外周血不同感染性指标在血流细菌感染早期诊断价值的研究

Various infected markers in early diagnosis of blood bacterial infections

目的 探讨白细胞计数（White blood cell count, WBC）、中性粒细胞百分比（neutrophil percentage,NEU%）、C-反应蛋白（C-reactive protein,CRP）及降钙素原（procalcitonin,PCT）检测指标在血流细菌感染早期辅助诊断价值.方法 回顾性研究太原市第三人民医院2015年114例血流细菌感染患者（菌血症组）和247例非血流细菌感染患者（对照组）,同时检测WBC、NEU%、CRP及PCT等指标并进行统计学分析.采用受试者工作特征曲线（ROC）评价WBC、NEU%、CRP及PCT在血流细菌感染诊断的准确性.结果 菌血症患者与对照组患者性别和年龄差异无统计学意义（χ2=0.7731,t=0.9900,P〉0.05）.菌血症组和对照组WBC、NEU%、CRP和PCT水平比较应用Z检验,差异有统计学意义（P值均〈0.05）.菌血症组革兰阳性菌与革兰阴性菌间WBC、NEU%和CRP 水平比较差异无统计学意义（P值均〉0.05）,而PCT水平比较差异有统计学意义（P〈0.05）.以血培养阳性为阳性标准绘制ROC曲线,ROC曲线下面积比较,四项联合检测〉PCT〉CR〉NEU%〉WBC, 四项联合检测面积最大（0.834）,PCT曲线下面积（0.827）与四项联合检测曲线下面积差异无统计学意义.但大于CRP（0.721,Z=2.332,P〈0.05）、NEU%（0.677,Z=3.355,P〈0.01）及WBC（0.593,Z=3.786,P〈0.01）.结论 WBC、NEU%、CRP及PCT在血流感染中均有一定诊断价值,其中PCT诊断价值较高,并且能够预测革兰阳性或阴性细菌感染.

Objective To assess the early diagnostic value of white blood cell count （WBC）, neutrophil percentage （NEU%）, C-reactive protein （CRP） and procalcitonin （PCT） in blood bacterial infection.Methods Clinical data of 114 patients with bacterial blood stream infections（BSI group） and 247 patients without bloodstream infections （control group） admitted to Taiyuan Third People＆#39;＆#39;s Hospitalin 2015 were retrospectively analyzed.The WBC, NEU%, CRP and PCT were measured in all patients.Receiver opearating characteristic curve （Roc） was used to evalute the accuracy of WBC, NEU%, CRP and PCT in the diagnosis of blood stream bacterial infectious.Results There were no significant differences in gender and age between two groups （χ2=0.7731, t=0.9900, both 〉0.05）.The WBC, NEU%, CRP and PCT levels in BSI group were significantly higher than those in control group （all P〈0.05）.There were no significant differences in WBC, NEU% and CRP levels between G＋ bacterial and G-bacterial infections in bacteremia group （〉0.05）, while there was significant difference in PCT level （P〈0.05）.In diagnosis of bacteremia, the area under the ROC curve of PCT（0.827） was the largest, followed by CRP （0.721）, NEU% （0.677） and WBC （0.593）, the differences were statistically significant（Z=2.332, 3.355 and 3.786, P〈0.05 or 〈0.01）.Conclusion WBC, NEU%, CRP and PCT levels are of certain diagnostic value for bacterial bloodstream infections, particularly the PCT.In addition, PCT can predict G＋ bacterial and G-bacterial infections.