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目的分析血清降钙素原(PCT)检测对血流感染早期诊断和预后评估的价值。方法收集2014年10月-2015年12月怀疑为菌血症的住院患者315例,进行血培养和PCT检测,以血流感染的诊断标准为依据分为感染组103例和对照组212例,血培养阳性患者进一步分为革兰阳性菌感染组37例和革兰阴性菌感染组66例,比较各组PCT水平。结果感染组PCT水平为(3.95±6.81)ng/ml高于对照组的(0.32±1.58)ng/ml,差异有统计学意义(P<0.05)。革兰阳性菌感染亚组的PCT水平及PCT阳性率均低于革兰阴性菌感染亚组,差异均有统计学意义(P<0.05)。PCT<0.5 ng/ml时,对血流感染诊断的阴性预测值为90.72%,对排除血流感染可提供较好的参考。PCT>10ng/ml时,阳性预测值为92.17%,推断发生血流感染的可能性较大。对PCT>2 ng/ml的患者每隔2 d复查PCT水平观察患者预后发现,10例死亡患者PCT一直处于高水平,而其他患者PCT水平下降,病情改善。结论血清PCT检测对细菌性血流感染的早期诊断和预后评估均有较大的临床价值。
Objective To analyze the value of serum procalcitonin (PCT) test in the early diagnosis and prognosis of bloodstream infection. Methods 315 hospitalized patients with suspected bacteremia from October 2014 to December 2015 were enrolled in this study. Blood cultures and PCT tests were performed. Based on the diagnostic criteria of bloodstream infection, 103 patients were divided into infection group (n = 212) and control group (n = Blood culture positive patients were further divided into Gram-positive bacteria infection group of 37 cases and Gram-negative bacteria infection group of 66 cases, the PCT levels in each group were compared. Results The PCT level in infected group was (3.95 ± 6.81) ng / ml higher than that in control group (0.32 ± 1.58) ng / ml, the difference was statistically significant (P <0.05). The PCT level and PCT positive rate in gram-positive bacteria subgroup were lower than that in gram-negative bacteria subgroup, the differences were statistically significant (P <0.05). PCT <0.5 ng / ml, the negative predictive value for the diagnosis of bloodstream infection was 90.72%, to exclude bloodstream infection can provide a good reference. When PCT> 10ng / ml, the positive predictive value was 92.17%, suggesting that the possibility of bloodstream infection was high. PCT levels were reviewed every 2 days in patients with PCT> 2 ng / ml. The prognosis of the patients was observed. PCT was consistently high in 10 deaths and PCT was reduced in other patients. Conclusion Serum PCT detection has great clinical value in the early diagnosis and prognosis of bacterial bloodstream infections.