血清SAA、HBP联合检测在危重症患者细菌感染诊断与疗效评价中的价值探讨

The value of combined detection of serum SAA and HBP in the diagnosis and evaluation of bacterial infection in critically ill patients

目的探讨血清淀粉样蛋白A(Serum amyloid A,SAA)和肝素结合蛋白(Heparin binding protein,HBP)联合检测在危重症患者细菌感染诊断与疗效评价中的价值。方法选择2014年3月到2016年3月在我院ICU病房进行治疗的感染患者124例,作为观察组,再将其按照细菌培养结果分为细菌感染组和非细菌感染组,另选择64例同时间段来我院进行体检的健康受试者,作为对照组。测定所有受试者治疗前血液中SAA、HBP和白细胞(white blood cells,WBC)水平,并测定观察组患者治疗后不同时间点血液中SAA、HBP和WBC水平;对比SAA、HBP联合检测和WBC在细菌感染性疾病诊断中的敏感性和特异性。结果细菌感染组SAA、HBP和WBC均明显高于对照组,同时SAA和HBP明显高于非细菌感染组,差异具有统计学意义(P<0.05),细菌感染组和非细菌感染组WBC没有显著差异(P>0.05);随着治疗的进行,细菌感染组SAA和HBP水平逐步下降;SAA和HBP单独诊断的敏感性和特异性均显著高于WBC监测,SAA和HBP联合诊断敏感性显著提高,但特异性下降。结论 SAA和HBP联合检测可操作性强,可以实时监测患者病情变化,准确判断感染类型,应该得到进一步的研究和推广。

Objective To investigate the value of combined detection of serum SAA and HBP in the diagnosis and evaluation of bacterial infection in critically ill patients. Methods From March 2014 to March 2016,124 cases of infection were examined and treated in our hospital and they were selected as the experimental group. The experimental group were divided into the bacterial infection group and the non bacterial infection group according to the results of bacterial culture. Another 64 cases of healthy volunteers during the same period were selected as the control group. The level of SAA,HBP and white blood cells in blood of all subjects were determined before treatment and at different time points. The sensitivity and specificity of SAA,HBP and white blood cells in the diagnosis of bacterial infectious diseases were compared. Results In the bacterial infection group,SAA,HBP and WBC were significantly higher than those in the control group（ P〈0. 05）,and SAA and HBP were significantly higher than those in the non bacterial infection group（ P〈0. 05）,while there was no significant difference in WBC level between the bacterial and non bacterial groups（ P〉0. 05）. With the treatment,the level of SAA and HBP in the bacterial infection group was gradually decreased. The sensitivity and specificity of SAA and HBP monitoring in the diagnosis of bacterial infection were significantly higher than that of WBC. SAA and HBP combined diagnostic sensitivity significantly increased,but the specificity declined. Conclusion SAA and HBP combined diagnosis can effectively distinguish the type of infection and monitoring the patient＇s condition changes. It is feasible and worthy of clinical promotion.