降钙素原与白细胞计数联合检测在维持性血液透析患者合并肺部感染中的临床诊断价值

目的探讨降钙素原(procalcitonin,PCT)、白细胞计数(WBC)在维持性血液透析(maintenance hemodialysis,MHD)患者合并肺部感染中的临床应用价值。方法收集2017年6月至2018年12月在川北医学院附属医院血液净化中心行MHD治疗且肺部感染诊断明确的87例患者作为感染组,同时期无肺部感染或其他部位感染的MHD患者共75例作为非感染组,收集患者的一般资料及临床检验资料,包括年龄、性别、体质量指数、原发病、血常规、血生化、甲状旁腺激素、C反应蛋白、PCT等进行回顾性分析。结果 (1)与非感染组相比,感染组的白蛋白、总胆固醇水平明显降低;WBC、中性粒细胞百分比、PCT、C反应蛋白水平明显升高,差异有统计学意义(P0.05)。(2)多因素Logistic回归分析结果提示:PCT(OR=70.625,95%CI 13.783～361.891,P0.05)、WBC(OR=1.435,95%CI 1.133～1.817,P0.05)是MHD患者合并肺部感染的独立危险因素。(3)PCT、WBC、PCT+WBC两者联合诊断MHD患者合并肺部感染的受试者工作特征曲线下面积分别为0.880(0.828～0.932)、0.717(0.638～0.797)和0.905(0.859～0.951)(均P0.05)。结论 PCT、WBC是MHD患者合并肺部感染的独立危险因素,PCT与WBC两者联合检测对肺部感染的诊断效能更优。     

动态检测降钙素原对食管癌微创术后感染的早期诊断价值

【摘要】 目的 评价动态检测降钙素原对食管癌微创术后感染的早期诊断价值。方法〓选择我院胸外科2015年6月至2016年6月食管癌微创手术患者68例为观察对象(观察组),同期健康体检患者30例为健康组;分别检测实验组术后第1、2、3、5天的静脉血PCT值,其中10例发生感染,归为感染组,余58例为未感染组。比较感染组、未感染组及健康组三组的PCT值。结果〓术后第1天感染组、未感染组PCT较健康组升高(P<0.05),感染组和未感染组无统计学差异;术后第2天感染组较未感染组PCT升高(P<0.05),术后第3天及第5天感染组较未感染组PCT有显著升高(P<0.01),术后前两天未感染组较健康组升高有显著统计学差异(P<0.05),第3及第5天无明显统计学差异。结论〓动态检测降钙素原对食管癌微创术后合并感染有早期诊断价值,术后第2天PCT≥2.06 μg/mL时警示有可能合并细菌感染,可尽早开始针对性地抗感染治疗。     

降钙素原在急性胰腺炎中的应用

降钙素原是降钙素的前体物质 ,作为一种炎症介质 ,近年来成为鉴别严重细菌感染的新型参数。本文就降钙素原在急性胰腺炎中的应用作一综述     

血沉及降钙素原在髋关节置换术后早期感染中的价值

目的：探讨血沉与血清降钙素原在髋关节置换术后早期感染中的诊断价值。方法回顾性分析我院近年来15例髋关节置换术后早期感染的患者（感染组）及无感染的17例患者（对照组）的临床资料,分析患者术前及术后血沉及血清降钙素原的检测情况。结果感染组与对照组术前血沉无明显差异,术后感染组与对照组血沉均加快,但感染组血沉明显快于对照组,两者差异有统计学意义（P ＜0．05）;感染组与对照组术前血清降钙素原水平相近,对照组术后水平较术前未升高,而感染组术后血清降钙素原明显升高,与对照组相比差异有统计学意义（P ＜0．05）。结论血沉及血清降钙素原为髋关节置换术后早期感染的敏感性及特异性均较高检测指标,对髋关节术后感染的早期诊断极有帮助,可作为髋关节术后有无感染的常用指标。     

降钙素原在严重细菌感染诊断中的应用价值

严重细菌感染时,感染者体内的降钙素原（PCT）明显升高。2006--2007年,笔者对严重细菌感染患者的血清PCT进行检测,并与同期C．反应蛋白（CRP）、结合珠蛋白（HP）、铜蓝蛋白（CER）、α1-酸性糖蛋白（α1-AG）、α1-抗胰蛋白酶（α1-AT）、WBC及红细胞沉降率（ESR）比较,旨在探讨PCT对严重细菌感染的诊断价值。     

血清降钙素原(PCT)在新生儿感染中的临床应用和诊断价值

目的:了解降钙素原在新生儿感染中的临床应用和诊断价值,为临床提供诊断依据.方法:应用免疫荧光法对108例感染新生儿和20例对照组的血清降钙素原(PCT)进行测定.结果:细菌感染组PCT95.7％ (67/70),病毒感染组PCT阳性率5.3％ (2/38),对照组阳性率5％(1/20).PCT阳性率两两比较,有显著性差异.差异有统计学意义(p＜0.05).结论:血清降钙素原(PCT)是快速鉴别细菌感染和病毒感染、细菌感染预后的判断及治疗监测的主要指标之一,以PCT＞2ng/ml为诊断标准时,诊断的灵敏度与特异度均较高.PCT在新生儿感染中的临床应用优于C-反应蛋白.     

