PCT、CRP及内毒素对血流感染致病菌类型鉴别能力的研究

Study on the ability of PCT,CRP and endotoxin to distinguish the types of pathogenic bacteria in bloodstream infection

目的探讨降钙素原(PCT)、C-反应蛋白(CRP)和内毒素对血流感染致病菌类型的诊断能力及在血流感染中的临床价值。方法选择江苏大学附属人民医院2018-2019年血培养阳性并且检测了PCT/CRP/内毒素的患者进行研究,分别比较不同致病菌所致血流感染患者的炎症指标水平,并评价各炎症指标的诊断效能。结果革兰阴性菌(G^(-)菌)血流感染患者的PCT、CRP和内毒素水平均明显高于革兰阳性菌(G^(+)菌)血流感染患者,链球菌血流感染患者的PCT水平明显高于葡萄球菌血流感染患者,产超广谱β-内酰胺酶肠杆菌科细菌(ESBL)血流感染患者的CRP水平明显低于非ESBL血流感染患者,差异均有统计学意义(P<0.05)。结论PCT、CRP和内毒素均能有效预测G+菌和G-菌所致血流感染的致病菌类型,其中PCT的预测能力最强;此外,PCT具有鉴别葡萄球菌和链球菌所致血流感染的能力,CRP可以鉴别ESBL与非ESBL所致血流感染。因此,各炎症指标在血流感染的早期诊断和治疗中具有重要意义。

Objective To investigate the diagnostic ability of procalcitonin(PCT),C-reactive protein(CRP)and endotoxin in the types of pathogenic bacteria in bloodstream infections and their clinical value in bloodstream infections.Methods Selected patients with positive blood cultures from 2018 to 2019 in the Affiliated People′s Hospital of Jiangsu University and tested PCT/CRP/endotoxin for research.The levels of inflammatory indicators in patients with bloodstream infections caused by different pathogens were compared,and the diagnostic efficiency of inflammatory indicators were evaluated.Results The PCT,CRP and endotoxin levels of patients with gram-negative bacteria(G^(-)bacteria)bloodstream infection were significantly higher than those of patients with gram-positive bacteria(G+bacteria)bloodstream infections,and patients with streptococcal bloodstream infections had significantly higher PCT levels than patients with staphylococci bloodstream infections.The CRP level of patients with extended-spectrumβ-lactamase-producing enterobacteriaceae(ESBL)bloodstream infection was significantly lower than that of patients with non-ESBL bloodstream infections,and the differences were statistically significant(P<0.05).Conclusion PCT,CRP and endotoxin can effectively predict the types of pathogenic bacteria of bloodstream infections caused by G^(+)bacteria and G-bacteria,and PCT has the highest predictive ability.In addition,PCT has the ability to differentiate bloodstream infections caused by Staphylococcus and Streptococcus,and CRP can differentiate bloodstream infections caused by ESBL and non-ESBL.Therefore,various inflammatory indicators are of great significance in the early diagnosis and treatment of bloodstream infections.