PCT与CRP在粒细胞缺乏合并细菌感染中的诊疗价值

Diagnosis Value of PCT and CRP in Deficiency Complicated with Bacterial Infection in Granulocyte

目的：探讨降钙素原（ PCT）和C反应蛋白（ CRP）对粒细胞缺乏患者合并感染的预测价值。方法应用前瞻性研究方法，采集并分析2013年7月-2014年7月内蒙古自治区人民医院血液科收治的132例粒细胞缺乏患者，入院第2天、第4天、第6天、第8天、第10天测定PCT、CRP水平动态变化。结果入院第2天，细菌感染组PCT和CRP测定值及阳性数均明显高于非细菌感染组，其中PCT诊断细菌感染的敏感度为98．7％，特异性为98．2％，阳性预测值为98．7％，阴性预测值为98．2％，约登指数为0．969；与CRP的各项评价指标相比，PCT具有更佳的敏感度、特异性及准确率。细菌感染组经给予抗生素治疗，入院第6天PCT水平明显下降者，疗效佳，部分PCT无明显下降者，经调整抗生素治疗后，第8天、第10天PCT明显下降，治疗有效。 CRP无法提示感染类型，对疗效判断敏感度差。结论在粒细胞缺乏合并细菌感染的患者中，PCT比CRP具有更佳的敏感度、特异性，其鉴别诊断价值更高；通过检测PCT可及时了解患者感染程度、指导抗生素应用、调整治疗时间、判断疾病预后。

Objective To explore the values of the dynamic changes of C-reactive protein（ CRP） and procalcitonin （ PCT） in the diagnosis and treatment of infectious diseases.Methods By prospective study, the levels and dynamic changes of CRP,PCT were moni-tored and analyzed in 132 infectious patients on the 2 day admitted to hospital,and the 4,6,8,10 day after received antibiotic treatment. Results On the second day , determination of bacterial infection group PCT and CRP value and positive numbers were significantly high-er than non bacterial infection group.The sensitivity of PCT for the diagnosis of bacterial infection was 98.7%, the specificity was 98.2%, the positive predictive value was 98.7%, the negative predictive value was 98.2%, the Youden′s index was 0.969.Compared with the evaluation indexes of CRP, PCT had better sensitivity, specificity and accuracy.Bacterial infection group were treated with anti-biotic treatment.On the sixth day, the level of PCT decreased obviously and curative effect was good and there was no significant decrease in PCT level.Adjusted after antibiotic treatment, PCT decreased obviously on eighth days, tenth days, got the effect.CRP can′t prompt type of infection, and judge the curative effect of poor sensitivity.Conclusion In agranulocytosis complicated with bacterial infection pa-tients, the value of PCT is better than CRP in sensitivity, specificity, differential diagnosis.The detection of PCT can help us timely un-derstand the patients with infection, antibiotic use, adjust the treatment time, judge the prognosis of the disease.