CAJ | 학술논문

目的检测神经科重症监护病房患者血清降钙素原浓度,探讨其对神经科重症监护病房脓毒症患者诊断的价值.方法检测111例神经科重症监护病房住院患者怀疑脓毒症时血清降钙素原浓度,同时分别采集患者血液或脑脊液标本进行细菌培养及鉴定.组间比较采用x2检验、t检验或非参检验.结果结合临床表现和细菌学证据确诊为脓毒症患者85例,其中有明确细菌学证据的包括脑膜炎患者40例,血流感染39例,细菌学证据阴性而依据临床症状诊断为脓毒症的患者6例;不能最终确诊脓毒症的患者26例.确诊脓毒症患者和未确诊患者血清降钙素原中位水平分别为3.52(0.05～49.80) μg/L和0.46(0.04～7.63) μg/L,两组差异有统计学意义(Z=-5.013,P＜0.01).革兰阳性细菌感染和革兰阴性细菌感染患者血清降钙素原中位水平分别为3.21(0.12～36.78) μg/L和3.52(0.05～49.80)μg/L,两组差异无统计学意义(Z=-0.250,P=0.803),而两组均显著高于未确诊脓毒症患者(Z值分别为-3.479和-4.971,均P＜0.01).血流感染、脑膜炎和无细菌学证据的脓毒症患者血清降钙素原水平分别为3.99(0.24～49.80)、3.77(0.05～41.06)和3.94(0.05～6.28) μg/L,3组间差异无统计学意义(x2=0.647,P=0.723),但均显著高于未确诊脓毒症患者(Z值分别为-4.566,-4.528和-2.312,均P＜0.01).血清降钙素原用于诊断脓毒症的受试者工作特征(ROC)曲线下面积为0.826(95％CI为0.736～0.916,P＜0.01).ROC曲线最佳临界值为1.825 μg/L,敏感度为82.9％,特异度为75.9％,约登指数为0.588,阳性预测值为93.3％,阴性预测值为65.7％,阳性似然比为3.44,阴性似然比为0.23.结论在细菌培养结果出来前,血清降钙素原水平对神经科重症监护病房脓毒症的早期诊断具有一定的参考价值.
목적 검측신경과중증감호병방환자혈청강개소원농도,탐토기대신경과중증감호병방농독증환자진단적개치.방법 검측111례신경과중증감호병방주원환자부의농독증시혈청강개소원농도,동시분별채집환자혈액혹뇌척액표본진행세균배양급감정.조간비교채용x2검험、t검험혹비삼검험.결과 결합림상표현화세균학증거학진위농독증환자85례,기중유명학세균학증거적포괄뇌막염환자40례,혈류감염39례,세균학증거음성이의거림상증상진단위농독증적환자6례;불능최종학진농독증적환자26례.학진농독증환자화미학진환자혈청강개소원중위수평분별위3.52(0.05～49.80) μg/L화0.46(0.04～7.63) μg/L,량조차이유통계학의의(Z=-5.013,P＜0.01).혁란양성세균감염화혁란음성세균감염환자혈청강개소원중위수평분별위3.21(0.12～36.78) μg/L화3.52(0.05～49.80)μg/L,량조차이무통계학의의(Z=-0.250,P=0.803),이량조균현저고우미학진농독증환자(Z치분별위-3.479화-4.971,균P＜0.01).혈류감염、뇌막염화무세균학증거적농독증환자혈청강개소원수평분별위3.99(0.24～49.80)、3.77(0.05～41.06)화3.94(0.05～6.28) μg/L,3조간차이무통계학의의(x2=0.647,P=0.723),단균현저고우미학진농독증환자(Z치분별위-4.566,-4.528화-2.312,균P＜0.01).혈청강개소원용우진단농독증적수시자공작특정(ROC)곡선하면적위0.826(95％CI위0.736～0.916,P＜0.01).ROC곡선최가림계치위1.825 μg/L,민감도위82.9％,특이도위75.9％,약등지수위0.588,양성예측치위93.3％,음성예측치위65.7％,양성사연비위3.44,음성사연비위0.23.결론 재세균배양결과출래전,혈청강개소원수평대신경과중증감호병방농독증적조기진단구유일정적삼고개치.
Objective To test the serum procalcitonin (PCT) concentration of patients in neurological intensive care units (NICU),and to explore the diagnostic value of PCT level in patients with sepsis in NICU.Methods Serum PCT concentration was detected in 111 patients with suspected sepsis in NICU.At the same time,the samples of blood or cerebral spinal fluid (CSF) were collected to perform bacterial cultures and identifications.Chi-square test,t-test,or nonparametric test were used for statistical analysis.Results Eighty-five patients were diagnosed with sepsis by combining clinical manifestations with evidences of bacteriology.Forty patients with meningitis and 39 patients with bloodstream infection were defined by the evidences of bacteriology,and 6 patients were diagnosed on the basis of clinical symptoms of infection.Twenty-six patients were not diagnosed with sepsis finally.Median level of PCT in sepsis group was 3.52 (0.05-49.80) μg/L,and 0.46 (0.04-7.63) μg/L in non-sepsis group.There was statistical significance between the two groups (Z=-5.013,P＜0.01).Median level of PCT in patients with gram-positive bacterial infection was 3.21 (0.12-36.78) μg/L and 3.52 (0.05-49.80) μg/L in those with gram-negative bacterial infection,which were not significantly different between groups (Z=-0.250,P=0.803).However,median levels of PCT in the two groups was both significant higher than undiagnosed sepsis patients (0.46 [0.04-7.63] μg/L; Z=-3.479 and Z=-4.971,respectively,both P＜0.01).The PCT concentrations in patients with bloodstream infection,meningitis and clinically diagnosed sepsis were 3.99 (0.24-49.80),3.77 (0.05-41.06) and 3.94 (0.05 -6.28) μg/L,respectively,which was not statistically different among the three groups (x2 =0.647,P=0.723).However,all of them were all significantly higher than undiagnosed patients (0.46 [0.04-7.63] μg/L; Z=-4.566,Z=-4.528 and Z=-2.312,respectively,all P＜0.01).The area under receiver operating characteristic (ROC) curve of PCT concentration for the diagnosis of sepsis in NICU was0.826 (95％ CI:0.736-0.916,P＜0.01).The optimal cut-off value of ROC curve was 1.825 μg/L,with sensitivity of 82.9％,specificity of 75.9％ and Youden index of 0.588.And positive and negative predictive values were 93.3 ％ and 65.7％,respectively.Positive and negative likelihood ratios were 3.44 and 0.23,respectively.Conclusion The level of serum PCT may preliminarily predict the sepsis before the bacterial culture result,and it might have potential early diagnostic value of sepsis in NICU patients.