降钙素原、CD64%、中性粒细胞/淋巴细胞比值、C反应蛋白在监测早期细菌血流感染中的临床意义

Clinical significance of procalcitonin,CD64%,neutrophil/lymphocyte ratio and C-reactive protein in monitoring early bacterial bloodstream infection

目的探讨降钙素原(PCT)、CD64阳性细胞百分比(CD64%)、中性粒细胞/淋巴细胞比值(NLR)、C反应蛋白(CRP)水平对早期血流感染(BSI)的预测价值。方法回顾性分析BSI 125例,其中血培养阳性的BSI患者100例,血培养阴性患者25例,在血培养的同时抽取外周血检测血常规和PCT、CD64%、CRP水平。比较BSI患者血培养阳性及阴性组间上述炎症血清标志物的差异,并分析其对BSI的预测作用。结果BSI患者PCT、CD64%、CRP、NLR及WBC水平均超过正常临界值,除NLR及WBC外,PCT、CD64%、CRP在血培养阳性组及血培养阴性组患者间水平相当,差异无统计学意义(P>0.05)。PCT诊断效能最高,曲线下面积(AUC)达到0.92,灵敏度90.00%,特异度100.00%。同时PCT对革兰阳性(G+)菌株及革兰阴性(G-)菌株均有较好的诊断灵敏度。G-菌中PCT水平高于G+菌,差异有统计学意义(P<0.05)。结论PCT、CD64%、CRP、NLR均有助于诊断早期BSI,其中PCT诊断效能最高,适用于早期BSI筛查。

Objective To investigate the predictive value of procalcitonin(PCT),CD64 positive cells percentage(CD64%),neutrophil/lymphocyte ratio(NLR)and CRP in early blood stream infection(BSI).Methods One hundred and twenty-five cases of bloodstream infection were retrospectively analyzed,including 100 cases of blood culture positive and 25 cases of blood culture negative.The blood culture was conducted,meanwhile peripheral blood was collected to detect blood routine and PCT,CD64%,CRP levels.The differences in above inflammatory serum markers were compared between the blood culture negative group and positive group,and their predictive effect on BSI was analyzed.Results The PCT,CD64%,CRP,NLR and WBC levels in the patients with BSI exceeded the normal threshold values.Except NLR and WBC,the levels of PCT,CD64%and CRP were equal in the blood culture positive group and the blood culture negative group,and the difference was not statistically significant(P<0.05).PCT had the highest diagnostic efficiency,the area under the ROC curve(AUC)reached 0.92,the sensitivity was 90.00%,and specificity was 100.00%.At the same time,PCT had good diagnostic sensitivity in Gram-positive(G+)strains and Gram-negative(G-)strains.The PCT level in the G-group was higher than that in the G+group,and the difference was statistically significant(P<0.05).Conclusion PCT,CD64%,CRP and NLR are helpful in diagnosing early BSI,in which PCT is the highest in diagnostic efficiency and suitable for early BSI screening.