降钙素原对发热早期急诊患者细菌感染的预测价值

Predictive value of procalcitonin for bacterial infection in patients with early fever in emergency department

目的 探讨在急诊科对发热早期的患者进行降钙素原（procalcitonin,PCT）检测对细菌感染的预测价值. 方法 收集急诊科2013-01-01 ～2013-09-06期间收治的在出现症状后6-12h就诊的发热患者,经筛选后入选患者82例,根据病情、检查及疗效将患者分为细菌感染组和非细菌感染组.比较两组间白细胞计数阳性率的差异及PCT阳性率的差异.同时比较白细胞计数和PCT对细菌感染预测是否有差异,以及联合PCT及白细胞计数有无叠加效应. 结果 白细胞计数及PCT在细菌感染组和非细菌感染组之间无论是数值上还是阳性率均差异显著（P＜0.05）,但是二者在预测细菌感染的灵敏度及特异度上并无差异.白细胞计数或PCT任一项阳性作为判断细菌感染的标准可以大大提高判断的灵敏度（76.7％）,但不提高特异度. 结论 白细胞及PCT均可以用于辅助鉴别急诊早期高热是否存在细菌感染,且PCT对细菌感染及非细菌感染的预测准确性并不优于白细胞.

Objective To explore the value of procalcitonin（PCT） detection in prediction of bacterial infection in patients with early fever in the emergency department.Methods Eighty-two patients with fever who visited a doctor in 6-12 h after symptoms appeared were collected in the emergency department of our hospital from January 1,2013 to September 6,2013.Patients were divided into bacterial infection group and non-bacterial infection group according to their illness,examination and effect of treatment.The positive rate of white blood cells count and the positive rate of PCT between two groups were compared.Meanwhile,the difference in prediction of bacterial infection between white blood cell count and PCT were compared as well.The additive effect of PCT and WBC count was compared.Results The positive rates and the concentrations of white blood cells count and PCT were significantly higher in bacterial infection group than in non-bacterial infection group（P ＜ 0.05）,while the sensitivity and specificity of white blood cell counts and PCT had no difference in prediction of bacterial infection.When either WBC count or PCT is positive as the standard of judging the bacterial infection,the sensitivity was increased（76.7％）,but not the specificity.Conclusion White blood cells count and PCT can both be used in assisted identification of bacterial infection in early fever,and the accuracy of PCT in prediction of bacterial infection is not superior to that of white blood cells count.