降钙素原与血常规相关指标联合检测对早期鉴别混合细菌血流感染的诊断价值

Diagnostic value of combined detection of procalcitonin and blood routine related indicators in early differential diagnosis of mixed bacterial bloodstream infection

目的探讨血常规相关指标及降钙素原(PCT)联合检测对早期鉴别混合细菌血流感染的诊断价值。方法回顾性选取2021年1月至2024年3月于宁夏医科大学总医院就诊的295例血流感染患者作为研究对象,结合血培养报阳时间和PCT排除血培养污染菌,辅助诊断血流感染。依据血培养结果将患者分为单菌感染组和多菌感染组。再将多菌感染组又分为革兰染色结果阴性、阳性组和革兰染色结果混合组,分析单菌感染组与多菌感染组,以及革兰染色结果阴性、阳性组和革兰染色结果混合组PCT及血常规指标水平差异。采用多因素Logistic回归分析发生混合细菌血流感染及混合革兰染色细菌血流感染的独立危险因素。采用受试者工作特征(ROC)曲线分析各项指标单独及联合检测对混合细菌血流感染及混合革兰染色细菌血流感染的诊断价值。结果单菌感染组与多菌感染组白细胞计数(WBC)、中性粒细胞百分比(NEUT%)、中性粒细胞绝对值(NEUT#)、单核细胞绝对值(MXD)、中性粒细胞与淋巴细胞比值(NLR)、中性粒细胞与血小板计数(PLT)比值(NPR)、全身炎症反应指数(SIRI)、全身免疫炎症指数(SII)及PCT水平比较,差异均有统计学意义(P<0.05);革兰染色结果阴性、阳性组和革兰染色结果混合组WBC、NEUT%、NEUT#、NLR、NPR、SIRI、SII及PCT水平比较,差异均有统计学意义(P<0.05)。多因素Logistic回归分析结果显示,WBC和PCT水平升高是发生混合细菌血流感染及混合革兰染色细菌血流感染的独立危险因素(P<0.05)。WBC、PCT联合检测鉴别诊断混合细菌血流感染的曲线下面积(AUC)为0.899,灵敏度、特异度分别为83.3%、84.3%;WBC、PCT联合检测鉴别诊断混合革兰染色细菌血流感染的AUC为0.946,灵敏度、特异度分别为93.3%和90.0%。结论WBC、PCT联合检测对早期鉴别混合细菌血流感染及混合革兰染色细菌血流感染有较高的诊断价值。

Objective To investigate the diagnostic value of combined detection of blood routine related indicators and procalcitonin(PCT)in early differential diagnosis of mixed bacterial bloodstream infection.Methods A total of 295 patients with bloodstream infection in the General Hospital of Ningxia Medical University from January 2021 to March 2024 were selected retrospectively as the research objects.Combined with the positive time of blood culture and PCT,blood culture contaminating bacteria were excluded to aid in the diagnosis of bloodstream infection.According to the results of blood culture,the patients were divided into mono-bacterial infection group and multi-bacterial infection group.The polymicrobial infection group was further divided into Gram stain negative group,Gram stain positive group and Gram stain mixed group.The differences of PCT and blood routine indexes between single bacterial infection group and polymicrobial infection group,as well as Gram stain negative group,Gram stain positive group and Gram stain mixed group were analyzed.Multivariate Logistic regression analysis was used to analyze the independent risk factors of mixed bacterial bloodstream infection and mixed Gram stain bacterial bloodstream infection.The receiver operating characteristic(ROC)curve was used to analyze the diagnostic value of each index alone and in combination for mixed bacterial bloodstream infection and mixed Gram stain bacterial bloodstream infection.Results White blood cell count(WBC),neutrophil percentage(NEUT%),absolute neutrophil count(NEUT#),absolute monocyte count(MXD),neutrophil-to-lymphocyte ratio(NLR),neutrophil-to-platelet ratio(NPR),and systemic inflammatory response index(SIRI),systemic immune inflammation index(SII)and PCT levelswere measured in the mono-bacterial infection group and multi-bacterial infection group,and differences were statistically significant(P<0.05).There were significant differences in WBC,NEUT%,NEUT#,NLR,NPR,SIRI,SII,and PCT levels among Gram stain negative group,Gram stain positive group,and Gram stain mixed group(P<0.05).Multivariate Logistic regression analysis showed that increased WBC and PCT levels were independent risk factors for mixed bacterial bloodstream infection and mixed Gram stain bacterial bloodstream infection(P<0.05).The area under the curve(AUC)of combined detection of WBC and PCT in the differential diagnosis of mixed bacterial bloodstream infection was 0.899,and the sensitivity and specificity were 83.3% and 84.3% respectively.The AUC of combined detection of WBC and PCT in the differential diagnosis of mixed Gram stain bacterial bloodstream infection was 0.946,and the sensitivity and specificity was 93.3% and 90.0% respectively.Conclusion The combined detection of WBC and PCT has a high diagnostic value in the differential diagnosis of early mixed bacterial bloodstream infection and mixed Gram stain bacterial bloodstream infection.