降钙素原检测在感染性疾病中的临床应用

Clinical application of detecting serum PCT on diagnosis of infectious disease

目的探讨降钙素原(PCT)、超敏C-反应蛋白(hs-CRP)及血清淀粉样蛋白(SAA)对局部和全身细菌感染的鉴别价值。方法通过测定局部细菌感染患者92例、全身细菌感染患者120例及非感染患者34例的PCT、hs-CRP和SAA值,分析PCT、hs-CRP和SAA在各感染组间的关系,并应用ROC曲线及logistic回归方程进行分析。结果局部细菌感染组、全身细菌感染组及非感染组间PCT、hs-CRP和SAA差异有统计学意义(P<0.05)。局部细菌感染组与全身细菌感染组间PCT、hs-CRP和SAA差异有统计学意义(P<0.05)。全身细菌感染组PCT、hs-CRP和SAA浓度水平高于其他两组,局部细菌感染组高于非感染组。PCT用于诊断全身细菌感染及其与局部细菌感染加以鉴别的敏感度、特异度、曲线下面积(AUC)明显高于hs-CRP和SAA。采用logistic回归分析,回归方程式为:log(p/1-p)=0.117+0.16×PCT+0.01×hs-CRP,方程中PCT的偏回归系数(B)为最大,表明PCT对局部感染与全身细菌感染有较高的鉴别诊断效能。结论血清PCT、hs-CRP和SAA可用于全身细菌感染性疾病的诊断。与hs-CRP和SAA相比,PCT是一个较好的全身细菌感染的诊断指标,有效地对局部感染和全身细菌感染加以鉴别,且对判断病情轻重及预后有较好的价值,可以指导临床早期用药。

Objective To explore the clinical value of detecting serum PCT, hs-CRP and SAA in distinguishing local bacterial infection from systemic bacterial infection, and to provide the experimental basis for the diagnosis and treatment of infectious disease. Methods The serum levels of PCT, hs-CRP and SAA were exmamined in tire patients with local bacterial infection（n = 92）, systemic bacterial infection（ n = 120） and in the patients without infection（n =34）. Tire relationships between the above indicators and bacterial infections were analyzed. ROC method and binary logistic regression were used to analyze the data. Results There were significant differences in the serum levels of PCT, hs-CRP and SAA among the three groups（ P 〈 0. 05 ）. There were significant differences in the senam levels of PCT, hs-CRP and SAA beween tile local bacterial infection group and the systemic bacterial infection group （ P 〈 0. 05 ）. The serum levels of PCT, hs-CRP and SAA in the patients with systemic bacterial infection was significantly higher than those in the patients with local bacterial infection and those without infection. The specificity, sensitivity and AUC of PCT were higher than those of hs-CRP and those of SAA for diagnosing systemic bacterial infection and for distinguishing local bacterial infection. The regression equation was log（ p/1 - p） = 0. 117 ＋ 0. 16 × PET ＋ 0. 01 × hs-CRP, which was obtained by the binaly logistic regression analysis, in which the partial regression coefficient（B） of PCT was the biggest in the equation, indicating that PCT had higher efficiency for distinguishing local bacterial infection from systemic infection. Conclusion The levels of serum hs-CRP, PCT and SAA can be used for the diagnosis of systemic bacterial infection. Compared with CRP, PCT is a good marker for the diagnosi of systemic bacterial infections, especially for the early diagnosis.