联合检测炎症指标对不同病原菌血流感染的诊断价值

摘要

目的 探讨联合检测降钙素原(PCT)、C反应蛋白(CRP)、白细胞(WBC)和中性粒细胞百分比(NEU%)对革兰阳性(G+)球菌、革兰阴性(G-)杆菌及真菌所致血流感染的诊断价值.方法 回顾性分析2014年1月-2015年12月某医院389例血培养阳性患者的检测结果,根据血培养结果分为G+球菌、 G-杆菌和真菌血流感染组,比较不同组别患者的炎症指标是否存在差异.结果 经Mann-Whitney U检验显示,G-杆菌感染组患者血PCT高于G+球菌、真菌感染组(G-杆菌感染组与G+球菌感染组比较:Z=-2.68,P<0.01;G-杆菌感染组与真菌感染组比较:Z=-2.46,P<0.05).若以PCT≥0.5 ng/mL、CRP≥5.0 mg/L、NEU%≥70%及WBC≥10×109/L作为阳性的截点,统计分析显示,G-杆菌感染组患者血PCT阳性率较G+球菌、真菌感染组高(G-杆菌感染组与G+球菌感染组比较:χ2=5.94,P<0.05;G-杆菌感染组与真菌感染组比较:χ2=7.721,P<0.01);G-杆菌感染组患者血CRP阳性率较G+球菌感染组高(χ2=5.03,P<0.05).用二分类logistic回归对四项指标在鉴别G+球菌、G-杆菌和真菌血流感染的作用大小比较分析,仅PCT对鉴别G-杆菌、G+球菌和真菌有统计学差异(P<0.01).结论 PCT在区分血培养G-杆菌、G+球菌和真菌时有较高的准确度,若能动态监测PCT,同时结合CRP、WBC、NEU%的结果综合判断,可以在血流感染早期指导临床医生快速判断患者的病情并合理用药,从而降低血流感染患者的病死率.%Objective To investigate the diagnostic value of combined detection of procalcitonin (PCT), C-reactive protein (CRP), white blood cell (WBC), and neutrophil percentage (NEU%) in bloodstream infection with gram-positive coccus(G+), gram-negative bacillus (G-)and fungus.Methods Detection results of positive blood culture of 389 patients in a hospital between January 2014 and December 2015 were analyzed retrospectively, according to the results of blood culture, patients were divided into G+ coccus, G-bacillus and fungal bloodstream infection groups, inflammatory indicators of different groups of patients were compared.Results Mann-Whitney U test revealed that PCT level of G-infection group was higher than that of G+ and fungal infection group (comparison between G-infection group and G+ infection group : Z=-2.68,P<0.01;comparison between G-infection group and fungal infection group: Z=-2.46,P<0.05).If PCT≥0.5 ng/mL, CRP≥5.0 mg/L, NEU%≥70% and WBC≥10×109/L were as the cut-off point, statistical analysis revealed the positive rate of PCT in G-infection group was higher than that in G+ and fungal infection group(comparison between G-infection group and G+ infection group:χ2=5.94,P<0.05;comparison between G-infection group and fungal infection group:χ2=7.721,P<0.01);the positive rate of CRP in G-infection group was higher than that in G+ infection group (χ2=5.03,P<0.05).Binary logistic regression was adopted to analyze the efficacy of four indicators for the differentiation of bloodstream infection caused by G+ coccus, G-bacillus, and fungus, only PCT had significant difference in the identification of bloodstream infection caused by G-bacillus, G+ coccus and fungus(P<0.01).Conclusion PCT has high accuracy in differentiating G-bacillus, G+ coccus, and fungus of blood culture, dynamic monitoring of PCT combined with detection results of CRP, WBC, and NEU%, patient's condition can be judged rapidly, and antimicrobial agents can be used rationally, so the mortality of patients with bloodstream infection can be reduced.