不同炎症因子对细菌性血流感染所致脓毒症患者的早期诊断价值
불동염증인자대세균성혈류감염소치농독증환자적조기진단개치
The diagnostic value of different pro-inflammatory factor in early diagnosis of sepsis in patients with bloodstream infection
  • 万方数据
    中华危重病急救医学 중화위중병급구의학
    Chinese Critical Care Medicine
    2014年 3期 165-170 ,共6页

    陈炜%赵磊%牛素平%王锁柱%盛博%甄洁%古旭云%吕超

    진위%조뢰%우소평%왕쇄주%성박%견길%고욱운%려초

    降钙素原%C-反应蛋白%内毒素%血流感染%脓毒症 降鈣素原%C-反應蛋白%內毒素%血流感染%膿毒癥
    강개소원%C-반응단백%내독소%혈류감염%농독증
    Procalcitonin%C-reactive protein%Endotoxin%Bloodstream infection%Sepsis
    目的 比较降钙素原(PCT)、C-反应蛋白(CRP)、内毒素等炎症因子在细菌性血流感染所致脓毒症患者中的水平差异及其早期诊断价值.方法 回顾性分析2012年2月至2013年5月入住首都医科大学附属北京世纪坛医院重症监护病房(ICU)确诊为脓毒症且血培养阳性的132例患者的临床资料,根据血培养结果将脓毒症患者分为革兰阴性(G-)杆菌血流感染组(98例)和革兰阳性(G+)球菌血流感染组(34例),比较两组患者6h内的炎症因子,如白细胞计数(WBC)、中性粒细胞比例(N)、CRP、PCT、内毒素水平等的差异及其之间的相关性；绘制各炎症因子对血流感染所致脓毒症诊断的受试者工作特征曲线(ROC曲线),根据曲线下面积(AUC)来评价其对血流感染所致脓毒症的诊断价值,根据最佳诊断临界值评估各数值对血流感染诊断的敏感性和特异性.结果 ①G-菌组PCT、CRP、内毒素水平明显高于G+菌组[PCT(μg/L):5.11(0.99,18.00)比1.00(0.36,2.73),Z=49.647,P=0.000; CRP(mg/L):111.5±57.4比75.9±56.6,t=9.947,P=0.000；内毒素(ng/L):18.00(8.75,28.00)比5.00(5.00,6.25),Z=52.333,P=0.000],而WBC、N差异无统计学意义.②相关性分析显示:G菌组患者PCT与CRP(r=0.671,P=0.000)、PCT与内毒素(r=0.916,P=0.000)、CRP与内毒素(r=0.687,P=0.004)均呈正相关；G+菌组患者PCT与CRP(r=0.620,P=0.000)、PCT与内毒素(r=0.487,P=0.010)、PCT与WBC(r=0.537,P=0.001)、PCT与N(r=0.432,P=0.011)、CRP与内毒素(r=0.674,P=0.000)、内毒素与WBC(r=0.197,P=0.024)均呈正相关；而所有细菌性血流感染患者PCT与CRP(r=0.538,P=0.000)、PCT与内毒素(r=0.740,P=0.000)、PCT与WBC (r=0.259,P=0.003)、CRP与内毒素(r=0.579,P=0.000)、内毒素与WBC(r=0.197,P=0.024)均呈正相关.③ROC曲线分析显示:在G-菌血流感染所致脓毒症患者,PCT的AUC为0.825,最佳诊断临界值＞2.455 μg/L时敏感度71.4％、特异度96.2％; CRP的AUC为0.761,最佳诊断临界值＞79.45 mg/L时敏感度64.3％、特异度80.8％；内毒素的AUC为0.797,最佳诊断临界值＞ 15.5 ng/L时敏感度61.2％、特异度94.2％.在G+菌血流感染所致脓毒症患者,PCT的AUC为0.619,最佳诊断临界值＞ 1.585 μg/L时敏感度41.2％、特异度82.7％；CRP的AUC为0.533,最佳诊断临界值＞95.25 mg/L时敏感度32.4％、特异度82.7％.结论 G-菌血流感染所致脓毒症患者PCT、CRP、内毒素水平高于G+菌血流感染者,三者联合检测有望成为早期判断血流感染所致脓毒症及其病情严重程度的指标.
    목적 비교강개소원(PCT)、C-반응단백(CRP)、내독소등염증인자재세균성혈류감염소치농독증환자중적수평차이급기조기진단개치.방법 회고성분석2012년2월지2013년5월입주수도의과대학부속북경세기단의원중증감호병방(ICU)학진위농독증차혈배양양성적132례환자적림상자료,근거혈배양결과장농독증환자분위혁란음성(G-)간균혈류감염조(98례)화혁란양성(G+)구균혈류감염조(34례),비교량조환자6h내적염증인자,여백세포계수(WBC)、중성립세포비례(N)、CRP、PCT、내독소수평등적차이급기지간적상관성；회제각염증인자대혈류감염소치농독증진단적수시자공작특정곡선(ROC곡선),근거곡선하면적(AUC)래평개기대혈류감염소치농독증적진단개치,근거최가진단림계치평고각수치대혈류감염진단적민감성화특이성.결과 ①G-균조PCT、CRP、내독소수평명현고우G+균조[PCT(μg/L):5.11(0.99,18.00)비1.00(0.36,2.73),Z=49.647,P=0.000; CRP(mg/L):111.5±57.4비75.9±56.6,t=9.947,P=0.000；내독소(ng/L):18.00(8.75,28.00)비5.00(5.00,6.25),Z=52.333,P=0.000],이WBC、N차이무통계학의의.②상관성분석현시:G균조환자PCT여CRP(r=0.671,P=0.000)、PCT여내독소(r=0.916,P=0.000)、CRP여내독소(r=0.687,P=0.004)균정정상관；G+균조환자PCT여CRP(r=0.620,P=0.000)、PCT여내독소(r=0.487,P=0.010)、PCT여WBC(r=0.537,P=0.001)、PCT여N(r=0.432,P=0.011)、CRP여내독소(r=0.674,P=0.000)、내독소여WBC(r=0.197,P=0.024)균정정상관；이소유세균성혈류감염환자PCT여CRP(r=0.538,P=0.000)、PCT여내독소(r=0.740,P=0.000)、PCT여WBC (r=0.259,P=0.003)、CRP여내독소(r=0.579,P=0.000)、내독소여WBC(r=0.197,P=0.024)균정정상관.③ROC곡선분석현시:재G-균혈류감염소치농독증환자,PCT적AUC위0.825,최가진단림계치＞2.455 μg/L시민감도71.4％、특이도96.2％; CRP적AUC위0.761,최가진단림계치＞79.45 mg/L시민감도64.3％、특이도80.8％；내독소적AUC위0.797,최가진단림계치＞ 15.5 ng/L시민감도61.2％、특이도94.2％.재G+균혈류감염소치농독증환자,PCT적AUC위0.619,최가진단림계치＞ 1.585 μg/L시민감도41.2％、특이도82.7％；CRP적AUC위0.533,최가진단림계치＞95.25 mg/L시민감도32.4％、특이도82.7％.결론 G-균혈류감염소치농독증환자PCT、CRP、내독소수평고우G+균혈류감염자,삼자연합검측유망성위조기판단혈류감염소치농독증급기병정엄중정도적지표.
