降钙素原联合中性粒细胞/淋巴细胞比值在不同类型血流感染中的应用价值

The clinic evaluation of procalcitonin combined with Neurophil/lymphocyte ratio in different types of bloodstream infections

目的研究降钙素原(PCT)、中性粒细胞/淋巴细胞比值(NLR)在不同类型血流感染(BSI)中的变化及其临床价值。方法收集2017年8月至2018年8月251例血培养阳性住院患者临床资料,分为血培养污染组和BSI组。BSI组进一步分为革兰阴性细菌(G-)组、金黄色葡萄球菌(SA)组、凝固酶阴性葡萄球菌(CNS)组。分析血常规和PCT数据,分别采用F检验和K-W秩和检验比较不同组的NLR和PCT。绘制受试者工作特征(ROC)曲线评价NLR、PCT及二者联合诊断的临床价值。结果(1)与血培养污染组比较,BSI组NLR、PCT水平明显增加,差异有统计学意义(P<0.01);NLR在G-组与血培养污染组、血培养SA组与血培养污染组、CNS组与血培养污染组、G-组与CNS组、SA组与CNS组间比较差异有统计学意义(P<0.05),PCT在G-组与血培养污染组、SA组与血培养污染组、CNS组与血培养污染组比较差异有统计学意义(P<0.05)。(2)PCT鉴别BSI与血培养污染、G-与血培养污染、SA与血培养污染、CNS与血培养污染、G-与血培养污染的AUC分别为0.895、0.951、0.877、0.919、0.680,具有诊断价值(P<0.05)。NLR鉴别BSI与血培养污染、G-与血培养污染、SA与血培养污染、CNS与血培养污染的AUC分别为0.922、0.934、0.929、0.856,具有诊断价值(P<0.05)。PCT+NLR联合检测用于鉴别BSI与血培养污染、G-与血培养污染、SA与血培养污染、CNS与血培养污染、G-与SA的AUC分别为0.946、0.950、0.947、0.856、0.664,具有诊断价值(P<0.05)。结论PCT和NLR炎性指标在判断血培养污染和BSI中有着明显的优势,在区别不同类型BSI中有一定的应用价值,为鉴别BSI提供了新的思路。

Objective To study the changes and clinical value of procalcitonin(PCT)and neutrophil/lymphocyte ratio(NLR)in different types of bloodstream infections(BSI).Methods The clinical data of 251 inpatients with positive blood culture from August 2017 to August 2018 were collected and divided into blood culture contamination group and BSI group.The BSI group was further divided into Gram-negative bacteria(G-)group,Staphylococcus aureus(SA)group and Coagulase-negative Staphylococcus(CNS)group.Blood routine and PCT data were analyzed,and F-test and K-W rank sum test were used to analyse the NLR and PCT in different groups.The receiver operating characteristic(ROC)curve was drawn to evaluate the clinical a diagnosis value of NLR,PCT and their combination.Results Compared with the blood culture contamination group,NLR and PCT in the BSI group increased significantly and the differences were statistically significant(all P<0.05).There were statistically significant differences of NLR between G-group and contamination group,SA group and contamination group,CNS group and contamination group,G-group and CNS group,SA group and CNS group(P<0.05).There were statistically significant differences of PCT between the G-group and contamination group,the SA group and the contamination group,the CNS group and the contamination group(P<0.05).The AUC of PCT in identifying BSI and blood culture comtamination,G-and blood culture comtamination,SA and blood culture comtamination,CNS and blood culture comtamination,G-and SA was 0.895,0.951,0.877,0.919,0.680,showing a diagnostic value(P<0.05).The AUC of NLR in BSI and blood culture comtamination,G-and blood culture comtamination,SA and blood culture comtamination,CNS and blood culture comtamination was 0.922,0.934,0.929,0.856,showing a diagnostic value(P<0.05).The AUC of PCT+NLR combined detection in BSI and blood culture comtamination,G-and blood culture comtamination,SA and blood culture comtamination,CNS and blood culture comtamination,G-group and SA group was 0.946,0.950,0.947,0.856,0.664,showing a diagnostic value(P<0.05).Conclusion PCT and NLR inflammatory indicators have obvious advantages in judging contamination and BSI,and have certain application value in distinguishing different types of BSI,which provides new ideas for identifying BSI.