外周血指标联合检测对胞内与胞外细菌感染的鉴别诊断价值研究

Study on value of combined detection of peripheral blood indicators in differentiation diagnosis of intracellular and extracellular bacterial infection

目的分析血清降钙素原(PCT)、C-反应蛋白(CRP)与白细胞计数(WBC)在不同种类细菌感染时的临床价值。方法采用回顾性队列研究,按临床患者终诊结果将患者分为胞内菌组和胞外菌组,采用受试者工作特征曲线(ROC曲线)比较PCT、CRP和WBC 3项炎性指标对胞内菌和胞外菌感染的诊断价值,并计算PCT、CRP和WBC等3项指标联合对胞内菌和胞外菌感染阳性的检出率。结果胞内菌组中血PCT、CRP和WBC均低于胞外菌组,差异有统计学意义(P<0.05)。PCT和WBC诊断胞内菌感染的ROC曲线下面积(AUC)均在0.5~0.7,低于胞外菌感染。PCT、CRP和WBC 3项指标联合对胞内菌的阳性检出率为93%,单独的PCT指标及PCT+WBC 2项指标联合对胞内菌的阳性检出率分别为26%、33%。结论胞内菌和胞外菌感染时炎性指标WBC、PCT和CRP有较大差异,PCT和WBC对胞内菌感染诊断效果不理想。PCT正常值并不预示一定不存在感染,临床医师需要结合临床症状及其他指标,考虑是否有胞内菌感染。

Objective To evaluate the clinical value of procalcitonin（PCT）,C-reactive protein（CRP）and white blood cell count（WBC）in different kinds of bacterial infection.Methods A retrospective cohort study was adopted.The clinical patients were divided into the intracellular bacteria group and extracellular bacteria group according to the final diagnosis results.The receiver operating characteristic（ROC）curves were adopted to compare the diagnostic values of 3indicators of PCT,CRP and WBC for intracellular bacterial infection and extracellular bacterial infection.The positive detection rate of 3-indicator combined detection for the intracellular bacterial infection and extracellular bacterial infection was calculated.Results The levels of blood PCT,CRP and WBC in the intracellular bacteria group were all lower than those in the extracellular bacteria group,the difference was statistically significant（P0.05）.The areas under the curve（AUC）of PCT and WBC for diagnosing intracellular bacterial infection all were 0.5-0.7,which were lower than that of extracellular bacterial infection.The positive detection rate of combined detection of PCT,CRP and WBC for the intracellular bacteria was 93%,which of single PCT and 2-indicator combination of PCT＋WBC were 26% and33% respectively.Conclusion The inflammatory indicator PCT,CRP and WBC have greater difference in intracellular bacterial infection and extracellular bacterial infection.The diagnostic results of PCT and WBC for intracellular bacterial infection are unsatisfactory,therefore clinical doctors need to combine with clinical symptoms and other indicators and consider whether having intracellular bacterial infection.