降钙素原在脓毒症患者血流感染病原菌分布的应用价值研究

Study of application value of procalcitonin in pathogen distribution of bloodstream infection in patients with sepsis

目的探讨血清降钙素原(PCT)定量检测在脓毒症患者血流感染病原菌分布中的应用价值,为临床合理使用PCT指标预测脓毒症患者血流感染病原菌结果提供依据。方法选取2016年1月至2021年6月收治的200例血培养阳性并同时进行PCT检测的脓毒症患者作为研究对象,按照革兰阴性菌、革兰阳性菌感染将其分为G^(-)组(165例)和G^(+)组(35例)。分析病原菌的检出情况、比较两组的血清PCT水平,使用受试者工作特征(ROC)曲线分析PCT的最佳临界值。结果共分离出病原菌200株,革兰阴性菌165株,占比82.5%,革兰阳性菌35株,占比17.5%。G^(-)组的血清PCT水平高于G^(+)组,差异具有统计学意义(P<0.05)。ROC曲线结果显示,曲线下面积为0.674,95%置信区间为0.564~0.783;约登指数为0.300时,最佳临界值为16.65 ng/mL,灵敏度为0.706,特异度为0.594。结论PCT在脓毒症患者血流感染病原菌分布中具有一定的应用价值,可在早期对怀疑脓毒症患者的合理用药提供依据,可与血培养联合检测以降低脓毒症患者的抗感染失败风险,提高治疗有效率。

Objective To explore the application value of quantitative detection of serum procalcitonin(PCT)in pathogen distribution of bloodstream infection in patients with sepsis,and to provide a basis for clinical rational use of PCT index to predict the results of pathogenic bacteria of bloodstream infection in patients with sepsis.Methods A total of 200 sepsis patients with positive blood culture and PCT detection admitted from January 2016 to June 2021 were selected as the research objects.According to the infection of Gram-negative bacteria and Gram-positive bacteria,the patients were divided into G^(-)group(165 cases)and G^(+)group(35 cases).The detection of pathogens were analyzed and serum PCT level of the two groups were compared,and the optimal critical value of PCT was analyzed by receiver operating characteristic(ROC)curve.Results A total of 200 strains of pathogenic bacteria were isolated,165 strains of Gram-negative bacteria,accounted for 82.5%,and 35 strains of Gram-positive bacteria,accounted for 17.5%.The serum PCT level in the G^(-)group was higher than that in the G^(+)group,and the difference was statistically significant(P<0.05).The results of ROC curve showed that the area under the curve was 0.674 and the 95%confidence interval was 0.564-0.783;when the Youden index was 0.300,the optimal critical value was 16.65 ng/mL,the sensitivity was 0.706,and the specificity was 0.594.Conclusion PCT has certain application value in pathogen distribution of bloodstream infection in patients with sepsis.It can provide a basis for rational drug use in patients with suspected sepsis in the early stage.It can be combined with blood culture to reduce the risk of anti-infection failure in patients with sepsis and improve the effective rate of treatment.