血清降钙素原对ICU血流感染患者菌种鉴别中的应用研究

The clinical value of PCT levels in bacteria identification in ICU patients with bloodstream infection

目的 探讨血清降钙素原（PCT）水平测定在ICU血流感染患者菌种鉴别中的应用价值.方法 对本院ICU 2007年12月至2013年12月收治的540例血流感染患者的PCT水平进行检测并对患者标本分离的菌种进行鉴别,分析PCT水平在鉴别血流感染菌种的有效性.结果 540例血流感染患者中,G＋菌感染患者比例最高（49.63％）,G-菌感染患者比例次之（38.52％）,真菌感染患者比例最低（11.85％）,三者间差异有统计学意义（P＜0.05）.G-菌感染组PCT水平及阳性率均显著高于G＋菌感染组和真菌感染组,差异有统计学意义（P＜0.05）,G＋菌和真菌感染组之间差异无统计学意义（P＞0.05）.PCT界定为2.04 ng/ml时,血清PCT水平区分G-和G＋的灵敏度和特异度分别为82.18％和76.09％;PCT界定为3.16 ng,/ml时,血清PCT水平鉴别血流感染G-菌与真菌种的灵敏度和特异度分别为59.42％和65.73％.结论 应用血清PCT水平鉴别G-菌与G＋菌、真菌所致血流感染具有较高的临床价值,PCT水平≥2.04 ng/ml时,发生G-菌感染几率较大,PCT水平对G＋菌与真菌的鉴别准确度较差.

Objective To investigate the clinical value of procalcitonin （PCT） levels in bacteria identification in intensive care unit （ICU） patients with bloodstream infection.Methods There were 540 cases of patients with bloodstream infection in our ICU between December 2007 and December 2013.The PCT levels and bacteria were identified.The application effectiveness of PCT levels in the bacteria identification was studied.Results The G＋ bacteria infection rate was 49.63% （268/540）,G-bacteria infection rate was 38.52% （208/540）,and the fungal infection rate was 11.85% （64/540）.The patients of G-bacteria had significant difference with G ＋ bacteria and fungal infection （P 〈 0.05）.The PCT average and positive rate of G-bacteria were significantly higher than G ＋ bacteria and fungi group （P 〈 0.05）,respectively.G＋ bacteria and fungi infection did not have significant difference （P 〉 0.05）.When PCT 〉 2.04 ng/ml,the sensitivity and specificity that applying serum PCT level to identify the between G-and G＋ bacteria were 82.18% and 76.09%,respectively.When PCT 〉3.16 ng/ml,the sensitivity and specificity that applying serum PCT level to identify the between G-and fungus bacteria were 59.42% and 65.73%,respectively.Conclusions The identification between G-bacteria and G ＋ bacteria,fungi with applying PCT level in bloodstream infections had high accuracy.When the PCT levels was greater than 2.04 ng/ml,the occurrence of G-bacteria was greater risk of infection.The accuracy of PCT level identifying the G ＋ bacteria and fungi was poor.