血清降钙素原检测在细菌性感染疾病早期诊断中的临床应用

Clinical application of serum procalcitonin detection in early diagnosis of bacterial infection

目的探讨血清降钙素原(PCT)检测在细菌性感染疾病早期诊断中的临床应用价值。方法选取347例感染性疾病患者为研究对象,根据病原学和血清免疫学确诊实验分为细菌性感染组(212例)和病毒性感染组(135例)。采用ATB细菌鉴定分析系统进行细菌培养及鉴定;采用乳胶增强免疫散射比浊法在罗氏Cobas E411型全自动电化学发光免疫分析仪上测定血清PCT和C反应蛋白(CRP)水平;统计对比分析各组指标的检测结果。结果细菌性感染组中,PCT检测结果阳性率为86.79%,明显高于病毒性感染组的6.67%(χ~2=214.519,P<0.001),且与细菌培养结果比较差异无统计学意义(χ~2=0.125,P=0.724)。ROC曲线分析结果显示,CRP、PCT、WBC及ESR的ROC曲线下面积分别为0.805、0.912、0.787和0.673,标准误(s)分别为0.050、0.053、0.041和0.028,95%置信区间分别为0.731~0.892、0.877~0.964、0.693~0.835和0.612~0.763。结论 PCT不仅可以作为早期诊断细菌性感染的特异性指标,还可用于细菌性感染与病毒性感染的鉴别诊断,同时动态监测PCT水平变化对治疗细菌性感染也有一定的指导作用,值得临床推广应用。

Objective To investigate the clinical value of detection of serum procalcitonin （PCT）in early diagnosis of bacterial infection.Methods A total of 347 patients with infections diseases were selected as research objects, and divided into bacterial infection group（ n = 212） and viral infection group （n = 135 ）.Bacterial culture and identification were carried out by ATB bacterial identification and analysis system.The serum levels of PCT and C-reactive protein（CRP） were measured by latex enhanced immune scattering turbidimetry on Roche Cobas E411 automated electrochemiluminescence immunoassay instrument. In addition,SPSS 13 statistical software was adopted to compare and analyze the test results of each group.Results In the bacterial infection group,the positive rate of PCT test was 86.79%, which was higher than that（ 6.67% ） of viral in- fection group（ X^2= 214.519,P〈0.001 ） ,and compared with bacterial cuhure results,difference was not statistically significant （X^2= 0.125,P= 0.724）.ROC curve analysis results also showed that the area of ROC curve of CRP, PCT, WBC and ESR were respectively 0.805,0.912,0.787 and 0.673,standard error （sx） were respectively 0.050,0.053,0.041 and 0.028,and 95% confidence intervals were respectively 0.731-0.892,0.877-0.964,0.693-0.835 and 0.612-0.763.Conclusion PCT can not only be used as a specific marker for early diagnosis of bacterial infection,but also for differential diagnosis of bacterial infection and viral infection.And dynamic monitoring of the levels of PCT changes also make certain guidance for the treatment of bacterial infection, and thus it is worthy of clinical application.