前降钙素原在门诊发热患者中诊断细菌感染的价值

Utility of procalcitonin as an diagnostic marker of bacteremia in outpatients with fever

目的探讨在门诊发热患者中前降钙原诊断细菌感染的价值。方法病例来源于2013年3月—2014年3月我科收治的发热患者,检测血降钙素原,结合细菌培养结果、最终诊断及抗生素治疗结果。评价前降钙素原鉴别细菌感染的诊断价值。结果共纳入216例患者,其中细菌培养阳性患者46例,非细菌感染组170例,分为局部感染组(n=29)、其他疾病组(n=118)和原因不明组(n=23)。降钙素原在细菌感染组明显增高(11.9±23.1vs1.2±10.3 ng/ml,P<0.05)。以0.4 ng/ml为分界点,敏感度和特异度分别是78.26%和80.59%。阴性预测值93.20%。结论针对发热患者,检测血清降钙素原水平可预测细菌感染,而且,低水平的降钙素原可排除细菌感染。因此,降钙素原的检测可指导内科医师抗菌素的合理应用。

Objective： To assess the ability of procalcitonin levels to differentiate bacterial from nonbacterial outpatients with fever. Methods： Serum samples and blood culture were obtained from 216 outpatients with fever between March 2013 and March 2014. We reviewed the final diagnosis and patient histories,including clinical presentation and antibiotic treatment. Results： A total of 216 outpatients with fevers were enrolled in this study： 46 patients with bacteremia（ bacterial infection group）; 170 withoutbacterial infection（ non-bacterial infection group）; PCT levels were significantly higher in patients with bacterial infection than in those with non-bacterial infection（ 11. 9 ± 23. 1 vs 1. 2 ± 10. 3 ng / m L,P〈0. 001）. The sensitivity and specificity were 78. 26% and 80. 59%,the negative predictive value were93. 20%,at a cutoff value of 0. 4 ng / m L. Conclusion In： Febrile outpatients,elevated PCT may help predict bacteremia; furthermore,low PCT levels were helpful for ruling out bacteremia as a diagnosis. Therefore,PCT assessment could help physicians limit the number of prescriptions for antibiotics.