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临床输血与检验

临床输血与检验 ›› 2016, Vol. 18 ›› Issue (1): 35-39.DOI: 10.3969/j.issn.1671-2587.2016.01.012

• 临床检验研究 • 上一篇    下一篇

降钙素原联合C反应蛋白检测在诊断细菌感染性疾病中的应用

宋晓菲,翁伟,陈继中   

  1. 244009 安徽省铜陵市人民医院输血科（宋晓菲,陈继中）; 检验科（翁伟）
  • 收稿日期:2015-07-22 出版日期:2016-02-20 发布日期:2016-10-10
  • 作者简介:宋晓菲（1987-）,女,安徽铜陵人,检验师,本科,主要从事免疫学检测工作,（E -mail）271527848@qq.com。

The Application of Procalcitonin Combined with C-reactive Protein Test in Differential Diagnosis of Bacterial Infections

SONG Xiao-fei, WENG Wei, CHEN Ji-zhong   

  1. Tongling First People’s Hospital,Tongling, Anhui 244009
  • Received:2015-07-22 Online:2016-02-20 Published:2016-10-10

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摘要： 目的探讨血清降钙素原 (PCT)与C反应蛋白（CRP）对诊断细菌性感染的临床价值,确定其诊断临界值。方法选取2013年4月~2014年7月间住院患者,于入院当天用药前同时采集静脉血和相关体液标本,分别采用双抗体夹心免疫层析法测定PCT水平、免疫比浊法测定CRP水平,应用全自动血培养仪和全自动微生物鉴定仪对外周血及相关体液标本做细菌培养和鉴定,根据细菌培养结果,将感染患者分为：革兰阴性菌感染组155例、革兰阳性菌感染组81例、非细菌性感染组100例及健康对照组100 例。采用受试者工作特征曲线（ROC）比较PCT、CRP对细菌性感染的诊断价值。结果革兰阴性菌感染组中位PCT和CRP水平分别为7.5（2.5~12.5）、70.5( 23.5~164.5);革兰阳性菌感染组中位PCT和CRP水平分别为2.5(2.5~7.5)、112(48~176);非细菌性感染组中位PCT和CRP水平分别为1(1~1)、49.5(16.5~115.5)、健康对照组中位PCT和CRP水平分别为0.07(0.03~0.09)、3(1~5),革兰阴性和阳性菌感染组的PCT、CRP水平均高于非细菌感染组（P<0.05）;革兰阴性菌感染组PCT水平高于革兰阳性菌感染组,差异有统计学意义（P<0.05）。革兰阴性菌感染组CRP水平和革兰阳性菌感染组比较,差异无统计学意义（P>0.05）。PCT曲线下面积（AUC）最大,为0.994,而CRP为0.969（P<0.05）,2项指标联合 PCT的AUC为0.997。PCT的灵敏度、特异性、准确度、阳性预测值、阴性预测值、阳性似然比、阴性似然比、约登（Youden）指数优于CRP。当PCT的最佳诊断点为0.195 ng/mL时,灵敏度达94.2%,特异性达100.0%、Youden指数为0.942,准确度为96.5%,阴、阳性预测值分别为92.6%和100.0%,阴、阳性似然比分别为0.058和0.942。结论PCT对细菌感染有重要的鉴别诊断作用。可作为早期独立辅助诊断细菌性感染的可靠指标。联合检测感染者PCT、CRP水平可作为病情监测和疗效评价指标。

关键词: 降钙素原, C反应蛋白, 革兰阳性菌, 革兰阴性菌, 细菌感染

Abstract: ObjectiveTo investigate the the prectical value of serum procalcitonin (PCT)/c-reactive protein (CRP) joint detection in the diagnosis of bacterial infections. MethodsVenous blood and body fluid specimens were collected from the in-patients without medical treatment after admission from April 2013 to July 2014. The PCT level was evaluated by double antibody sandwich immunochromatography and CRP was tested by the immune turbidimetry.Bacterial culture and identification were complished with automatic blood culture and microbe identifying system. The samples were divided into three groups:155 cases of Gram-,81 cases of Gram+ ,100 cases of negative bacteria infections, and 100 cases of healthy control. The receiver-operating characteristic curve (ROC) was used to assess the diagnositic value of PCT and CRP. ResultsThe PCT and CRP levels in Gram- infection group were found to be 7.5（2 .5-12.5） and 70 .5( 23.5-164.5);while those in Gram+ infection group were 2.5(2. 5-7.5)and 112 (48-176);and those in non-bacteria group were 1(1-1)and 49 .5( 16.5-115.5) compared with the levels of 0.07(0.03-0.09) and 3 ( 1-5) of PCT and CRP in healthy control.The PCT and CRP concentrations were higher in the bacteria infection than those in the control（P<0 .05）.Among them,PCT level of Gram- group increased more obviously than that of Gram+ group（P<0 .05）but no difference was noted of the CRP level between them（P>0 .05）. The AUG of PCT (0.994) was large compared with that of CRP（0.969, P<0 .05）.PCT test had advantage over CRP in sensitivity,specificity,accuracy,positive/negative predictive value, positive/ negative likelihood value and Youden index. ConclusionPCT may be used as a reliable marker in differentiation and early diagnosis of bacteria infections. Combined examination of both markers is valuable for disease monitoring and therapeutic evaluation in bacteria infections.

Key words: Procalcitonin, C-reactive, protein, Gram-positive, bacteria, Gram-negative, bacteria, Bacterial, infections

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