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目的探讨血清降钙素原(PCT)、C反应蛋白(CRP)、全血乳酸(LAC)三者联合检测对早期血流感染的诊断价值。方法选取2016年1月至2017年1月佛山市南海区第五人民医院急诊科和门诊科初诊患者,通过病史、症状和体征拟诊为疑似血流感染患者,再采用诊断金标准将疑似患者(研究对象)确诊分为血流感染组(90例)和非血流感染组(150例)。采用免疫化学发光法检测PCT,免疫比浊法检测CRP,全血仪器法检测LAC。采用循证检验医学的方法统计各联合指标的诊断价值性能指标。结果血流感染组PCT、CRP、LAC明显高于非血流感染组[(34.70±18.09)ng/ml vs(7.11±3.36)ng/ml;(69.14±34.41)mg/L vs(38.77±15.96)mg/L;(2.53±1.26)mmol/L vs(1.96±0.89)mmol/L,[P<0.05]。PCT、CRP和LAC具有最高诊断正确率的诊断界值分别为2.96ng/ml、29.9mg/L和2.3mmol/L,依据指标联合诊断价值四格表获得指标并联和串联的各诊断价值参数,三项指标并联灵敏度98.9%(漏诊率1.1%)为最高,三项指标串联特异性96.0%(误诊率4.0%)为最高。结论 PCT、CRP和LAC三者联合检测,能提高血流感染患者早期诊断的敏感性和特异性,具有重要的临床价值。
Objective To investigate the diagnostic value of combined detection of serum procalcitonin (PCT), C-reactive protein (CRP) and whole blood lactate (LAC) in early bloodstream infection. Methods From January 2016 to January 2017, the newly diagnosed emergency department and outpatient department of the Fifth People’s Hospital of Nanhai District, Foshan City were selected as patients suspected of having bloodstream infection according to their medical history, symptoms and signs, and then the suspected patients (Subjects) were diagnosed as bloodstream infection (90 cases) and non-bloodstream infection group (150 cases). Immunochemiluminescence was used to detect PCT, CRP was detected by immunoturbidimetry, and LAC was detected by whole blood instrument. Using the method of evidence-based test medicine to calculate the diagnostic value of each combination of indicators of performance indicators. Results The PCT, CRP and LAC in the bloodstream infection group were significantly higher than those in the non-bloodstream infection group [(34.70 ± 18.09) ng / ml vs (7.11 ± 3.36) ng / ml vs 69.14 ± 34.41 mg / L vs 38.77 ± 15.96 ) (2.53 ± 1.26) mmol / L vs (1.96 ± 0.89) mmol / L, respectively [P <0.05]. The diagnostic value of PCT, CRP and LAC with the highest diagnostic accuracy were 2.96ng / ml, 29.9mg / L and 2.3mmol / L, respectively. According to the diagnostic value of four tables, the diagnostic value parameters of indicators parallel and series were obtained, The three indicators parallel sensitivity of 98.9% (misdiagnosis rate of 1.1%) for the highest three series of serial specificity of 96.0% (misdiagnosis rate of 4.0%) for the highest. Conclusion The combined detection of PCT, CRP and LAC can improve the sensitivity and specificity of early diagnosis of patients with bloodstream infection and has important clinical value.