降钙素原在鉴别重症监护病房血流感染患者菌种中作用.docVIP

降钙素原在鉴别重症监护病房血流感染患者菌种中作用 　　【摘要】目的 探讨血清降钙素原（procalcitonin，PCT）水平对鉴别重症监护病房（ICU）血流感染患者菌种类型的临床应用价值。方法 回顾性分析2010年1月至2012年12月广东省人民医院ICU所有血培养结果阳性且为单一菌株，并检测了血清PCT水平的患者。比较PCT水平在革兰阴性（G-）菌、革兰阳性（G+）菌及真菌血流感染患者之间的差异，同时根据受试者工作曲线（ROC）判断PCT的诊断性能。结果 纳入有效血流感染患者524例：G-菌206例，G+菌276例及真菌42例。三组PCT水平中位数分别为14.9 ng/ml、0.14 ng/ml、1.76 ng/ml，进行两两比较，组间PCT水平差异具有统计学意义（P-与G+菌所致血流感染的灵敏度为82.5%，特异度为80.1%；当界值设定为5.085 ng/ml时，血清PCT水平区分G-与真菌所致血流感染的灵敏度为68.0%，特异度为73.8%；G+菌与真菌的ROC曲线下面积为33.0%（P-菌与G+菌或真菌引起的ICU血流感染患者有一定的临床应用价值；但对G+菌与真菌引起血流感染的鉴别意义尚不确定。 　　【关键词】降钙素原；重症监护病房；血流感染；细菌种类 　　The clinical significance of procalcitonin to identifying microorganism strains in ICU patients with bloodstream infection WEN Miao-yun， FANG Ming，DENG Yi-yu， ZENG HonG-ke. Department of Emergency﹠Intensive Care Medicine， Guangdong General Hospital， Guangdong Academy of Medical Sciences， Guangzhou 510080，China 　　Corresponding author：ZENG HonG-ke， Email：zenghongke@VIP.163.com 　　【Abstract】Objective To investigate the level of serum procalcitonin （PCT） for exploring the clinical value in identifying microorganism strains in the intensive care unit （ICU） patients with blood stream infections. Methods A retrospective analysis of patients with positive blood culture of a single strain and with serum PCT levels detected simultaneously was carried out from January 2010 through December 2012. The comparisons of PCT levels were done among Gram-negative （ G- ） bacteria， Gram-positive （G+） bacteria and fungi in patients with bloodstream infections. The diagnostic performance of PCT was determined by the receiver operating characteristic curve （ROC）.Results A total of 524 patients with blood stream infection were enrolled and categorized into three different groups， namely G- bacteria infection group （n=206）， G+ bacteria infection group（n=276）， and fungi infection group （n=42）. The median value of PCT level of G- bacteria group was 14.9 ng/ml， which was significantly higher than that of the other two groups with 0.14 ng/ml and 1.76 ng/ml， r