临床致病菌耐药程度对血浆降钙素原水平的影响

Effect of antibiotic-resistance of clinical pathogenic bacteria on plasma level of procalcitonin

目的:了解临床致病菌不同耐药程度对患者血浆降钙素原水平的影响,并分析降钙素原与C-反应蛋白(CRP)的相关性。方法:分别用循环增强荧光免疫法(CEFA)和免疫比浊法检测29例一般耐药鲍曼不动杆菌感染患者(GRAB)、29例泛耐药鲍曼不动杆菌患者(ERAB)、30例一般耐药金黄色葡萄球菌患者(GRSA)、31例泛耐药金黄色葡萄球菌患者(ERSA)和40例健康体检人员(对照组)血浆中的降钙素原和CRP水平,用Kruskal-Wallis H检验(两两比较用Nemenyi法检验)比较鲍曼不动杆菌组、金黄色葡萄球菌组和对照组,以及一般耐药菌组、泛耐药菌组和对照组的降钙素原和CRP水平。用Spearman等级相关分析得出降钙素原与CRP的相关性。结果:降钙素原水平:鲍曼不动杆菌组与金黄色葡萄球菌组无显著性差异(P>0.05),且两组均明显高于对照组(P均<0.05);一般耐药菌组与对照组无显著性差异(P>0.05),且两组均明显低于泛耐药菌组(P均<0.05)。CRP水平:鲍曼不动杆菌组与金黄色葡萄球菌组无显著性差异(P>0.05),且两组均明显高于对照组(P均<0.05);一般耐药菌组与泛耐药菌组无显著性差异(P>0.05),两组均明显高于对照组(P均<0.05)。GRAB组、ERAB组、GRSA组和ERSA组的降钙素原与CRP均呈正相关(P值均<0.05),对照组的降钙素原与CRP无明显相关性(P=0.952)。结论:一般耐药致病菌感染不能明显提高患者血浆的降钙素原水平,致病菌耐药程度越高越能刺激降钙素原的表达。当致病菌感染时,患者血浆中的降钙素原与CRP水平呈正相关。

Objective : To comprehend the contributions of Gram stain classification and differentstrength of antibiotic-resistance of clinical pathogenic bacteria to the levels of procalcitonin( PCT) in bacteriainfected patients, and to analyze the correlations between PCT and C-reactive protein ( CRP) in severalgroups of bacteria infected patients. Methods: PCT and CRP were detected by circular enhanced fluorescenceimmunoassay (CEFA) and immunoturbidimetric assay. The selected patients were general antibioticresistantAcinetobacter Baumannii infected group (GRAB) , extensively antibiotic-resistant Acinetobacter Baumanniiinfected group (ERAB) , general antibiotic-resistant Staphylococcus Aureus infected group (G R SA ),extensively antibiotic-resistant Staphylococcus Aureus infected group(ERSA). The healthy control group wasalso chosen. Kruskal Wallis H test (post hoc pairwise comparison with Nemenyi test) was used to statisticallycompare the levels of PCT and CRP among the three groups of Acinetobacter Baumannii infected group( AB) , Staphylococcus Aureus infected group ( SA) and the control group, and among the three groups ofgeneral antibiotic-resistant bacteria group (GR) , extensively antibiotic-resistant bacteria group (ER ) andthe control group . Spearman rho correlation analyses was used to evaluate the correlation between PCT andCRP . Results: PCT levels: there was no significant difference between Group AB and Group SA ( P >0 . 05 ) , and the two groups were higher than the control group ( P all < 0. 05 ) ; there was no significantdifference between Group GR and the control group (P >0. 05) , and two groups were lower than Group ER(P all < 0 .0 5 ). CRP levels: there was no significant difference between Group AB and Group SA (P >0. 05 ) , and the two groups were higher than the control group ( P all < 0. 05 ) ; there was no significantdifference between Group GR and Group E R (P > 0 .0 5 ), and the two groups were higher than the controlgroup (P all <0. 05) . It was found that PCT positively correlated with CRP only in bacteria infected patients( P <0. 05 ) , but not in healthy people( P = 0. 952 ) . Conclusion; General antibiotic-resistant bacteria infectionmay not prominently elevate the levels of PCT in patients. The bacteria with higher antibiotic-resistance may more strongly stimulate the expression of PCT in patients than the general antibiotic-resistant bacteria.Gram-negative bacteria infection stimulate the expression of PGT in patients may as the same as Gram-positive bacteria in levels. There was positive correlation between PCT and CRP only in bacteria infected patients but not in healthy people.