降钙素原在败血症中的诊断意义

Clinical significance of procalcitonin in diagnosis of sepsis

目的通过分析血清降钙素原(PCT)在由革兰阴性菌和革兰阳性菌引起败血症患者中的血清浓度,明确PCT对不同菌引起败血症的诊断意义,为早期治疗提供理论依据。方法搜集医院发热患者145例,血培养阳性患者74例,阴性患者71例;血培养阳性患者中革兰阴性菌和革兰阳性菌各37例,比较不同组间PCT血清浓度。结果革兰阳性菌引起败血症以表皮葡萄球菌为主占21.62%,革兰阴性菌引起败血症以肺炎克雷伯菌为主占18.92%;通过比较3组间PCT表达水平,发现革兰阴性菌组PCT血清浓度明显高于革兰阳性菌组和血培养阴性组患者,而革兰阴性菌或革兰阳性菌不同菌间PCT表达差异无统计学意义;通过ROC曲线分析发现PCT诊断革兰阴性菌引起败血症的灵敏度为81.0%、特异性为93.0%、曲线下面积为92.0%。结论 PCT对于革兰阴性菌引起败血症具有较高的诊断价值,而对于非败血症及革兰阳性菌引起的败血症诊断意义不大。

OBJECTIVE To analyze the concentrations of serum procalcitonin（PCT）of the patients with sepsis induced by gram-negative bacteria and gram-positive bacteria and define the clinical significance of PCT in diagnosis of the sepsis so as to provide theoretical basis for early treatment.METHODS A total of 145 fever patients were enrolled in the study,including 74 cases with positive blood culture and 71 cases of with negative blood culture.Among the patients with positive blood culture,there were 37 cases with gram-negative bacteria cultured positive and 37 cases with gram-negative bacteria cultured positive.RESULTS The Staphylococcus epidermidis was the predominant species of gram-positive bacteria causing the sepsis,accounting for 21.62%,and the Klebsiella pneumoniae was dominant among the gram-negative bacteria causing the sepsis,accounting for 18.92%.As compared with the expression of PCT among the three group,the concentration of serum PCT of the gram-negative bacteria group was significantly higher than that of the gram-positive bacteria group and the negative blood culture group,however,there was no significant difference in the expression of PCT between the different species of gram-negative bacteria or gram-positive bacteria.The ROC curve analysis showed that the sensitivity of the PCT in diagnosis of sepsis caused by the gram-negative bacteria was 81.0%,the specificity 93.0%,the area under curve92.0%.CONCLUSIONThe PCT has significant value in the diagnosis of sepsis caused by the gram-negative bacteria but has little significance in the diagnosis of non-sepsis or the sepsis caused by the gram-positive bacteria.