CAJ | 학술논문

目的：探讨血清降钙素原（PCT）与菌血症之间的关系，评价血清PCT在预测血培养确证的菌血症方面的诊断价值。方法采用回顾性研究，以同时进行血培养及PCT检测的1690例患者为研究对象，对其结果进行分析。研究对象分为3组，即血培养阳性组（129例）、血培养阴性组（1463例）和血培养污染组（98例），比较3组之间PCT浓度的差异，并将血培养阳性组分为革兰阴性菌组、革兰阳性菌组和假丝酵母菌组，从而进一步比较PCT浓度在阳性组内的差异。结果血培养阳性组PCT浓度高于血培养阴性组和血培养污染组[中位数（四分位数）分别为2．62（0．37～12．80）、0．17（0．07～0．62）和0．20（0．09～0．72）ng/mL，P＜0．0001]。革兰阴性菌组、假丝酵母菌组和革兰阳性菌组PCT阳性率分别为74．5％、37．5％和66．7％，PCT浓度[中位数（四分位数）]分别为6．24（0．43～16．09）、0．47（0．22～3．18）和1．09（0．24～4．05）ng/mL，革兰阴性菌组PCT浓度明显高于革兰阳性菌组和假丝酵母菌组（P＜0．05）。结论除临床其他指标外，PCT作为一种可靠的检测指标，可用于排除血培养的污染和非感染性疾病情况，为菌血症提供早期的预示信息，从而改善和提高菌血症诊断的准确性，避免非必需的抗菌药物治疗，对临床诊疗具有很大的临床意义。
목적：탐토혈청강개소원（PCT）여균혈증지간적관계，평개혈청PCT재예측혈배양학증적균혈증방면적진단개치。방법채용회고성연구，이동시진행혈배양급PCT검측적1690례환자위연구대상，대기결과진행분석。연구대상분위3조，즉혈배양양성조（129례）、혈배양음성조（1463례）화혈배양오염조（98례），비교3조지간PCT농도적차이，병장혈배양양성조분위혁란음성균조、혁란양성균조화가사효모균조，종이진일보비교PCT농도재양성조내적차이。결과혈배양양성조PCT농도고우혈배양음성조화혈배양오염조[중위수（사분위수）분별위2．62（0．37～12．80）、0．17（0．07～0．62）화0．20（0．09～0．72）ng/mL，P＜0．0001]。혁란음성균조、가사효모균조화혁란양성균조PCT양성솔분별위74．5％、37．5％화66．7％，PCT농도[중위수（사분위수）]분별위6．24（0．43～16．09）、0．47（0．22～3．18）화1．09（0．24～4．05）ng/mL，혁란음성균조PCT농도명현고우혁란양성균조화가사효모균조（P＜0．05）。결론제림상기타지표외，PCT작위일충가고적검측지표，가용우배제혈배양적오염화비감염성질병정황，위균혈증제공조기적예시신식，종이개선화제고균혈증진단적준학성，피면비필수적항균약물치료，대림상진료구유흔대적림상의의。
Objective To investigate the relationship of serum procalcitonin (PCT)and bacteremia,and to evaluate the diagnosis significance of serum PCT to predict bacteremia determined by blood cultures.Methods A total of 1 690 patients undergoing blood cultures and PCT were concurrently enrolled for detecting bacteremia by retrospective analysis.The patients were classified into blood culture positive group(129 cases),blood culture negative group(1 463 cases)and contaminated blood culture group(98 cases).According to the difference of PCT concentration,the blood culture positive group was subclassified into 3 groups,gram-negative bacterium group,gram-positive bacterium group and Candida mycoderma group.The difference of PCT concentration in the blood culture positive group was further analyzed comparatively.Results The concentration of PCT in blood culture positive group was higher than those of blood culture negative group and contaminated blood culture group [medians(quartiles)were 2.62(0.37-12.80),0.17 (0.07-0.62)and 0.20(0.09-0.72)ng/mL,P<0.000 1].In gram-negative bacterium group,Candida mycoderma group and gram-positive bacterium group,the positive rates of serum PCT were 74.5%,37.5% and 66.7%, respectively,while the PCT concentrations [medians (quartiles)were 6.24(0.43-16.09),0.47(0.22-3.18)and 1. 09(0.24-4.05)ng/mL.PCT concentration in gram-negative bacterium group was higher than those in gram-positive bacterium group and Candida mycoderma group (P<0.05 ).Conclusions In addition to other clinical parameters, PCT is a reliable parameter for ruling out blood culture contamination and non-bacterial conditions.PCT is effective as a parameter for predicting early bacteremia,and is able to improve the accuracy of diagnosis and avoid the unnecessary antimicrobial usage.PCT has great clinical significance for the clinical diagnosis and treatment.