CAJ | 학술논문

目的比较降钙素原、C反应蛋白、内毒素等炎性生物标记物对革兰氏阴性菌血流感染患者其早期诊断的预测价值.方法回顾性分析北京世纪坛医院病房住院的血培养阳性的革兰氏阴性菌感染患者79例,收集其性别、年龄、病情严重程度(APACHEⅡ评分)、血培养细菌种类等资料,同时分析这些患者入科6h内的白细胞(WBC)计数、中性粒细胞(NEU)百分比、C-反应蛋白(CRP)、降钙素原(PCT)、内毒素(endotoxin)的水平.结果 ①革兰氏阴性菌性血流感染患者的炎症生物标记物呈正相关的分别为PCT与endotoxin(r=0.916),PCT与CRP (r=0.496),CRP与endotoxin(r=0.387);且与APACHEⅡ呈明显相关(PCT/APACHEⅡ=0.408,endotoxin/APACHEⅡ=0.399,CRP/APACHEⅡ=0.425).②受试者工作特征曲线(ROC曲线)显示,在革兰氏阴性菌血流感染的脓毒症患者的AUCPCT=0.715(敏感性64.6％,特异性80.7％),AUCCRP =0.666(敏感性67.7％,特异性78.6％),AUCendotoxin=0.771(敏感性78.8％,特异性81.8％);③ROC曲线显示,在革兰氏阴性菌血流感染的严重脓毒症/脓毒性休克患者的AUCPCT＝0.865(敏感性86.2％,特异性77.5％),AUCCRP=0.733(敏感性72.4％,特异性75.0％),AUCendotoxin=0.618(敏感性70.7％,特异性67.5％).结论血清PCT、CRP、内毒素水平在革兰阴性菌血流感染患者早期诊断有预测价值,在脓毒症期内毒素最为特异,而严重脓毒症期或休克期,PCT最为特异,均与疾病的严重程度呈正相关.
목적 비교강개소원、C반응단백、내독소등염성생물표기물대혁란씨음성균혈류감염환자기조기진단적예측개치.방법 회고성분석북경세기단의원병방주원적혈배양양성적혁란씨음성균감염환자79례,수집기성별、년령、병정엄중정도(APACHEⅡ평분)、혈배양세균충류등자료,동시분석저사환자입과6h내적백세포(WBC)계수、중성립세포(NEU)백분비、C-반응단백(CRP)、강개소원(PCT)、내독소(endotoxin)적수평.결과 ①혁란씨음성균성혈류감염환자적염증생물표기물정정상관적분별위PCT여endotoxin(r=0.916),PCT여CRP (r=0.496),CRP여endotoxin(r=0.387);차여APACHEⅡ정명현상관(PCT/APACHEⅡ=0.408,endotoxin/APACHEⅡ=0.399,CRP/APACHEⅡ=0.425).②수시자공작특정곡선(ROC곡선)현시,재혁란씨음성균혈류감염적농독증환자적AUCPCT=0.715(민감성64.6％,특이성80.7％),AUCCRP =0.666(민감성67.7％,특이성78.6％),AUCendotoxin=0.771(민감성78.8％,특이성81.8％);③ROC곡선현시,재혁란씨음성균혈류감염적엄중농독증/농독성휴극환자적AUCPCT＝0.865(민감성86.2％,특이성77.5％),AUCCRP=0.733(민감성72.4％,특이성75.0％),AUCendotoxin=0.618(민감성70.7％,특이성67.5％).결론 혈청PCT、CRP、내독소수평재혁란음성균혈류감염환자조기진단유예측개치,재농독증기내독소최위특이,이엄중농독증기혹휴극기,PCT최위특이,균여질병적엄중정도정정상관.
Objective To investigate the value of inflammatory biomarkers such as procalcitonin (PCT),C-reactive protein (CRP),and endotoxin in early diagnosis of bacteriemia patients infected with gram-negative bacteria.Methods A cohort of 79 bacteriemia patients infected with gram-negative bacteria admitted from February 2011 to May 2013 were enrolled for retrospective study.Collected data for analysis included gender,age,disease severity (APACHE Ⅱ score),bacterial isolates from blood culture and other general information.The inflammatory biomarkers such as white blood cell (WBC),neutrophils (NEU),Creactive protein (CRP),procalcitonin (PCT),and endotoxin were assayed within 6 hours after admission.SPSS version 16.0 software was used for statistical analysis.The test of normality was used for analysis of continuous variables,t-test for inter-group comparison and non-parametric statistics for non-normal distribution variables.The AUC of ROC was calculated for determining the sensitivity and specificity of biomarkers for diagnosis of bacteriemia.Results (1) Statistically positive correlations were found among serum PCT,CRP,and endotoxin levels (PCT/CRP =0.916,PCT/endotoxin =0.496,Endotoxin/CRP =0.387),and between those and APACHE Ⅱ score were (PCT/APACHE Ⅱ =0.505,Endotoxin/APACHE Ⅱ =0.467,CRP/APACHE Ⅱ =0.278),respectively,in bacteriemia patients infected with gram-negative bacteria.(2) The receiver operating characteristic (ROC) curve indicated that AUC PCT =0.715 (sen 64.6％,spe 80.7％),AUC CRP =0.666 (sen 67.7％,spe 78.6％),AUC endotoxin =0.771 (sen 78.8％,spe 81.8％) in gram-negative bacteria bloodstream infection patients.(3) The AUC PCT =0.865 (sen 86.2％,spe 77.5％),AUC CRP =0.733 (sen 72.4％,spe 75.0％),AUCendotoxin =0.618 (sen 70.7％,spe 67.5％) in bacteriemia patients infected with gram-negative bacteria in severe sepsis and septic shock group.Conclusions The plasma PCT,CRP,and endotoxin have early predictive value in bacteriemia patients infected with Gram-negative bacteria.In sepsis stage,the level of serum endotoxin has the most significant value for diagnosis.In severe sepsis and septic shock stages,the PCT is the most value for diagnosis of bacteriemia.All biomarkers are positively correlated with severity of the disease.