血清PCT定量检测对术后血流感染早期诊断及抗菌药物应用中的指导价值

The value of quantitative detection of serum PCT in the early diagnosis of postoperative bloodstream infection and the application of antibiotics

目的探讨血清降钙素原(PCT)定量检测对术后血流感染早期诊断及指导抗菌药物应用的价值,为临床抗菌药物治疗提供依据。方法回顾性分析广东省中山市人民医院2017年3月至2020年6月收治的133例术后感染患者的临床资料,其中血流感染组72例,局部感染组61例,比较两组PCT及白细胞介素(IL)-6水平,同时分析白细胞计数(WBC)、中性粒细胞绝对值(NEU#)、中性粒细胞百分比(NEU%)、中性粒细胞与淋巴细胞比值(NLR)、淋巴细胞绝对值(LY#)、淋巴细胞百分比(LY%)等指标。结果血流感染组的WBC、NEU#、NLR、PCT及IL-6水平均明显高于局部感染组,差异有统计学意义(P<0.05);PCT联合IL-6检测诊断效能最优,灵敏度达83.64%,特异度达68.66%;血流感染组中,革兰阴性菌感染患者血清PCT水平明显高于革兰阳性菌感染患者,差异有统计学意义(P<0.05),其中革兰阴性菌以大肠埃希菌及肺炎克雷伯菌为主,二者感染患者PCT水平分别为2.64(0.81,5.91)、6.31(1.17,10.79)ng/mL;革兰阳性菌以金黄色葡萄球菌及肺炎链球菌为主,血清PCT水平分别为0.67(0.32,0.94)和2.18(0.90,3.05)ng/mL。结论定量检测血清PCT水平可对术后血流感染进行早期预测,且能够对术后血流感染的病原菌类型进行进一步推测,为术后血流感染患者早诊断,以及合理使用抗菌药物提供依据。

Objective To investigate the early diagnostic effect of procalcitonin(PCT)and the value of guiding the use of antibiotics on post-operative bloodstream infections(BSI).Methods Retrospective analysis of 133 patients(72 cases in BSI group and 61 cases in localized infection group)with post-operative infections from March 2017 to June 2020 in People′s Hospital of Zhongshan.All the collected 133 blood samples were detected and analyzed the indicators including serum calcitonin original(PCT),interleukin(IL)-6,white blood cell count(WBC),neutrophils absolute value(NEU#),neutrophil percentage(NEU%),neutrophils and lymphocytes ratio(NLR),lymphocyte absolute value(LY#),lymphocyte percentage(LY%)and soon.Results The expression of WBC,NEU#,NLR,PCT,IL-6 in BSI group were higher than those in localized infection group(P<0.05).The diagnostic efficiency of combined detection of PCT and IL-6 was optimal,which sensitivity and specificity were up to 83.64%and 68.66%respectively.Moreover,in BSI group,significantly higher expression of PCT were found in patients with gram negative bacteria infection when compared to gram positive bacteria infection(P<0.05).In gram negative bacteria infection,the bacteria were mainly E.coli and Klebsiella pneumoniae,whose PCT were 2.64(0.81,5.91)and 6.31(1.17,10.79)ng/mL,while in gram positive infection,the mainly bacteria were Staphylococcus aureus and Streptococcus pneumonia,and the corresponding PCT level were 0.67(0.32,0.94)and 2.18(0.90,3.05)ng/mL.Conclusion PCT could be an early predictive marker of post-operative BSI,and the expression level could help to speculate the possible type of pathogen,which help to provide the basis of early diagnosis of postoperative BSI as well as the accurate usage of antibiotics.