血清降钙素原检测在呼吸道感染患者临床诊断中的应用

Application of Serum Procalcitonin Quantitative Detection in Diagnosis of Respiratory Tract Infection

目的探讨血清降钙素原(procalcitonin,PCT)在呼吸道感染患者临床诊断中的应用价值。方法对2013年6月—2015年6月解放军白求恩国际和平医院收治的呼吸道感染414例的血清PCT检测结果结合痰培养及9项呼吸道病原体Ig M抗体联合检测结果进行分析。结果 414例呼吸道感染中PCT检测阳性132例(31.88%)。痰培养阳性225例(54.35%),其中单纯细菌阳性160例(单纯革兰阳性菌11例,单纯革兰阴性菌96例,2种及以上细菌阳性53例),单纯假丝酵母菌阳性44例,假丝酵母菌合并细菌阳性21例。痰培养无病菌生长的189例9项呼吸道病原体Ig M抗体检测阳性66例(34.92%),全阴性123例(65.08%)。痰培养及9项呼吸道病原体Ig M抗体联合检测不同结果间PCT中位数及其阳性率比较差异均有统计学意义(P<0.05)。痰培养无病菌生长且9项呼吸道病原体Ig M检测全阴性与痰培养单纯革兰阴性菌阳性、2种及以上细菌阳性、假丝酵母菌合并细菌阳性PCT中位数及其阳性率比较差异均有统计学意义(P<0.05)。痰培养无病菌生长而9项呼吸道病原体Ig M抗体检测阳性与痰培养单纯革兰阴性菌阳性、2种及以上细菌阳性的PCT中位数及其阳性率比较差异亦均有统计学意义(P<0.05)。414例呼吸道感染中PCT阳性患者病死率(15.15%)明显高于PCT阴性患者病死率(3.55%),差异具有统计学意义(P<0.05)。结论血清PCT检测联合痰培养及9项呼吸道病原体Ig M抗体检测对诊断和鉴别诊断呼吸道感染具有重要的参考价值。血清PCT检测可作为快速排除和诊断细菌性呼吸道感染的重要手段。

Objective To investigate application values of serum procalcitonin（ PCT） in diagnosis of patients with respiratory tract infection. Methods PCT detection results of 414 patients with respiratory tract infection during June 2013 and June 2015 were analyzed combined with results of sputum culture and 9 Ig M type Zg M antibodys of respiratory pathogens. Results Among 414 patients with respiratory tract infection,positive PCT was found in 132 patients（ 31. 88%）,and positive sputum culture was found in 225 patients（ 54. 35%）,which included 160 only positive bacteria（ 11 cases of only gram-positive bacteria,96 cases of gram-negative bacteria,and 53 cases of two or more positive bacteria）,44 cases of only positive candida,and 21 cases of both candida and bacteria positive. Among 189 patients with negative sputum culture for pathogens,66 patients（ 34. 92%） were positive,and 123 patients（ 65. 08%） were negative for 9 Ig M type antibodys of respiratory pathogens. PCT median and positive rates in detection results by sputum culture and 9 Ig M type antibodys of respiratory pathogens showed statistically significant differences（ P〈0. 05）. Values of PCT median and positive rates between negative sputum culture for pathogens and negative 9 Ig M type antibodys of respiratory pathogens with gram negative bacteria group,two or more positive group,and candida combined with bacteria positive group showed statistically significant differences（ P〈0. 05）. Values of PCT median and positive rates between negative sputum culture for pathogens and positive 9 Ig M type antibodys of respiratory pathogens between positive gram negative bacteria group and two or more positive group showed statistically significant differences（ P〈0. 05）.Mortality rate of PCT positive patients（ 15. 15%） was significantly higher than 3. 55% of PCT negative patients in 414 patients with respiratory tract infection（ P〈0. 05）. Conclusion Serum PCT combined with sputum culture and 9 Ig M type antibodys of respiratory pathogens detection has important reference value in diagnosis of respiratory tract infection,so serum PCT detection can be regarded as a quick excluding and diagnosis test for respiratory tract infection.