血液指标在革兰阳性球菌和阴性杆菌感染中的诊疗效能

Diagnostic Efficacy of Blood Inicators in the Diagnosis and Treatment of Grampositive Cocci and Gramnegative Bacilli Infection

目的探索不同血液指标单项使用、联合运用、动态监测对于细菌感染诊断、鉴别诊断、预后疗效判定的效能差异。方法选取玉溪市人民医院2015年1月至2022年9月有感染症状或体征,且培养为单一病原体的1843例为病例组,同期未感染者2298例为对照组,收集2组相同血液指标。变量按性别、年龄段、标本类型等进行分组。采用SPSS24.0和Medcalc20.0进行统计学处理。结果各血液指标单独诊断有无感染的效能AUC介于0.656~0.937,联合运用后AUC介于0.907~0.987;不同标本鉴别诊断G+c和G-b效能为血液中PCT单独运用AUC(男0.875,女0.769),而男性黏膜分泌物、无菌体液和未成年男性痰液中单独鉴别诊断效能均≤0.7,但联合运用效能分别是AUC(0.789,0.737,0.86);动态监测成年入院24 h、48 h、72 h的PCT、IL-6、CRP、WBC、LAC对G+c和G-b预后疗效,差异具有统计学意义(P<0.05)。结论血液指标对细菌感染与否具有一定诊断价值,且存在性别差异,合理的联合运用效能更高;单独或联合使用血液指标对不同标本类型的G+c/G-b鉴别诊断价值不同,血液标本单项使用PCT效能最高;成年男性体表黏膜分泌物、无菌体液未成年男性痰液以联合运用模式效果最佳,女性联合使用效能均不佳;动态监测PCT、CRP、IL-6、LAC、WBC对感染预后疗效评估具有较高价值,G+c感染以24 h的IL-6、G-b感染以72 h的PCT评估效能最高。

Objective To explore the differences in the effectiveness of using different blood indicators individually,in combination,and for dynamic monitoring in the diagnosis,differential diagnosis,and prognosis of bacterial infections.Methods 1843 cases with infectious symptoms or signs from January 2015 to September 2022 at the People’s Hospital of Yuxi City were selected as the case group,and 2298 uninfected individuals during the same period were selected as the control group.Blood indicators of the two groups were collected.Variables were grouped according to gender,age group,specimen type,etc.SPSS 24.0 and Medcalc 20.0 were used for statistical analysis.Results The individual diagnostic efficacy of various blood indicators for detecting infection ranges from 0.656 to 0.937.When used together,the efficacy ranges from 0.907 to 0.987.The efficacy of distinguishing between G+c and G-b in different specimens is as follows:when PCT is used alone in blood,the AUC is 0.875 for males and 0.769 for females.However,the individual diagnostic efficacy in male mucous secretions,sterile body fluids,and non-adult male sputum is all≤0.7.Yet,when used together,the efficacy is AUC(0.789,0.737,0.86)respectively.The dynamic monitoring of PCT,IL-6,CRP,WBC,and LAC in adult patients at 24 h,48 h,and 72 h after admission shows statistically significant differences in prognostic efficacy for G+c and G-b(P<0.05).Conclusions Blood indicators have a certain diagnostic value for determining whether there is a bacterial infection,and there are gender differences.The combined use of these indicators is more effective.The diagnostic value of using blood indicators alone or in combination for distinguishing between G+c and G-b in different types of specimens varies.The use of PCT alone in blood specimens is the most effective.For adult males,the combined use of body surface mucous secretions and sterile body fluids is most effective,while for underage males,the combined use of sputum is most effective.The combined use for females is not effective.Dynamic monitoring of PCT,CRP,IL-6,LAC,and WBC has a high value for evaluating the prognosis and therapeutic effect of infections.The evaluation of G+c infection is most effective at 24 hours for IL-6,and for G-b infection,it is most effective at 72 hours for PCT.