血清降钙素原联合痰培养检测在呼吸道感染中的临床应用价值

Clinical value of sputum culture and procalcitonin quantitative detection in diagnosis of respiratory tract infection

目的探讨血清降钙素原（PCT）联合痰培养检测在呼吸道感染疾病中的临床应用价值。方法对2013年4月-2014年3月南京大学医学院附属鼓楼医院516例确诊为呼吸道感染患者同时送检的首次痰培养及PCT检测结果进行分析,比较患者痰培养结果与血清PCT浓度的关系,分析革兰阴性细菌、革兰阳性细菌及真菌感染后患者体内PCT分布水平的差异。结果 516例呼吸道感染患者中,痰培养阳性344例（66.6%）,PCT阳性201例（39.0%）,痰培养和PCT联合检测阳性（即任一指标阳性为阳性）383例（74.2%）。18例痰培养阴性的患者PCT水平为0.29（0.12,0.51）μg/L,154例痰培养结果为口腔正常菌群的患者PCT水平为0.26（0.14,0.49）μg/L,344例痰培养结果为病原菌的患者PCT水平为0.81（0.21,3.68）μg/L。痰培养结果为病原菌的患者PCT水平明显高于痰培养阴性患者和痰培养结果为口腔正常菌群的患者,差异有高度统计学意义（P〈0.01）。PCT在革兰阴性细菌、革兰阳性细菌及真菌中的阳性率分别为61.7%（50/81）、57.1%（8/14）及60.1%（98/163）,比较革兰阴性细菌感染、革兰阳性细菌感染及真菌感染患者的PCT水平,差异无统计学意义（P〉0.05）。结论 PCT联合痰培养检测扩大了呼吸道感染疾病的检测范围,可作为快速排除和诊断呼吸道感染的重要检测手段,对呼吸道感染性疾病诊断、鉴别具有重要的临床应用价值。

Objective To explore the value of procalcitonin quantitative detection and sputum culture in the diagnosis of respiratory tract infections. Methods From April 2013 to March 2014, in Drum Tower Hospital Affiliated of Nanjing University Medical School, 516 cases of patients with respiratory tract infection were selected, results of the PCT and sputum culture were analyzed. The relationship between sputum culture and PCT concentrations was compared; the distribution of PCT levels in patients of Gram-negative bacteria, Gram-positive bacteria and fungal infection was summarized. Results Among 516 patients with respiratory tract infection, the positive ratios of sputum culture results and procalcitonin were respectively 66.6%（344 cases）, 39.0%（201 cases）, sputum culture and procalcitonin joint determination of total positive rate（mean either a positive indicator is positive） was 74.2%（383 cases）. The PCT level of 18 sputum culture-negative patients was 0.29（0.12, 0.51） μg/L; 154 sputum culture results of normal oral flora was0.26（0.14, 0.49） μg/L; 344 sputum culture results of pathogen was 0.81（0.21, 3.68） μg/L. The PCT level of sputum culture results of pathogen was higher than that of sputum culture-negative patients, the difference was statistically significant（P〈0.01）. The positive rates of PCT in Gram-positive bacteria, Gram-negative bacteria and fungal infection were 61.7%（50/81）, 57.1%（8/14） and 60.1%（98/163）, the difference was not statistically significant（P〉0.05）.Conclusion The detection of sputum culture and procalcitonin quantitative is conducive to the diagnosis of Respiratory tract infections. It is an important indicator of disease diagnosis, efficacy testing and disease prognosis that can reduce the misjudgment of bacterial contamination, bacterial colonization of the respiratory tract infection.