降钙素原、C-反应蛋白、白细胞和中性粒细胞在鉴别血流感染中的应用价值

The Application Value of Procalcitonin, C-reactive Protein, Leukocytes and Neutrophils in Differential Bloodstream Infection

目的研究降钙素原、C-反应蛋白、白细胞和中性粒细胞在鉴别血流感染中的应用价值。方法选取2018年1-12月临床收治的442例血流感染患者,分为革兰阳性菌感染组178例和革兰阴性菌感染组264例,对比分析两组患者的降钙素原(PCT)、C-反应蛋白(CRP)、白细胞计数(WBC)和中性粒细胞绝对值之间差异性,并分析不同菌属间检测结果的差异性。结果革兰阴性菌感染组的PCT和CRP检测水平显著高于革兰阳性菌感染组(U=858、146,P=0.000、0.000),两组间WBC和中性粒细胞绝对值差异无统计学意义(U=214、214,P=0.432、0.105);革兰阴性菌感染组中不同菌属感染患者间PCT、CRP、WBC和中性粒细胞检测结果差异无统计学意义(P=0.212、0.379、0.530、0.436);革兰阳性菌感染组中不同菌属感染患者的CRP和中性粒细胞水平差异无统计学意义(P=0.127、0.077),而金黄色葡萄球菌感染患者PCT和WBC水平分别是(5.48±0.38)ng/mL和(26.46±2.15)×10~9/L明显高于凝固酶阴性葡萄球菌感染患者(P=0.009、0.014)。结论 PCT和CRP指标在预测革兰阴性菌造成的血流感染中具有较大价值,并可用于与革兰阳性菌造成血流感染的鉴别。

Objective To study the application value of procalcitonin, C-reactive protein, leukocytes and neutrophils in differential bloodstream infection. Methods A total of 442 patients with bloodstream infections from January to December 2018 were enrolled. The patients were divided into 178 cases of Gram-positive infection group and 264 cases of Gram-negative infection group. The 2 groups of patients was compared of Differences between(procalcitonin PCT), C-reactive protein(CRP), white blood cell count(WBC), and neutrophil absolute values, and analysis of differences in detection results between different strains. Results The PCT and CRP levels in the Gram-negative bacterial infection group were statistically significant higher than those in the Gram-positive bacterial infection group(U=858,146, P=0.000, 0.000). There was no statistically significant difference in WBC and neutrophil count between the two groups(U=214, 214, P=0.432, 0.105);there were no statistically significant differences in PCT, CRP, WBC and neutrophil test results between patients infected with Gram-negative bacteria in different infection groups,the difference was not statistically significant(P=0.212,0.379, 0.530, 0.436);there was no significant difference in CRP and neutrophil levels between patients infected with Grampositive bacteria in different infection groups(P=0.127,0.077), while PCT and WBC levels in patients with S. aureus infection were(5.48±0.38)ng/mL and(26.46±2.15)×10~9/L were significantly higher than those with coagulase-negative staphylococcal infection(P=0.009, 0.014). Conclusion PCT and CRP indicators have great value in predicting bloodstream infection caused by Gram-negative bacteria, and can be used to identify bloodstream infections caused by Gram-positive bacteria.