （18. 9-217 ）mg/L , significantly higher than （3. 5- 138.8 ）mg/L of the negative blood culture group, the difference was significant （P〈0. 01）; the PCT determination value of the positive group was （0.21-100） ng/ml, significantly higher than （0.02-1.76） ng/ml） of the negative blood culture group （P〈0. 01）; the difference in the CRP determination value between the gram- positive bacteria and the gram-negative bacteria was not significant, but with statistical significance in the PCT determination value （P〈0. 05） . CONCLUSION PCT and CRP can be served as the monitoring indicators for the bacterial blood stream infections; the patients with gram-negative bacteria blood stream infections have higher PCT value than the patients with gram-positive bacteria blood stream infections.