血清降钙素原检测联合粪便菌群分析对医院感染患者病原菌判定价值的研究

Study on the value of serum procalcitonin combined with the intestinal microbiota composition on diagnosis of pathogens in patients with nosocomial infection

目的探讨重症患者医院感染时,血清降钙素原(PCT)检测联合粪便菌群分析对判定病原菌为革兰阴性(G^-)菌或革兰阳性(G^+)菌的临床价值.方法分析2015年12月至2018年12月期间收治于安徽医科大学附属省立医院重症医学科(ICU)的110例出现医院感染患者的临床资料,根据细菌培养结果及临床资料分析将患者分为G^-菌感染组(G^-菌组)63例和G^+菌感染组(G^+菌组)47例.比较两组患者的血清PCT、粪便菌群分析结果及相关临床资料,根据受试者工作特征曲线(ROC)得出血清PCT水平和粪便G^-菌与G^+菌比例的诊断临界值,并对临床应用价值进行探讨.结果G^-菌组患者的血清PCT水平及血糖、心率、全身炎症反应综合征(SIRS)评分和急性生理学与慢性健康状况评分系统Ⅱ(APACHEⅡ评分)均高于G^+菌组患者(P<0.05),而且G^-菌组粪便G^-菌占比高于G^+菌组(62.7%vs.32.9%,P<0.01).血清PCT≥1.02 ng/mL用于G^-菌感染初步诊断的敏感度为73.02%,曲线下面积为(AUC)0.82(0.74~0.90);粪便G^-菌与G^+菌的比例≥3对G^-菌感染初步诊断的敏感度为63.49%,AUC为0.81(0.73~0.89);血清PCT检测联合粪便菌群分析初步判定G^-菌的敏感度为82.54%,AUC为0.77(0.67~0.86),敏感度高于血清PCT或粪便菌群分析单独应用(P<0.05).结论血清PCT检测联合粪便菌群分析初步判定ICU患者医院感染的病原菌为G^-菌或G^+菌具有较高的敏感度和准确度,值得临床应用.

Objective To analyze the clinical value of serum procalcitonin(PCT)combined with the intestinal microbiota composition for the early diagnosis of gram-negative(G^-)bacteria and gram-positive(G^+)bacteria in ICU patients with nosocomial infection.Methods From December 2015 to December 2018,the clinical data of 110 patients with nosocomial infection in ICU was analyzed.And the patients were divided into the G^+bacterial group(47 cases)and the G^-bacterial group(63 cases).The clinical data,serum PCT concentration and the intestinal microbiota composition of the two groups were compared.According to the analysis of ROC curve,the optimal diagnostic values of serum PCT and the intestinal microbiota composition for the diagnosis of pathogens were determined.Results Compared with the patients in the G^+bacterial group,the PCT concentration,blood glucose,heart rate,the score of SIRS and APACHE U of patients in G^-bacterial group were higher(P<0.05).And the ratio of fecal G^-bacteria to G^+bacteria was higher in G^-bacterial group(62.7%vs.32.9%,P<0.01).When the diagnostic cut-off point was PCTM1.02 ng/mL,the area under the curve(AUC)was 0.82(0.74~0.90),the sensitivity was 73.02%.When the diagnostic cut-off point was the ratio of fecal G^-bacteria to G^+bacteria3,AUC was 0.81(0.73~0.89),the sensitivity was 63.49%.The sensitivity of PCT combined with the gut microbiota composition for diagnosing G^-bacteria was 82.54%,AUC was 0.77(0.67-0.86).The sensitivity was higher than that of PCT or fecal flora analysis alone(P<0.01).Conclusion The serum PCT combined with the gut microbiota composition had the high sensitivity and accuracy for diagnosing pathogens of the patients with nosocomial infectionin ICU.It is worthy of clinical application.