联合检测炎症指标对不同病原菌血流感染的诊断价值

Diagnostic value of combined detection of inflammatory indicators in bloodstream infection with different pathogenic bacteria

摘要:

目的探讨联合检测降钙素原（PCT）、C反应蛋白（CRP）、白细胞（WBC）和中性粒细胞百分比（NEU%）对革兰阳性（G+）球菌、革兰阴性（G-）杆菌及真菌所致血流感染的诊断价值。方法回顾性分析2014年1月—2015年12月某医院389例血培养阳性患者的检测结果，根据血培养结果分为G+球菌、 G-杆菌和真菌血流感染组，比较不同组别患者的炎症指标是否存在差异。结果经MannWhitney U检验显示，G-杆菌感染组患者血PCT高于G+球菌、真菌感染组（G-杆菌感染组与G+球菌感染组比较：Z=-2.68，P＜0.01； G-杆菌感染组与真菌感染组比较：Z=-2.46，P＜0.05）。若以PCT≥0.5 ng/mL、CRP≥5.0 mg/L、NEU%≥70%及WBC≥10×109/L作为阳性的截点，统计分析显示，G-杆菌感染组患者血PCT阳性率较G+球菌、真菌感染组高（G-杆菌感染组与G+球菌感染组比较：χ2=5.94，P＜0.05；G-杆菌感染组与真菌感染组比较：χ2=7.721，P＜0.01）； G-杆菌感染组患者血CRP阳性率较G+球菌感染组高（χ2=5.03，P＜0.05）。用二分类logistic回归对四项指标在鉴别G+球菌、G-杆菌和真菌血流感染的作用大小比较分析，仅PCT对鉴别G-杆菌、G+球菌和真菌有统计学差异（P＜0.01）。结论PCT在区分血培养G-杆菌、G+球菌和真菌时有较高的准确度，若能动态监测PCT，同时结合CRP、WBC、NEU%的结果综合判断，可以在血流感染早期指导临床医生快速判断患者的病情并合理用药，从而降低血流感染患者的病死率。

Abstract:

ObjectiveTo investigate the diagnostic value of combined detection of procalcitonin (PCT), Creactive protein (CRP), white blood cell (WBC), and neutrophil percentage (NEU%) in bloodstream infection with grampositive coccus(G+), gramnegative bacillus (G- ）and fungus. MethodsDetection results of positive blood culture of 389 patients in a hospital between January 2014 and December 2015 were analyzed retrospectively, according to the results of blood culture, patients were divided into G+ coccus, G- bacillus and fungal bloodstream infection groups, inflammatory indicators of different groups of patients were compared. ResultsMannWhitney U test revealed that PCT level of G- infection group was higher than that of G+ and fungal infection group (comparison between G- infection group and G+ infection group : Z=-2.68，P＜0.01；comparison between G- infection group and fungal infection group: Z=-2.46，P＜0.05）. If PCT≥0.5 ng/mL, CRP≥5.0 mg/L, NEU%≥70% and WBC≥10×109/L were as the cutoff point, statistical analysis revealed the positive rate of PCT in G- infection group was higher than that in G+ and fungal infection group(comparison between G- infection group and G+ infection group：χ2=5.94，P＜0.05；comparison between G- infection group and fungal infection group：χ2=7.721，P＜0.01）；the positive rate of CRP in G- infection group was higher than that in G+ infection group (χ2=5.03，P＜0.05）. Binary logistic regression was adopted to analyze the efficacy of four indicators for the differentiation of bloodstream infection caused by G+ coccus,   G- bacillus, and fungus, only PCT had significant difference in the identification of bloodstream infection caused by G- bacillus, G+ coccus and fungus(P<0.01). ConclusionPCT has high accuracy in differentiating G- bacillus, G+ coccus, and fungus of blood culture, dynamic monitoring of PCT combined with detection results of CRP, WBC, and NEU%, patient’s condition can be judged rapidly, and antimicrobial agents can be used rationally, so the mortality of patients with bloodstream infection can be reduced.