中国全科医学
中國全科醫學
중국전과의학
CHINESE GENERAL PRACTICE
2014年
32期
3823-3826
,共4页
降钙素%发热%菌血症%诊断试验%急诊监护病房
降鈣素%髮熱%菌血癥%診斷試驗%急診鑑護病房
강개소%발열%균혈증%진단시험%급진감호병방
Calcitonin%Fever%Bacteremia%Diagnosis test%Emergency care unit
目的:评估降钙素原(PCT)对急诊监护病房(ECU)急性发热患者菌血症的诊断价值。方法选取2012年1-12月绍兴市人民医院 ECU 收治的急性发热(体温≥38℃)患者215例,根据排除条件共纳入200例。根据血培养结果将其分为菌血症组(55例)、局部感染组(120例)和非感染性疾病组(25例),记录各组患者 PCT、外周血白细胞计数(WBC)和 C 反应蛋白(CRP)水平,并比较 PCT、WBC、CRP 预测发热患者发生菌血症的价值。结果3组 PCT、CRP、WBC 比较,差异均有统计学意义(P <0.01),其中菌血症组 PCT 分别高于局部感染组和非感染性疾病组,差异均有统计学意义(u =975.5、257.5,P <0.01)。菌血症组各菌种感染患者间 PCT、CRP、WBC 比较,差异均无统计学意义(P >0.05),其中革兰阳性球菌感染患者 PCT 高于革兰阴性杆菌感染患者,差异有统计学意义(u =171.5,P <0.05)。当 PCT 临界值为0.5μg/ L 时,其诊断菌血症的灵敏度为67.3%,特异度为73.8%,Youden指数为0.411;当临界值为0.4μg/ L 时,其诊断菌血症的灵敏度为89.1%,特异度为62.8%,Youden 指数为0.519。PCT、CRP、WBC 预测发热患者发生菌血症的 ROC 曲线下面积(AUC)分别为0.845、0.716、0.702。结论在预测急性发热患者是否发生菌血症时,相比 CRP 和 WBC,PCT 是一个更为可靠的指标,适当下调 PCT 临界值可以进一步提高其诊断菌血症的灵敏度。
目的:評估降鈣素原(PCT)對急診鑑護病房(ECU)急性髮熱患者菌血癥的診斷價值。方法選取2012年1-12月紹興市人民醫院 ECU 收治的急性髮熱(體溫≥38℃)患者215例,根據排除條件共納入200例。根據血培養結果將其分為菌血癥組(55例)、跼部感染組(120例)和非感染性疾病組(25例),記錄各組患者 PCT、外週血白細胞計數(WBC)和 C 反應蛋白(CRP)水平,併比較 PCT、WBC、CRP 預測髮熱患者髮生菌血癥的價值。結果3組 PCT、CRP、WBC 比較,差異均有統計學意義(P <0.01),其中菌血癥組 PCT 分彆高于跼部感染組和非感染性疾病組,差異均有統計學意義(u =975.5、257.5,P <0.01)。菌血癥組各菌種感染患者間 PCT、CRP、WBC 比較,差異均無統計學意義(P >0.05),其中革蘭暘性毬菌感染患者 PCT 高于革蘭陰性桿菌感染患者,差異有統計學意義(u =171.5,P <0.05)。噹 PCT 臨界值為0.5μg/ L 時,其診斷菌血癥的靈敏度為67.3%,特異度為73.8%,Youden指數為0.411;噹臨界值為0.4μg/ L 時,其診斷菌血癥的靈敏度為89.1%,特異度為62.8%,Youden 指數為0.519。PCT、CRP、WBC 預測髮熱患者髮生菌血癥的 ROC 麯線下麵積(AUC)分彆為0.845、0.716、0.702。結論在預測急性髮熱患者是否髮生菌血癥時,相比 CRP 和 WBC,PCT 是一箇更為可靠的指標,適噹下調 PCT 臨界值可以進一步提高其診斷菌血癥的靈敏度。
목적:평고강개소원(PCT)대급진감호병방(ECU)급성발열환자균혈증적진단개치。방법선취2012년1-12월소흥시인민의원 ECU 수치적급성발열(체온≥38℃)환자215례,근거배제조건공납입200례。근거혈배양결과장기분위균혈증조(55례)、국부감염조(120례)화비감염성질병조(25례),기록각조환자 PCT、외주혈백세포계수(WBC)화 C 반응단백(CRP)수평,병비교 PCT、WBC、CRP 예측발열환자발생균혈증적개치。결과3조 PCT、CRP、WBC 비교,차이균유통계학의의(P <0.01),기중균혈증조 PCT 분별고우국부감염조화비감염성질병조,차이균유통계학의의(u =975.5、257.5,P <0.01)。균혈증조각균충감염환자간 PCT、CRP、WBC 비교,차이균무통계학의의(P >0.05),기중혁란양성구균감염환자 PCT 고우혁란음성간균감염환자,차이유통계학의의(u =171.5,P <0.05)。당 PCT 림계치위0.5μg/ L 시,기진단균혈증적령민도위67.3%,특이도위73.8%,Youden지수위0.411;당림계치위0.4μg/ L 시,기진단균혈증적령민도위89.1%,특이도위62.8%,Youden 지수위0.519。PCT、CRP、WBC 예측발열환자발생균혈증적 ROC 곡선하면적(AUC)분별위0.845、0.716、0.702。결론재예측급성발열환자시부발생균혈증시,상비 CRP 화 WBC,PCT 시일개경위가고적지표,괄당하조 PCT 림계치가이진일보제고기진단균혈증적령민도。
Objective To investigate the diagnostic value of serum procalcitonin(PCT)in acute fever patients with bacteremia(BACT)in emergency care unit(ECU). Methods A total of 200 febris acuta patients( temperature≥38 ℃ ) admitted to the ECU of Shaoxing People's Hospital from January to December 2012 were divided,according to blood culture re-sults,into groups BACT(n = 55),Local infection(LI group,n = 120),non - LI(n = 25). The levels of PCT,white blood cell(WBC)and CRP were recorded,the values of PCT,WBC,CRP predicting BACT were compared. Results There was significant difference in PCT,CRP,WBC among 3 groups(P < 0. 01),higher in BACT group than in groups LI,non - LI, the difference was significant(u = 975. 5,257. 5,respectively;P < 0. 01). There was no difference in PCT,CRP,WBC a-mong varying strains of BACT group(P > 0. 05),and PCT higher in gram - positive bacilli infectors than in gram - negative in-fectors(u = 171. 5,P < 0. 05). When PCT critical value was 0. 5 μg/ L,its sensitivity diagnosing BACT was 67. 3% ,its spe-cificity was 73. 8% ,Youden index was 0. 411;when PCT critical value was 0. 4 μg/ L,its sensitivity was 89. 1% ,its specifici-ty was 62. 8% ,Youden index was 0. 519. The areas under ROC curve of PCT,CRP,WBC were 0. 845,0. 716,0. 702. Conclusion In predicting BACT in acute fever patients,PCT is a more reliable index than CRP,WBC. Appropriately lowering PCT critical value can improve its sensitivity in diagnosing BACT.