降钙素原在肿瘤患者细菌血流感染鉴别中的临床价值研究

Clinical value of procalcitonin in identification of bacterial bloodstream infections in tumor patients

目的探讨血清降钙素原(PCT)水平对鉴别肿瘤患者细菌血流感染病原体的临床应用价值,为临床应用提供参考。方法收集2012年7月1日-2015年6月30日医院214例血培养结果阳性,并检测了血清PCT水平的肿瘤患者的临床资料;比较PCT水平、白细胞计数(WBC)和体温在革兰阴性菌、革兰阳性菌血流感染患者间的差异,同时根据受试者工作曲线(ROC)判断PCT的诊断价值。结果革兰阴性菌组和革兰阳性菌组PCT水平中位数分别为15.12、0.42ng/ml,革兰阴性菌组血清PCT明显高于革兰阳性菌组,组间比较差异有统计学意义(P<0.01);两组患者WBC计数、体温差异无统计学意义;根据ROC曲线,当界值设定为0.54ng/ml时,血清PCT水平区分革兰阴性菌与革兰阳性菌所致血流感染的灵敏度为83.1%,特异度为79.5%。结论血清PCT水平对鉴别革兰阴性菌与革兰阳性菌引起的肿瘤患者的血流感染有一定的提示意义,可为临床早期使用抗菌药物提供参考。

OBJECTIVE To explore the clinical value of procalcitonin （PCT） level in identification of bacterial blood-stream infections in tumor patients so as to provide guidance for clinical application. METHODS From Jul 1, 2012 to Jun 30, 2015, a total of 214 tumor patients who were positive for blood culture were enrolled in the study, the level of serum PCT was detected, and the clinical data of the patients were analyzed. The PCT level, white blood cell （WBC） counts, and body temperature were observed and compared between the patients with gram-negative bacteria infections and the patients with gram-positive bacteria infections, and the diagnostic performance of PCT was determined based on the receiver-operating-characteristic （ROC） curve. RESULTS The median PCT level of the gram-negative bacteria group was 15.12 ng/ml, significantly higher than 0.42 ng/ml of the gram-positive bacteria group（P〈0.01）. There was no significant difference in the WBC counts or body temperature between the two groups of patients. According to the ROC curve, when the critical value was set as 0.54 ng/ml, the sensitivity of the serum PCT level was 83.1% in discriminating from the bloodstream infection caused by gram-negative bacteria from the bloodstream infection caused by gram-positive bacteria, the specificity 79.5 %. CONCLUSION The serum PCT level of the tumor patients has certain indicating significance in distinguishing from the bloodstream infections caused by gram-negative bacteria to the bloodstream infections caused by gram-positive bacteria, and it can provide guidance for clinical use of antibiotics in early stage.