目的 探讨早期联合测定外周血降钙素原(PCT)、C反应蛋白(CRP)和内毒素对不同病原菌血流感染的脓毒症鉴别诊断的临床价值.方法 回顾性分析2012年1月至2013年12月首都医科大学附属世纪坛医院ICU血培养阳性的脓毒症患者152例,根据血培养结果分革兰阴性杆菌与革兰阳性球菌及真菌血流感染组,分别观察患者入科后第1天的外周血PCT、CRP、内毒素和三者联合后的水平在早期诊断的价值.结果 (1)共收集血流感染病例152例,革兰阴性菌共93例(61.18％),以肺炎克雷伯氏菌、鲍曼不动杆菌、大肠埃希氏菌、洋葱伯克霍尔德菌、铜绿假单胞菌为主;革兰阳性菌43例(28.29％),金黄色葡萄球菌13例(8.55％);真菌16例(10.53％).(2)对三组患者的炎症指标进行比较,革兰阴性菌组内毒素阳性60例(64.52％),革兰阳性菌及真菌组均未检测到内毒素阳性值.革兰阴性菌PCT为7.760 (3.365,28.585) ng/mL,革兰阳性菌为0.705 (0.265,3.225) ng/mL,真菌为1.245 (0.543,1.998) ng/mL,三组间差异具有统计学意义;CRP在革兰阴性菌为(126.01±66.53) mg/L,革兰阳性菌(77.58±54.21) mg/L,真菌(140.14±71.21) mg/L,血流感染真菌组升高更为明显.(3)比较各细菌组的受试者工作特征曲线(ROC曲线)的诊断效应,区分革兰阳性菌组和真菌组的ROC曲线显示,AUCPCT+CRP=0.791,PCT截点为0.92 ng/mL,CRP截点为68.00 mg/L,敏感性为50％,特异性为95.5％;区分革兰阴性菌组和真菌组的ROC曲线显示:AUCPCT+CRP+LPS=0.947,PCT截点为2.16ng/mL,CRP截点为94.10 mg/L时,内毒素阳性为截点,敏感性为82.8％,特异性为100％;区分革兰阴性菌组和革兰阳性菌组的ROC曲线显示AUCPCT+CRP+LPS=90.2％,PCT截点为2.68 ng/mL,CRP截点为106.5 mg/L,内毒素阳性为截点,敏感性为74.2％,特异性为97.7％.结论 重症监护病房的血流感染仍以革兰阴性菌为主,早期联合外周血PCT、CRP、内毒素检测,与单一炎症因子相比,可明显提高对不同病原菌血流感染脓毒症患者早期诊断的敏感性和特异性.
目的 探討早期聯閤測定外週血降鈣素原(PCT)、C反應蛋白(CRP)和內毒素對不同病原菌血流感染的膿毒癥鑒彆診斷的臨床價值.方法 迴顧性分析2012年1月至2013年12月首都醫科大學附屬世紀罈醫院ICU血培養暘性的膿毒癥患者152例,根據血培養結果分革蘭陰性桿菌與革蘭暘性毬菌及真菌血流感染組,分彆觀察患者入科後第1天的外週血PCT、CRP、內毒素和三者聯閤後的水平在早期診斷的價值.結果 (1)共收集血流感染病例152例,革蘭陰性菌共93例(61.18％),以肺炎剋雷伯氏菌、鮑曼不動桿菌、大腸埃希氏菌、洋蔥伯剋霍爾德菌、銅綠假單胞菌為主;革蘭暘性菌43例(28.29％),金黃色葡萄毬菌13例(8.55％);真菌16例(10.53％).(2)對三組患者的炎癥指標進行比較,革蘭陰性菌組內毒素暘性60例(64.52％),革蘭暘性菌及真菌組均未檢測到內毒素暘性值.革蘭陰性菌PCT為7.760 (3.365,28.585) ng/mL,革蘭暘性菌為0.705 (0.265,3.225) ng/mL,真菌為1.245 (0.543,1.998) ng/mL,三組間差異具有統計學意義;CRP在革蘭陰性菌為(126.01±66.53) mg/L,革蘭暘性菌(77.58±54.21) mg/L,真菌(140.14±71.21) mg/L,血流感染真菌組升高更為明顯.(3)比較各細菌組的受試者工作特徵麯線(ROC麯線)的診斷效應,區分革蘭暘性菌組和真菌組的ROC麯線顯示,AUCPCT+CRP=0.791,PCT截點為0.92 ng/mL,CRP截點為68.00 mg/L,敏感性為50％,特異性為95.5％;區分革蘭陰性菌組和真菌組的ROC麯線顯示:AUCPCT+CRP+LPS=0.947,PCT截點為2.16ng/mL,CRP截點為94.10 mg/L時,內毒素暘性為截點,敏感性為82.8％,特異性為100％;區分革蘭陰性菌組和革蘭暘性菌組的ROC麯線顯示AUCPCT+CRP+LPS=90.2％,PCT截點為2.68 ng/mL,CRP截點為106.5 mg/L,內毒素暘性為截點,敏感性為74.2％,特異性為97.7％.結論 重癥鑑護病房的血流感染仍以革蘭陰性菌為主,早期聯閤外週血PCT、CRP、內毒素檢測,與單一炎癥因子相比,可明顯提高對不同病原菌血流感染膿毒癥患者早期診斷的敏感性和特異性.
