血清PCT、CRP联合NLR在细菌性血流感染中的应用价值

Application value of serum PCT,CRP combined with NLR in bacterial bloodstream infection

目的探讨血清降钙素原(PCT)、C反应蛋白(CRP)联合中性粒细胞与淋巴细胞比值(NLR)在细菌性血流感染(BSI)早期诊断及鉴别诊断中的应用价值。方法选取2022年1-12月就诊于复旦大学附属中山医院并诊断为细菌性BSI的339例患者作为血培养阳性组,选取同期收治的临床诊断为发热且血培养结果为阴性的185例患者作为血培养阴性组。根据病原菌类型分为革兰阴性菌感染(GN-BSI)组194例和革兰阳性菌感染(GP-BSI)组145例。将GN-BSI组分为肠杆菌目组(133例)、非发酵菌组(49例)及其他细菌组(12例)3个亚组。比较血清PCT、CRP和NLR在不同组别间的差异。采用受试者工作特征(ROC)曲线并计算曲线下面积(AUC)、灵敏度和特异度,评估血清PCT、CRP、NLR单项及联合诊断细菌性BSI的效能。结果血培养阳性组血清PCT、CRP和NLR水平高于血培养阴性组,差异均有统计学意义(P<0.05);GN-BSI组的PCT水平中位数为1.77 ng/mL,高于GP-BSI组的0.79 ng/mL,差异有统计学意义(P<0.05);肠杆菌目组血清PCT、CRP水平高于非发酵菌组,差异有统计学意义(P<0.05)。3项指标联合诊断细菌性BSI的AUC为0.866,灵敏度为0.752,特异度为0.816;3项指标联合鉴别诊断GN-BSI和GP-BSI的AUC为0.977,灵敏度为0.959,特异度为0.917;3项指标联合鉴别诊断肠杆菌目细菌BSI和非发酵菌BSI的AUC为0.842,灵敏度为0.699,特异度为0.857,均高于单项指标检测的诊断价值。结论血清PCT、CRP联合NLR对细菌性BSI早期诊断及鉴别诊断具有一定的临床价值。

Objective To explore the application value of serum procalcitonin(PCT),C-reactive protein(CRP)combined with neutrophil/lymphocyte ratio(NLR)in the early diagnosis and differential diagnosis of bacterial bloodstream infection(BSI).Methods A total of 339 patients diagnosed as bacterial BSI in the Affiliated Zhongshan Hospital,Fudan University from January to December 2022 served as the blood culture positive group,while 185 patients clinically diagnosed as fever and with the blood culture negative admitted and treated in this hospital during the same period were selected as the blood culture negative group.The patients were divided into the Gram negative bacterial infection group(GN-BSI,194 cases)and Gram positive bacterial infection group(GP-BSI,145 cases).The GN-BSI group was divided into the three subgroups of Enterobacteriales subgroup(133 cases),non-fermentative bacterial subgroup(49 cases)and the other bacterial subgroup(12 cases).The differences of serum PCT,CRP and NLR levels were compared among different groups.The receiver operating characteristic(ROC)curve was used and the area under the curve(AUC),sensitivity and specificity were calculated.The diagnostic efficiency of serum PCT,CRP and NLR alone and in combination for bacterial BIS was assessed.Results The serum PCT,CRP and NLR levels in the blood culture positive group were higher than those in the blood culture negative group,and the difference was statistically significant(P<0.05);the PCT median level in the GN-BSI group was 1.77 ng/mL,which was higher than 0.79 ng/mL in the GP-BSI group,and the difference was statistically significant(P<0.05).The serum PCT and CRP levels in the Enterobacteriales subgroup were higher than those in the non-fermentative bacterial subgroup,and the difference was statistically significant(P<0.05).In diagnosing bacterial BSI,the area under the curve(AUC)of the 3-indicator combined was 0.866,the sensitivity was 0.752 and the specificity was 0.816;in the differentiation diagnosis of GN-BSI and GP-BSI,AUC of the 3-indicator combined was 0.977,the sensitivity was 0.959,specificity was 0.917;in the differentiation diagnosis of Enterobacteriales BSI and and non-fermentative bacterial BSI,AUC of the 3-indicator combined was 0.842,the sensitivity was 0.699,the specificity was 0.857,which all were higher than the diagnostic value of single indicator detection.Conclusion Serum PCT,CRP and NLR have certain clinical value in the early diagnosis and differential diagnosis of bacterial BSI.