发热患者降钙素原水平与血培养阳性检出时间相关性

Correlations between procalcitonin level and time to blood culture positivity of febrile patients

目的探讨降钙素原(procalcitonin,PCT)与血培养阳性时间(time to blood culture positivity,TTP),对发热患者菌血症感染严重程度的判断及指导临床诊治价值。方法选择2014-05至2016-04住院患者173例,血培养均为阳性,同时进行PCT水平的检测。将患者按其是否发热分为,发热组139例与非发热组34例,按发热程度分低、中等、高热及超高热组,统计各组PCT和TTP,比较各组间PCT和TTP相关性。结果发热组与非发热组PCT、TTP两项指标平均值分别为3.41 ng/ml,13.81 h和1.83 ng/ml、22.79 h。发热组血清PCT水平高于非发热组,TTP低于非发热组。两组间比较差异均有统计学意义(P<0.05)。发热各组平均PCT分别为2.16 ng/ml、2.41 ng/ml、3.65 ng/ml、4.03 ng/ml。从低热组到超高热组PCT的变化结果表明,随着发热程度的加重,TCT含量呈逐渐上升趋势,两组间比较差异有统计学意义(P<0.05)。TTP结果表明,从低热组到超高热组TTP呈逐渐下降趋势。差异有统计学意义(P<0.01)。结论 PCT与发热患者菌血症感染程度呈正相关,表明菌血症越严重,PCT结果越高。TTP与发热患者菌血症感染程度呈负相关,表明菌血症越严重,TTP结果越短。将PCT与TTP两者结合检测,对临床预测感染程度有重要的参考价值。

Objective To explore the role of procalcitonin（ PCT） and time to blood culture positivity（ TTP） in evaluating the severity of bacteremia among febrile patients and the clinical implications. Methods 173 hospitalized patients who were positive in bacterial culture and treated between May 2014 and April 2016,were enrolled in this study and detected with PCT. These patients were divided into two groups： fever group（ n = 139） and non-fever group（ n = 34）; The fever group was further divided into low,medium,high and ultra-high fever groups. PCT and TTP were statistically analyzed and compared between the two groups. Results The mean values of PCT and TTP were 3. 41 ng / ml and13. 81 h,respectively,in fever group,but 1. 83 ng / ml and 22. 79 h,respectively,in non-fever group. Serum PCT level of fever group was higher than that of non-fever group,but TTP of fever group was lower. PCT and TTP were significantly different between fever and non-fever groups（ P 0. 05）. The mean values of PCT in four fever groups were2. 16 ng / ml,2. 41 ng / ml,3. 65 ng / ml and 4. 03 ng / ml respectively. PCT level tended to increase from low fever to ultra-high fever groups. There was significant difference between these fever groups（ P 0. 05）. The mean values of TTP in four fever groups were27. 35 h,22. 60 h,13. 27 h and 10. 46 h respectively. There was significant difference between these fever groups（ P 0. 01）.Conclusions PCT is positively associated with bacteremia infection levels of febrile patients,while TTP is negatively associated. PCT and TTP values can play an important role in predicting the level of bacteremia infection.