白细胞、降钙素原和C反应蛋白在血流感染早期诊断中的应用价值研究

目的探索白细胞(WBC)、C-反应蛋白(CRP)和降钙素原(PCT)在血流感染(BSI)早期诊断中的临床应用价值,为BSI的早期诊断提供依据。方法回顾性分析48例血液培养阳性患者(血培养阳性组)与50例血液培养阴性患者(血培养阴性组)WBC、PCT和CRP测定结果,比较两组及血培养阳性组中革兰阳性菌与革兰阴性菌感染者各指标检测结果;绘制受试者工作特征(ROC)曲线并计算ROC曲线下面积(AUC);采用二分类Logistic回归对3项指标预测血培养阳性的作用大小进行方程拟合。结果血培养阳性组PCT和CRP水平明显高于血培养阴性组,差异有统计学意义(P0.05),而两组WBC计数比较差异无统计学意义(P0.05)。血培养阳性组中革兰阳性菌与革兰阴性菌感染者仅PCT水平比较差异有统计学意义(P0.05)。WBC、PCT和CRP的AUC分别为0.579、0.746和0.624。二分类Logistic回归显示仅PCT对预测诊断具有统计学意义(P=0.013);三者联合预测诊断的阳性率为71.4%。结论三者均可作为BSI的早期诊断指标,而PCT和CRP较WBC有更重要的意义,并且PCT能较好地区分革兰阳性菌与革兰阴性菌感染。

Study on the application value of leukocyte,procalcitonin and C-reactive protein in early diagnosis of bloodstream infection

Objective To explore the clinical significances of leukocyte (WBC ) ,C‐reactive protein (CRP ) and procalcitonin (PCT) in early diagnosis of bacterial bloodstream infections (BSI) ,in order to provide references for early diagnosis of BSI . Methods The detection results of WBC ,PCT and CRP from 48 cases of patients with positive blood culture(positive blood culture group) and 50 cases of patients with negative blood culture(negative blood culture group) were retrospectively analysed .Then com‐pared the detection results between the two groups ,and between patients with gram‐positive bacteria infection and those with gram‐negative bacteria infection in the positive blood culture group .The diagnostic performance of WBC ,PCT and CRP were determined by drawing the receiver operator characteristic(ROC) curves ,and areas under ROC curves(ACUs) were calculated .The perform‐ance of the three indicators in predicting BSI were evaluated by using the binary logistic regression analysis .Results The levels of PCT and CRP in positive blood culture group was significantly higher than those in negative blood culture group ,had statistically significant differences(P<0 .05) ,while no statistically significant difference was found in WBC count between the two groups(P>0 .05) .In the positive blood culture group ,statistically significant difference was only found in PCT level between patients with gram‐positive bacteria infection and patients with gram‐negative bacteria infection(P<0 .05) .The AUCs of WBC ,PCT and CRP were 0 .579 ,0 .746 and 0 .624 ,respectively .The result of the binary logistic regression analysis showed that only PCT made a unique statistically significant contribution to the model(P=0 .013) for predictive diagnosis of BSI .And the positive predictive rate of joint detection of these three indicators was 71 .4% .Conclusion WBC ,PCT and CRP could be indicators for early diagnosis of BSI ,while PCT and CRP might have much more important significance ,moreover ,PCT could distinguish between gram‐positive bacterial in‐fection and gram‐negative bacteria infection .