血清降钙素原在重症急性胰腺炎病人菌血症诊断中的应用

Serum procalcitonin for prediction of bacteremia in patients with severe acute pancreatitis

目的:探讨重症急性胰腺炎(SAP)病人发生菌血症时,测定血清降钙素原(PCT)的临床意义。方法:选择我院普通外科ICU收治的SAP病人203例,进行外周血培养,并监测血清PCT浓度、C-反应蛋白(CRP)、全血白细胞计数(WBC)和中性粒百分比(NC)的变化。结果:在203例SAP病人中,血培养阳性79例,阴性124例。血培养阳性的病人血清PCT水平显著高于血培养阴性病人(P<0.05)。CRP浓度和NC%亦明显高于血培养阴性组(P<0.05);ROC分析显示,SAP血培养阳性病人的血清PCT分界值为2 ng/ml(P<0.05),灵敏度为84.8%,特异性为90.3%。结论:血清PCT可预测SAP病人的菌血症,敏度和特异性较高,对SAP并发菌血症的诊断具有良好的临床参考价值。

Objective： To investigate the role of serum procalcitonin （PCT） in predicting bacteremia in patients with severe acute pancreatitis （SAP）. Methods ： A total of 203 patients with SAP who admitted in our hospital between July, 2014 and March, 2016 were included in this study. The peripheral blood was collected from the patients to detect the growth of microorganisms. Serum PCT levels were measured by electricity chemiluminescence, and levels of C-reactive protein （CRP） , the counts of peripheral white blood cells （ WBC ） and the percent of neutrophils （ NC ） were also assessed. Results ： Of 203 patients, the blood culture was positive in 79 cases, while negative in remaining 124 cases. Serum PCT concentrations were significantly higher in patients with positive blood cultures than in cases with negative cultures （P 〈 0.05 ）. Plasma levels of CRP and NC% were significantly increased in culturingpositive patients as compared to those with negative cultures. Based on the ROC analysis, we showed that a concentration of serum PCT more than 2 ng/mL was suitable for determining the occurrence of bacteremia in SAP patients, with high sensitivity and specificity of 84.8% and 90.3%, respectively. Conclusion： Serum PCT might be chosen as a diagnostic marker to predict whether the SAP patients were implicated with bacteremia. Our data have important implication for clinical diagnosis of infections in SAP patients.