摘要
目的探讨降钙素原(PCT)、白介素6(IL-6)和PCT动态变化对危重病患者中心静脉导管相关性血行感染(CRBSI)的早期诊断及预后价值。方法对苏州九龙医院收治的36例中心静脉导管置管后怀疑CRBSI的危重病患者进行前瞻性研究。入组当天采集血样分析PCT、IL-6水平,同时留取血培养和导管标本,并于感染后第1、2、3、7天对患者行PCT监测。将患者分为CRBSI组与非CRBSI组,其中CRBSI组再分为感染控制组和感染未控制组,观察PCT动态变化与预后的关系。结果共有15例患者(41.67%)符合CRBIS诊断标准。在怀疑感染当天,CRBIS组的PCT和IL-6水平均明显高于非CRBIS组,差异有统计学意义(P<0.001和P<0.005)。ROC曲线分析显示:PCT和IL-6曲线下面积分别为0.832和0.78,理想的阳性和阴性预测CRBIS水平为4.3μg/L和464.5 ng/L,该临界值的敏感度为80.0%和77.3.%,特异度为95.2%和66.7%,阳性预测值为92.25%和61.12%,阴性预测值为86.95%和77.76%。在感染后第1、2、3、7天,感染控制组的PCT水平呈逐渐下降趋势,但感染未控制组仍保持在较高水平。结论 PCT和IL-6在早期诊断CRBSI中具有较高的特异性和阴性预测值,PCT的动态变化对病情预后有一定的预测价值。
Objective To evaluate the early diagnostic and prognosis value of procalcitonin (PCT), interleukin 6 (IL-6), and PCT kinetics for central venous catheter related bloodstream infections (CRBSI) in selected critically ill patients. Methods Thirty-six patients received central venous catheter, who were suspected of having CRBSI. All the patient blood samples were obtained for detection of PCT, IL-6 levels, and for blood culture on the first day, and catheter were also obtained for euhure. PCT levels were measured on day 1, 2, 3, and 7 after infection. The patients were divided into CRBSI group and non-CRBSI group. The CRBSI group was divided into controlled infeetion group and non-eontrolled infection group, and PCT kinetics for prognostic value was observed. Results Fifteen patients were diagnosed as CRBIS (41.67%). Levels of PCT and IL-6 were significantly higher in patients with CRBIS than those without CRBIS on the first infection day ( P 〈 0. 001 and P 〈 0. 005). The ROC curves indicated that the area under the curve (AUC) for PCT and IL- 6 was 0. 832 and 0.78, respectively. The cutoff points of PCT and IL-6 were set to be 4.3 tzg/L and 464.5 ng/L for patients with proven CRBSI, respectively. The corresponding sensitivity, specificity, positive predictive value, and negative predictive value were 80.0% and 77.3%, 95.2% and 66.7%, 92.25% and 61.12%, and 86.95% and 77.76%, respectively. PCT serum levels tended to decrease in patients with controlled CRBSI, whereas in non-controlled patients was proven to remain stably in high level. Conclusion PCT and IL-6 might be valuable early diagnostic parameters for CRBIS with high specificity and negative predictive value, and PCT kinetics has certain predictive value for the prognosis of CRBSI.
出处
《上海交通大学学报(医学版)》
CAS
CSCD
北大核心
2013年第11期1491-1495,共5页
Journal of Shanghai Jiao tong University:Medical Science
关键词
危重病
导管插入术
中心静脉
导管相关性血行感染
降钙素原
白介素6
critical illness
catheterization
central venous
catheter-related bloodstream infection
procalcitonin
interleukin 6