降钙素原鉴别恶性肿瘤患者发热原因的价值

Study on the Value of Serum Procalcitonin in the Differential Diagnosis of Fever in Cancer Patients

目的探讨血清降钙素原在恶性肿瘤患者发热原因鉴别诊断中的应用价值。方法采用金标半定量法分析90例发热且已经微生物培养证明存在细菌感染的恶性肿瘤患者（研究组）和30例非感染导致发热的恶性肿瘤患者（对照组）的PCT水平,比较两者的差异。结果在细菌感染导致发热的恶性肿瘤患者中,PCT的浓度为（10.25±1.45）ng/m L,而在非感染因素导致发热的恶性肿瘤患者中PCT浓度仅为（0.21±0.13）ng/m L。研究组PCT水平明显升高,阳性率高达85.6%,而对照组PCT阳性率仅为13.3%。与对照组相比,研究组PCT水平明显升高（P〈0.05）,两者之间的差异存在统计学意义。PCT诊断革兰阴性杆菌的灵敏度、特异度和准确率分别为86.6%、90.7%、88.2%;PCT诊断革兰阳性杆菌的灵敏度、特异度和准确率分别为82.6%、90.7%、87.9%。PCT的检测结果回报时间约2 h,明显短于细菌培养＋鉴定的时间48～72 h。结论 PCT水平可以作为鉴别恶性肿瘤患者发热原因的重要依据,从而为发热原因的早期诊断和抗生素治疗提供临床依据。

Objective To investigate the differential diagnosis value of serum procalcitonin（ PCT） in cancer patients with fever. Methods To compare the value of procalcitonin（ PCT） between 90 cases of cancer patients with fever caused by bacterial infection and 30 cases of cancer patients with fever caused by non-infection. Results In the group of bacterial infection,the mean concentration of procalcitonin（ PCT） was（ 10. 25 ± 1. 45） ng / m L,while in the group of non-infection group,mean concentration of PCT was（ 0. 21 ± 0. 13） ng / m L; The concentration of procalcitonin（ PCT） in infection group was significantly higher than that of non-infection group. In addition,the positive rate of infection group was 85. 6%,which was also significantly higher than the non-fection group（ 13. 3%）（ P〈0. 05）. The sensitivity,specificity and accuracy of PCT diagnosis of Gram-negative bacteria was 86. 6%,90. 7%,88. 2%,respectively; 82. 6%,90. 7%,87. 9% respectively in Gram-positive bacteria. The time of diagnosis of PCT test was about 2 hours,significantly shorter than that of bacterial culture and identification（ 48- 72 hours）. Conclusion PCT levels can be used as an important indicator to identify the causes of fever in cancer patients,which is helpful for physicians applying antibiotic therapy earlier according to serum PCT values.