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目的评价血清降钙素原(PCT)水平是否可以早期区分血流感染的不同病原体。方法回顾性分析广州医科大学第一附属医院重症医学科2011年1月至2013年12月收治的脓毒血症并有血培养阳性的资料完整患者142例,根据血培养阳性结果分成革兰阳性菌组(G+组)51例、革兰阴性菌组(G-组)75例和真菌组(fungal组)16例。比较三组患者间PCT与白细胞(WBC)计数水平。结果 G-组患者的PCT(65.32±49.23)μg/L明显高于G+组(5.36±4.37)μg/L和真菌组(1.59±1.22)μg/L,三组间差异有统计学意义。而WBC在三组间比较差异无统计学意义(P=0.62)。为PCT诊断是否由G-菌导致血流感染而描绘ROC曲线,曲线下面积为0.973(95%CI0.953~0.993)。诊断阈值为>17μg/L。特异度为95%,敏感度为84%。为PCT诊断是否由鲍曼不动杆菌导致血流感染而描绘ROC曲线,曲线下面积为0.965(95%CI0.941~0.990)。诊断阈值为>42μg/L,特异度为92%,敏感度为85%。为PCT诊断是否由真菌导致血流感染而描绘ROC曲线,曲线下面积为0.965,95%CI0.934~0.996。利用cut-off法得出PCT对于诊断是否真菌导致血流感染的诊断阈值为<2.1μg/L。特异度为82%,敏感度为95%。结论血清PCT升高水平可以早期鉴别血流感染的病原菌,具有较高的敏感度和特异度。
Objective To evaluate whether serum levels of procalcitonin (PCT) can differentiate between different pathogens in early bloodstream infections. Methods A retrospective analysis of the First Affiliated Hospital of Guangzhou Medical University, Department of Critical Care Medicine from January 2011 to December 2013 admitted to sepsis and blood culture-positive data of 142 patients complete, according to positive blood culture results were divided into Gram-positive 51 cases of bacteria group (G + group), 75 cases of gram-negative bacteria group (G-group) and 16 cases of fungal group. PCT and white blood cell (WBC) counts were compared between the three groups. Results The PCT (65.32 ± 49.23) μg / L in G-group was significantly higher than that in G + group (5.36 ± 4.37) μg / L and fungus group (1.59 ± 1.22) μg / L. There was significant difference among the three groups. The WBC in the three groups was no significant difference (P = 0.62). The ROC curve was plotted for PCT diagnosis of bloodstream infections caused by G-bacteria. The area under the curve was 0.973 (95% CI, 0.953 to 0.993). The diagnostic threshold is> 17 μg / L. Specificity was 95% and sensitivity was 84%. The ROC curve was plotted for the PCT diagnosis of whether Acinetobacter baumannii caused a bloodstream infection. The area under the curve was 0.965 (95% CI, 0.941-0.990). The diagnostic threshold was> 42 μg / L with a specificity of 92% and a sensitivity of 85%. The ROC curve was plotted for PCT diagnosis of bloodstream infections caused by fungi. The area under the curve was 0.965 and 95% CI0.934 to 0.996. The cut-off method was used to determine the diagnostic threshold of PCT for the diagnosis of fungal-induced bloodstream infections as <2.1 μg / L. The specificity was 82% and the sensitivity was 95%. Conclusions Serum PCT increased the level of early identification of pathogens of bloodstream infection, with high sensitivity and specificity.