血液炎症指标与尿常规联合检验对意识障碍卧床患者发生尿路感染的诊断价值

Diagnostic value of combined detection of blood inflammation and urine routine indicators for urinary tract infection in bedridden patients with consciousness disorders

目的 探讨血液炎症指标与尿常规联合检验对意识障碍卧床患者发生尿路感染(UTI)的诊断价值。方法 选择2019年1月—2023年6月泗洪医院收治的42例意识障碍卧床且发生UTI患者作为研究对象,纳入UTI组;另外选择同期50例未发生UTI的意识障碍卧床患者以及50例老年非卧床患者分别纳入未感染组和对照组。收集所有患者的降钙素原(PCT)、全身炎症反应指数(SIRI)、C-反应蛋白(CRP)与白蛋白(ALB)比值(CRP/ALB)、尿亚硝酸盐(NIT)以及尿白细胞酯酶(LEU)检测结果,比较并分析各组上述指标水平差异。绘制受试者工作特征曲线(ROC曲线)并计算ROC曲线下面积(AUC),分析各指标单独与联合检测对意识障碍卧床患者发生UTI的诊断效能。结果 UTI组的PCT、SIRI、CRP/ALB水平以及尿NIT、尿LEU阳性率均显著高于未感染组和对照组[PCT(μg/L):2.32±1.24比0.98±0.36、0.69±0.24;SIRI:6.08±1.36比4.15±1.06、3.25±0.86;CRP/ALB:2.23±1.36比1.68±0.65、1.23±0.21;尿NIT阳性率:73.81%比12.00%、10.00%;尿LEU阳性率:80.95%比10.00%、8.00%;均P <0.05]。单项指标中,尿LEU阳性率诊断意识障碍卧床患者发生UTI的AUC最大,为0.726[95%可信区间(95%CI)为0.698~0.781],特异度也最高,为78.4%;PCT的敏感度最高,为73.1%。5项指标联合应用诊断意识障碍卧床患者发生UTI的AUC达到0.896,此时特异度为87.9%,敏感度为90.2%,诊断准确率为91.30%。结论 将尿常规与比较稳定的血液炎症指标联合应用对意识障碍卧床患者发生UTI具有较高的诊断价值。

Objective To explore the diagnostic value of combined detection of blood inflammation and urine routine indicators for urinary tract infection(UTI)in bedridden patients with consciousness disorders.Methods The 42 patients bedridden with impaired consciousness and UTI admitted to Sihong Hospital from January 2019 to June 2023 were selected as research objects and included in UTI group.In addition,50 patients bedridden with impaired consciousness without UTI and 50 elderly patients were included in non-infection group and control group,respectively.The reaults of procalcitonin(PCT),systemic inflammatory response index(SIRI),C-reactive protein(CRP)to albumin(ALB)ratio(CRP/ALB)and the positive rates of urine nitrite(NIT)and urine leukocyte esterase(LEU)were collected from all patients,and the differences in above indexes were compared.The receiver operator characteristic(ROC)curve was plotted,the area under ROC curve(AUC)was calculated,and the diagnostic efficacy of each index in diagnosis of UTI in bedridden patients with impaired consciousness was analyzed.Results The levels of PCT,SIRI,CRP/ALB and the positive rates of urine NIT and urine LEU in UTI group were higher than those in non-infection group and control group[PCT(μg/L):2.32±1.24 vs.0.98±0.36,0.69±0.24;SIRI:6.08±1.36 vs.4.15±1.06,3.25±0.86;CRP/ALB:2.23±1.36 vs.1.68±0.65,1.23±0.21;positive rate of urine NIT:73.81%vs.12.00%,10.00%;positive rate of urine LEU:80.95%vs.10.00%,8.00%;all P<0.05].Among individual indicators,the AUC of urine LEU positive rate for diagnosis of UTI in bedridden patients with impaired consciousness was 0.726[95%confidence interval(95%CI)was 0.698-0.781],and the specificity was the highest(78.4%).The sensitivity of PCT was the highest(73.1%).The AUC of five indicators combination reached 0.896,with specificity of 87.9%,sensitivity of 90.2%and diagnostic accuracy of 91.30%.Conclusion The combination of urine routine and stable hematological indicators has high diagnostic value for UTI in bedridden patients with consciousness disorders.