血清PCT、CRP及IL-6联合检测诊断细菌性血流感染的临床价值分析

Analysis of the Clinical Value of Combined Detection of Serum PCT,CRP and IL-6 for the Diagnosis of Bacterial Bloodstream Infection

目的:探讨血清降钙素原(PCT)、C反应蛋白(CRP)及白介素-6(IL-6)联合检测诊断细菌性血流感染(BSI)的临床价值。方法:选取我院2015年8月到2016年10月收治的疑似细菌性BSI患者216例,入院后均送检血培养,根据培养结果将其分为阳性组(102例)和阴性组(114例)。统计细菌性BSI阳性率、革兰阳性菌感染率和革兰阴性菌感染率;检测血清PCT、CRP、IL-6水平,并比较两组患者的差异,同时绘制ROC曲线并计算出各指标及联合检测的灵敏度、特异度、阳性预测值、阴性预测值及约登指数值。结果:所有疑似BSI患者的细菌阳性检出率为47.22%,革兰阳性菌感染率与革兰阴性菌感染率对比无差异(P>0.05);阳性组的血清PCT、CRP、IL-6水平均明显高于阴性组(P<0.05);血清IL-6的AUC明显大于PCT和CRP(P<0.05);PCT、CRP及IL-6联合检测的灵敏度、特异度、阳性预测值、阴性预测值及约登指数均明显高于单项检测(P<0.05)。结论:血清PCT、CRP及IL-6对于BSI均有着一定诊断价值,而各指标联合检测诊断BSI的临床价值更高。

Objective： To study the clinical value of combined detection of serum calcitonin（PCT）,c-reactive protein（CRP） and interleukin-6（il-6） for the diagnosis of bacterial bloodstream infection（BSI）. Methods： From August 2015 to October 2015,216 cases of patients with suspected bacterial BSI were selected for this study,blood culture were performed after admission,according to the result of blood culture,the patients were divided into the positive group（102 cases） and the negative group（114 cases）. The bacterial BSI positive rate,gram-positive bacteria infection and gram-negative bacteria infection rate were calculated. The serum PCT and CRP,IL-6 levels were compared between the two groups of patients. The ROC curve and the sensitivity,specific,positive predictive value,negative predictive value were drawn and compared. Results： The positive detection rate of all suspected BSI patients was 47.22%,among which there was no difference in the infection rate of gram-positive bacteria（P〈0.05）. The serum PCT,CRP and il-6 levels of positive groups were significantly higher than those of the negative group（P〈0.05）. The AUC of il-6 was significantly larger than PCT and CRP（P〈0.05）.The sensitivity,specificity,positive predictive value,negative predictive value and Jordan index of PCT,CRP and il-6 were significantly higher than those of the single test（P〈0.05）. Conclusion： Serum PCT,CRP and IL-6 had some diagnostic value for the diagnosis of BSI,the combined detection can obviously improve the diagnostic value for BSI.