不同类型病原菌所致血流感染病人体内炎症因子水平变化的研究

Study on the changes of the inflammatory factors level in patients with bloodstream infection caused by different types of pathogens

目的:分析早期感染指标降钙素原(PCT)和C反应蛋白(CRP)水平在血流感染(BSI)病人体内的变化情况,探讨二者在诊断BSI方面的临床应用价值。方法:选择BSI病例(BSI组)及同期住院非BSI但有其他部位感染病例(非BSI组),各43例。比较2组在早期发生感染时(未经治疗前)PCT和CRP水平情况,并绘制ROC曲线,评价PCT及CRP早期诊断BSI的临床价值。结果:血培养结果显示,BSI病人中感染革兰阳性菌15例,占34.9%;革兰阴性菌28例,占65.1%;其中,革兰阳性菌以链球菌为主,革兰阴性菌以大肠埃希菌为主;早期发生感染时(未经治疗前)BSI组PCT和CRP水平均明显高于非BSI组(P<0.01);PCT和CRP水平均明显高于革兰阳性菌病人(P<0.01);不同细菌感染时,PCT和CRP的ROC曲线下面积分别为0.976和0.886,特异度分别为96.4%和78.6%,灵敏度分别为86.7%和94.55%。结论:针对BSIPCT和CRP检测具有早期诊断价值,且可初步判断病原菌类型,指导临床经验性用药,但具体用药方案需根据血培养的明确结果进行选择从而提高临床治疗效果。

Objective:To analyze the changes of the levels of procalcitonin(PCT)and C-reactive protein(CRP)in patients with bloodstream infection(BSI),and explore their clinical value in the diagnosis of BSI.Methods:The levels of PCT and CRP between the patients with BSI(BSI group,43 cases)and other sites infection without BSI(non-BSI group,43 cases)were compared in the early stage of infection(before treatment),and the ROC curve was drawn to evaluate the clinical value of PCT and CRP in the early diagnosis of BSI.Results:The results of blood culture showed that among the patients with BSI infection,15 cases were infected with Gram-positive bacteria,accounting for 34.9%,and 28 cases were infected with Gram-negative bacteria,accounting for 65.1%.The main Gram-positive bacterium was Streptococcus,and the main Gram-negative bacterium was Escherichia coli.The levels of PCT and CRP in BSI group were significantly higher than those in non-BSI group in the early infection(P<0.01),and the levels of PCT and CRP in BSI group were significantly higher than those in Gram-positive bacteria group(P<0.01).Among different bacteria infection,the area under the ROC curve of PCT and CRP were 0.976 and 0.886,respectively,the specificity of which was 96.4%and 78.6%,respectively,and the sensitivity of which was 86.7%and 94.55%,respectively.Conclusions:The detection of PCT and CRP has the early diagnostic value for BSI,and can preliminarily determine the type of pathogens,and guide clinical empirical medication.However,the specific medication scheme needs to be selected according to the clear results of blood culture to improve clinical therapeutic effects.