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目的探讨ICU内革兰阴性杆菌、阳性球菌和真菌血症患者降钙素原(PCT)的变化幅度及其临床意义。方法回顾性分析2011年1月至2013年4月盛京医院重症医学科血行感染的患者,纳入革兰阴性杆菌菌血症患者49例,革兰阳性球菌血症患者22例,念珠菌血症患者17例。比较三组患者菌血症发生3 d内PCT水平是否存在差异,比较三组急性生理学和慢性健康状态评分Ⅱ(APACHEⅡ评分)、WBC、乳酸、肌酐和C反应蛋白(CRP)等指标的差异。绘制受试者工作特征曲线(ROC曲线),评价PCT鉴别三种菌血症的能力。结果革兰阴性杆菌组PCT平均为(13.9±18.0)ng/mL[中位数:8.32 ng/mL,范围(2.47~78.26)ng/mL,革兰阳性球菌组PCT平均为(1.34±1.25)ng/mL[中位数:0.75 ng/mL,范围(0.10~4.81)ng/mL],真菌血症组PCT平均为(1.21±0.92)ng/mL[中位数:0.64 ng/mL,范围(0.30~2.89)ng/mL]。阴性杆菌菌血症PCT显著高于阳性球菌和真菌组,差异显著(P<0.01),ROC曲线下面积为0.980(95%CI 0.945~1.016);而阳性球菌和真菌血症两组PCT差异无明显统计学意义(P=0.833),两组ROC曲线下面积为0.049(95%CI,0.266~0.632,P=0.590)。结论革兰阴性杆菌菌血症PCT升高幅度显著高于阳性球菌和念珠菌,但阳性球菌和念珠菌血症患者发病早期PCT升高幅度无明显差异,PCT不能用以区分阳性球菌和念珠菌菌血症。
Objective To investigate the changes of procalcitonin (PCT) in patients with gram-negative bacilli, positive cocci and fungal sepsis in ICU and its clinical significance. Methods A retrospective analysis was performed on 49 patients with Gram-negative bacteremia, 22 patients with Gram-positive bacteremia, and 30 patients with candidal bacteremia in Shengjing Hospital from January 2011 to April 2013. 17 patients. The differences of PCT levels in the three groups were compared between the three groups. The acute physiology and chronic health status score Ⅱ (APACHEⅡscore), WBC, lactate, creatinine and C-reactive protein (CRP) were compared among the three groups. The receiver operating characteristic curve (ROC curve) was plotted to assess the ability of the PCT to identify the three bacteremic conditions. Results The PCT of Gram-negative bacilli group was (13.9 ± 18.0) ng / mL (median: 8.32 ng / mL, range: 2.47-78.26 ng / mL, (1.21 ± 0.92) ng / mL in the fungal group [median: 0.75 ng / mL, range: 0.10 to 4.81 ng / mL] (0.30-2.89) ng / mL]. The PCT of negative bacilli was significantly higher than that of positive cocci and fungi (P <0.01), and the area under ROC curve was 0.980 (95% CI 0.945 ~ 1.016) Significant statistical significance (P = 0.833). The area under the ROC curve for both groups was 0.049 (95% CI, 0.266-0.632, P = 0.590). Conclusions The increase of PCT in Gram-negative bacteremia was significantly higher than that of positive cocci and Candida, but there was no significant difference in the PCT increase between the positive cocci and candidaemia patients at the early stage of disease. PCT could not distinguish between positive cocci and candida Bacteremia.