목적 탐토조기연합측정외주혈강개소원(PCT)、C반응단백(CRP)화내독소대불동병원균혈류감염적농독증감별진단적림상개치.방법 회고성분석2012년1월지2013년12월수도의과대학부속세기단의원ICU혈배양양성적농독증환자152례,근거혈배양결과분혁란음성간균여혁란양성구균급진균혈류감염조,분별관찰환자입과후제1천적외주혈PCT、CRP、내독소화삼자연합후적수평재조기진단적개치.결과 (1)공수집혈류감염병례152례,혁란음성균공93례(61.18％),이폐염극뢰백씨균、포만불동간균、대장애희씨균、양총백극곽이덕균、동록가단포균위주;혁란양성균43례(28.29％),금황색포도구균13례(8.55％);진균16례(10.53％).(2)대삼조환자적염증지표진행비교,혁란음성균조내독소양성60례(64.52％),혁란양성균급진균조균미검측도내독소양성치.혁란음성균PCT위7.760 (3.365,28.585) ng/mL,혁란양성균위0.705 (0.265,3.225) ng/mL,진균위1.245 (0.543,1.998) ng/mL,삼조간차이구유통계학의의;CRP재혁란음성균위(126.01±66.53) mg/L,혁란양성균(77.58±54.21) mg/L,진균(140.14±71.21) mg/L,혈류감염진균조승고경위명현.(3)비교각세균조적수시자공작특정곡선(ROC곡선)적진단효응,구분혁란양성균조화진균조적ROC곡선현시,AUCPCT+CRP=0.791,PCT절점위0.92 ng/mL,CRP절점위68.00 mg/L,민감성위50％,특이성위95.5％;구분혁란음성균조화진균조적ROC곡선현시:AUCPCT+CRP+LPS=0.947,PCT절점위2.16ng/mL,CRP절점위94.10 mg/L시,내독소양성위절점,민감성위82.8％,특이성위100％;구분혁란음성균조화혁란양성균조적ROC곡선현시AUCPCT+CRP+LPS=90.2％,PCT절점위2.68 ng/mL,CRP절점위106.5 mg/L,내독소양성위절점,민감성위74.2％,특이성위97.7％.결론 중증감호병방적혈류감염잉이혁란음성균위주,조기연합외주혈PCT、CRP、내독소검측,여단일염증인자상비,가명현제고대불동병원균혈류감염농독증환자조기진단적민감성화특이성.
Objective To investigate the expression of procalcitonin (PCT) and C-reactive protein (CRP),and endotoxin in bloodstream infection with different microorganisms,so as to assess the value of these inflammatory cytokines in early diagnosis of sepsis in bloodstream infections patients.Methods Data of 152 septic bloodstream infected patients with 90 male and 62 female aged from 62 to 102 years and 79.2 ± 16.3 years in average admitted from January 2012 to December 2013 were analyzed retrospectively.According to the results of blood culture,the microorganisms could be categorized into gram-negative bacteria,gram-positive bacteria and fungus groups,and the levels of serum CRP,PCT,and endotoxin were compared among these groups of bloodstream infections patients within 24 hours after admission.Results (1) A total of 152 strains of microorganisms were surveyed including 92 gram-negative strains (61.18％),43 gram-positive strains (28.29％),and 16 fungal strains (10.53％).In the gram-negative strains,Klebsiella pneumoniae (n =29),Acinetobacter baumannii (n =24),Escherichia coli (n =23),Burkholderia cepacia (n =9) and Pseudomonas aeruginosa (n =4) were the most common isolates.In the Gram-positive strains,13 strains of Staphylococcus aureus were isolated.(2) In the gram-negative bacterial bloodstream infections group,there were 60 (64.52％) patients with endotoxin positive,and there were no endotoxin positive cases with detected gram-positive bacteria and fungal bloodstream infections.The median levels of PCT were significantly different among the three groups [gram-negative strains group:7.760 (3.365,28.585) ng/mL,gram-positive strains group:0.705 (0.265,3.225) ng/mL,fungal infection group:1.245 (0.543,1.998) ng/mL].In the fungal bloodstream infection group,the mean level of CRP was higher than that in other two groups [gram-negative strains group:(126.01 ± 66.53) mg/L,gram-positive strains group:(77.58 ±54.21) mg/L,fungal infection group:(140.14 ±71.21) mg/L].(3) The receiver operating characteristic (ROC) curve of inflammatory cytokines was made for the diagnostic value in bloodstream infections.ROC curve used to distinguish between gram-positive bacterial bloodstream infections group and fungal group showed that AUCPCT+CRP =0.791.When PCT cut-off value was 0.92 ng/mL,and CRP cut-off value was 68.00 mg/L,the sensitivity was 50％ and the specificity was 95.5％.ROC curve used to distinguish between the gram-negative bacterial bloodstream infections group and fungal group showed that AUCPCT+CRP+LPS =0.947.When PCT cut-off value was 2.16 ng/mL and CRP cutoff value was 94.10 mg/L,and endotoxin was positive,the sensitivity was 82.8％ and the specificity was 100％.ROC curve used to distinguish between gram-negative bacterial bloodstream infections group and gram-positive bacterial group showed that AUCPCT+CRP+LPS =0.947.When PCT cut-off value was 2.68 ng/ mL,CRP cut-off value was 106.5 mg/L,endotoxin was positive,the sensitivity was 74.2％ and the specificity was 97.7％.Conclusions Gram-negative bacteria were the most common microorganisms in bloodstream infections in ICU patients.Compared with single inflammatory cytokine,the serum concentrations of PCT,CRP and endotoxin used together could provide more sensitivity and specificity for the early diagnosis of bloodstream infection with different microorganisms.
