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目的探究降钙素原应用于诊断危重孕产妇发生细菌感染的临床价值。方法 2012年2月至2014年9月期间入住深圳市宝安区人民医院重症医学科的96例危重孕产妇纳入研究,其中存在细菌的36例为A组,无细菌感染的60例为B组;同期选取普通产科检查的孕产妇共52例作为对照组,其中存在细菌感染的C组共32例,无细菌感染的D组共20例,所有患者入科留置样本同步检测降钙素原(PCT)、白细胞(WBC)、C反应蛋白(CRP)。结果 PCT及CRP在四组的组间差异具有统计学意义F=3.90、F=4.19(P<0.05),A、C组的PCT(23.18±21.0)、(1.38±0.88)ng/ml)与B、D组(34.0±45.8)、0.3±0.2)ng/ml)组间差异具有统计学意义(P<0.05),但A组与C组间差异无统计学意义(P>0.05),CRP则发现仅A(128.63±86.5)mg/L)与B组(25.6±47.7)mg/L)差异有统计学意义(P<0.05)。采用受试者工作特征(ROC)曲线计算结果显示PCT对诊断孕产妇发生感染的曲线下面积为0.953,敏感性及特异性达90.6%和91.3%,约登指数最大值相应的PCT浓度:1.95 ng/ml为预测感染的最佳临界值;优于CRP的62.5%及68.3%(曲线下面积:0.701、15.5 mg/L)、WBC的56.3%和56.3%(曲线下面积:0.564、11.21×109/L)。结论 PCT在危重孕产妇中鉴别诊断发生细菌感染具有较强的敏感性及特异性。
Objective To investigate the clinical value of procalcitonin in the diagnosis of bacterial infections in critically ill pregnant women. Methods A total of 96 critically ill pregnant women admitted to Baoan District People ’s Hospital of Bao’an District from February 2012 to September 2014 were enrolled in this study. Among them, 36 cases were group A with bacteria, and 60 cases were group B without bacterial infection. In the same period, 52 pregnant women were selected as the control group. There were 32 cases in group C with bacterial infection and 20 cases in group D without bacterial infection. All the patients were enrolled in the sample for simultaneous detection of procalcitonin (PCT ), White blood cells (WBC), C-reactive protein (CRP). Results PCT and CRP had statistically significant differences among the four groups (F = 3.90, F = 4.19, P <0.05) and PCT (23.18 ± 21.0) and (1.38 ± 0.88) ng / (P <0.05). However, there was no significant difference between group A and group C (P> 0.05), while CRP The difference was statistically significant (P <0.05) only between A (128.63 ± 86.5) mg / L and B (25.6 ± 47.7) mg / L). The calculated receiver operating characteristic (ROC) curve showed that the area under the curve of PCT was 0.953 and the sensitivity and specificity were 90.6% and 91.3% respectively. The corresponding PCT concentration of maximum Youton index was 1.95 ng / ml was the optimal cutoff for predicting infection; better than 62.5% and 68.3% for CRP (area under the curve: 0.701, 15.5 mg / L), 56.3% and 56.3% for WBC (area under the curve: 0.564, 11.21 x 109 / L). Conclusions PCT has strong sensitivity and specificity in differential diagnosis of bacterial infection in critically ill pregnant women.