降钙素原、超敏C反应蛋白、白细胞介素6、白细胞联合检测在2型糖尿病血流感染诊断中的应用

Application of combined detection of PCT,hs-CRP,IL-6 and WBC in diagnosing type 2 diabetes mellitus bloodstream infection

目的通过分析2型糖尿病血流感染患者和非血流感染患者外周血降钙素原(PCT)、超敏C反应蛋白(hs-CRP)、白细胞介素-6(IL-6)及白细胞(WBC)水平,探讨4种炎症指标单一和联合检测在2型糖尿病血流感染诊断中的应用价值。方法回顾性分析2013年1月至2016年7月该院确诊为2型糖尿病血流感染患者85例(糖尿病血流感染组)和同期2型糖尿病非血流感染患者80例(糖尿病非血流感染组)临床资料,分析两组患者外周血各炎症指标水平,绘制各炎症指标受试者工作特征曲线(ROC曲线),计算出曲线下面积(AUC)和最佳临界值,检测方案分为单项目、2项目、3项目和4项目检测共24种方案。结果糖尿病血流感染组PCT、hs-CRP、IL-6和WBC水平均明显高于糖尿病非血流感染组,差异有统计学意义(P<0.05)。PCT、hsCRP、IL-6和WBC的AUC分别为0.909、0.818、0.838、0.760,最佳临界值依次为0.493ng/mL、11.19ng/mL、40.95pg/mL、11.87×109/L。PCT检测的约登指数和IL-6的准确度在单项目中最高;方案PCT/hsCRP、PCT+hs-CRP+IL-6的约登指数和准确度在联合检测方案中最高。结论 PCT检测在辅助诊断中有突出的价值,联合检测方案中PCT/hs-CRP、PCT+hs-CRP+IL-6对2型糖尿病血流感染的辅助诊断最有价值。

Objective To investigate the application value of single detection and combined detection of 4 kinds of inflammatory indicators of procalcitonin(PCT),high sensitivity C-reactive protein(hs-CRP),interleukin-6(IL-6)and white blood cell(WBC)in diagnosing type 2 diabetes mellitus(T2 DM)bloodstream by analyzing the levels of peripheral blood PCT,hs-CRP,IL-6 and WBC in the T2 DM bloodstream infection group and T2 DM non-bloodstream infection group.Methods The clinical data in 85 patients with T2 DM bloodstream infection(T2 DM bloodstream infection group)and contemporaneous 80 cases of T2 DM non-bloodstream infection(T2 DM non-bloodstream infection group)in this hospital from January 2013 to July 2016 were retrospectively analyzed.The levels of various inflammatory indicators in peripheral blood were analyzed.The receiver operating characteristic(ROC)curve of various inflammatory indicators was drawn,the area under the curve(AUC)and the best cut-off value were calculated.The detection schemes included 24 kinds of schemes such as the single indicator,2-indicator,3-indicator and 4-indicator.Results The levels of PCT,hs-CRP,IL-6 and WBC in the T2 DM bloodstream infection group were significantly higher than those in the T2 DM non-bloodstream infection group,the difference was statistically significant(P<0.05).AUC of PCT,hs-CRP,IL-6 and WBC were 0.909,0.818,0.838 and 0.760 respectively,with best cut-off values of 0.493 ng/mL,11.19 ng/mL,40.95 pg/mL and 11.87×109/L respectively.The Youden index of PCT was highest(0.65)and the accuracy of IL-6 was highest(83.33%)in the single indicator detection scheme.The Youden index and accuracy of the scheme of PCT/hs-CRP and PCT+hs-CRP+IL-6 were highest in the combined detection scheme.Conclusion PCT detection has the prominent value in the assisted diagnosis of T2 DM bloodstream infection.In the combined detection scheme,PCT/hs-CRP and PCT+hs-CRP+IL-6 have the highest value in the assisted diagnosis in T2 DM bloodstream infection.