多项指标联合检测在脓毒症患者革兰阴性菌血流感染的临床价值分析

Clinical value of combined detection of multiple indicators in bloodstream infection of gram-negative bacteria in patients with sepsis

目的研究C-反应蛋白(CRP)、血清降钙素原(PCT)及内毒素在革兰阴性(G-)菌血流感染所致脓毒症患者中早期诊断的临床应用价值,为临床治疗提供参考依据。方法选择2012年6月-2016年2月医院ICU病房收治确诊脓毒症患者112例,根据患者血样细菌培养结果,将其分为革兰阳性菌组(G+)29例组和G-组83例,对两组血流感染脓毒血症患者的炎症因子水平进行比较。结果 G-组患者血清PCT、内毒素、CRP水平都高于G+组,差异均有统计学意义(P<0.05);G+组、G-组及所有细菌组患者内毒素与PCT、CRP与PCT及内毒素与CRP间均呈正相关关系(P<0.05);G-、G+组特异性、曲线下面积以及敏感性均较高。结论 G-血流感染所致脓毒症患者PCT、内毒素、CRP水平高于G+血流感染者,3项指标在早期诊断G-血流感染所致脓毒症中具有重要的临床意义。

OBJECTIVE To study the clinical values of C-reactive protein（CRP）,serum procalcitonin（PCT）and endotoxin in the early diagnosis of sepsis caused by bloodstream infection of gram-negative（G-）bacteria,so as to provide references for clinical treatment.METHODS A total of 112 patients with sepsis in the ICU of the hospital were selected from Jun.2012 to Feb.2016.According to the bacterial culture results,the patients were divided into gram-positive bacteria group with 29cases（G＋）and gram-negative bacteria group with 83cases（G-）.The levels of inflammatory cytokines in sepsis patients with bloodstream infection were compared.RESULTS The levels of serum PCT,endotoxin and CRP in G- group were all higher than those in G＋ group（P0.05）.The levels of endotoxin and PCT,CRP and PCT,endotoxin and CRP in G＋ group,G- group and all patients in bacterial group had positive correlations（P0.05）.G-,G＋ specificity,area under the curve and sensitivity were higher.CONCLUSION The levels of PCT,endotoxin and CRP were higher in patients with sepsis caused by Gbloodstream infection than those with G ＋ bloodstream infection,and the three indexes had important clinical significances in the early diagnosis of sepsis caused by G-bloodstream infection.