    Objective To investigate the expression of different inflammatory variables,such as procalcitonin (PCT),C-reactive protein (CRP),and endotoxin in septic patients with bacterial bloodstream infection,in order to assess the value of these variables in early diagnosis.Methods The clinical data of 132 bacterial bloodstream infection patients with clinical diagnosis of sepsis in intensive care unit (ICU) of Beijing Shijitan Hospital of Capital Medical University from February 2012 to May 2013 were analyzed retrospectively.Patients were divided into Gram-negative (G-) bacterial bloodstream infection group (n =98) and Gram-positive (G+) bacterial bloodstream infection group (n =34) according to the result of blood culture.The inflammatory variables including white blood cell (WBC) count,percentage of neutrophils (N),CRP,PCT and level of endotoxin in blood of both groups within 6 hours of bloodstream infection were compared,and their correlation was analyzed.The receiver operating characteristic (ROC) curve of inflammatory variables for the diagnosis of bloodstream infection was plotted,and their diagnostic value for bloodstream infection was evaluated according to area under ROC curve (AUC),and finally the sensitivity and specificity of inflammatory variables for bloodstream infection were assessed based on the best diagnostic cut-off points.Results ① The levels of the variables,including PCT,CRP,and endotoxin content in the G-bacterial bloodstream infection group were significantly higher than that of G+ bacterial bloodstream infection group [PCT (μg/L):5.11 (0.99,18.00)vs.1.00 (0.36,2.73),Z=49.647,P=0.000; CRP (mg/L):111.5 ±57.4 vs.75.9 ±56.6,t=9.947,P=0.000;endotoxin (ng/L):18.00 (8.75,28.00) vs.5.00 (5.00,6.25),Z=52.333,P=0.000].There was no significant difference in WBC and N between two groups.② The results of the correlation coefficient of the inflammatory variables showed:in G-bacterial bloodstream infection group positive correlation was found between PCT and CRP (r=0.671,P=0.000),PCT and endotoxin (r=0.916,P=0.000),CRP and endotoxin (r=0.687,P=0.04).On the other hand,in G + bacterial bloodstream infection group,correlation was shown between PCT and CRP (r=0.620,P=0.000),PCT and endotoxin (r=0.487,P=0.010),PCT and WBC (r=0.537,P=0.001),PCT and N (r=0.432,P=0.011),CRP and endotoxin (r=0.674,P=0.000),endotoxin and WBC (r=0.197,P=0.024).In all of bloodstream infection patients positive correlation was found between PCT and CRP (r=0.538,P=0.000),PCT and endotoxin (r=0.740,P=0.000),PCT and WBC (r=0.259,P=0.003),CRP and endotoxin (r=0.579,P=0.000),endotoxin and WBC (r=0.197,P=0.024).③ The ROC curve in patients with the diagnosis of sepsis due to bloodstream infection showed that:in the G-bacterial bloodstream infection group,AUC for PCT was 0.825,sensitivity of 71.4％ and specificity of 96.2％ with the best cut-off value ＞2.455 μg/L; AUC for CRP was 0.761,sensitivity of 64.3％ and specificity of 80.8％ with the best cut-off value ＞79.45 mg/L; AUC for endotoxin was 0.797,sensitivity of 61.2％ and specificity of 94.2％ with the best cut-off value ＞ 15.5 ng/L.In the G+ bacterial bloodstream infection group,AUC for PCT was 0.619,sensitivity of 41.2％ and specificity of 82.7％ with the best cut-off value ＞ 1.585 μg/L; AUC for CRP was 0.533,sensitivity of 32.4％ and specificity of 82.7％ with the best cut-off value ＞95.25 mg/L.Conclusions The concentrations of PCT,CRP,and endotoxin in patients with G-bacterial bloodstream infection were significantly higher than those of G+ bacterial bloodstream infection group.They are valuable for the early diagnosis of bloodstream infection,and judgment of its severity,and it is more valuable with the combination of PCT,CRP,and endotoxin concentration determinations.
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