降钙素原检测在外科手术后应用的研究进展

降钙素原( PCT)是一种无激素活性的降钙素前肽物质,主要由神经内分泌细胞分泌,在蛋白酶的作用下可产生活性物质降钙素。生理条件下仅有少量 PCT进入血液。 PCT被广泛应用于临床细菌性感染和非细菌性感染的诊断、预后以及指导抗生素应用等方面,是近年来研究较多的感染相关性生物标志物。本文就降钙素原 PCT的生物学特性、检测方法以及在外科手术后应用中的研究进展做一综述。     

降钙素原在危重病中的研究进展

降钙索原(ProCT)为降钙素前体形式,危重病患者ProCT升高,作为一种新的指标ProCT对重危病人的评估有积极的意义。本文从ProCT结构、来源、ProCT测定在重危病人评估中的价值等方面介绍ProCT在危重病中的研究进展。     

降钙素原在急性胰腺炎及胰腺感染中的价值

目的 总结降钙素原(PCT)在急性胰腺炎的早期严重程度预测、治疗效果评价、预后评估及抗生素使用中的临床价值.方法 检索近年来国内外有关重症急性胰腺炎及胰腺感染坏死的血液学指标的文献并进行综述.结果 PCT在诊断重症急性胰腺炎的发生和胰腺感染坏死中具有较高的灵敏度和特异度,可以作为指导重症急性胰腺炎的早期临床治疗的工具....     

降钙素原在指导抗生素治疗中的临床价值

降钙素原(procalcitonin,PCT)由116个氨基酸组成,生理条件下在多种组织中低表达,脓毒症时PCT的表达明显增加.大约20年前,PCT作为脓毒症血清标志物开始受到关注[1].目前在众多脓毒症血清标志物中,PCT因具有高敏感性、高特异性的特点,在临床应用中前景广泛.     

Evaluation of the i-STAT point-of-care analyzer in critically ill adult patients

Point-of-care analyzers may benefit therapeutic decision making by reducing turn-around-time for samples. This is especially true when biochemical parameters exceed the clinical reference range, in which acute and effective treatment is essential. We therefore evaluated the analytical performance of the i-STAT point-of-care analyzer in two critically ill adult patient populations. During a 3-month period, 48 blood samples from patients undergoing cardiac surgery with cardiopulmonary bypass (CPB) and 42 blood samples from non-cardiac patients who needed intensive care treatment were analyzed on both the i-STAT analyzer (CPB and non-CPB mode, respectively) and our laboratory analyzers (RapidLab 865/Sysmex XE-2100 instrument). The agreement analysis for quantitative data was used to compare i-STAT to RapidLab for blood gas/electrolytes and for hematocrit with the Sysmex instrument. Point-of-care electrolytes and blood gases had constant deviation, except for pH, pO2, and hematocrit. A clear linear trend in deviation of i-STAT from RapidLab was noticed for pH during CPB (r = 0.32, p = .03) and for pO2 > 10 kPa during CPB (r = -0.59, p < .0001 when 10 相似文献   

Comparison of point-of-care activated clotting time systems utilized in a single pediatric institution

This study compares four different activated clotting time (ACT) point-of-care (POC) testing systems used at our institution for the management of patients undergoing heparin therapy. We evaluated these systems under identical conditions to determine their accuracy, reproducibility, ease of use, and cost. Two separate testing stations containing four ACT systems were used. The testing order was randomized for every sample and performed by two trained individuals. Samples of fresh heparinized whole blood were taken at regular intervals and distributed to each station. Each operator tested 50 samples, totaling 400 ACT tests. The ACT value was significantly affected by the type of machine used at both stations 1 and 2 (p < .001). Compared with all systems, the Medtronic ACT Plus Automated Coagulation Timer System (ACT Plus) resulted in the most consistent ACT values (median = 171, Interquartile Range (IQR): 169-175) and least variability (172.17 +/- 5.24). The Hemochron Signature Elite Whole Blood Microcoagulation System had the most variability (221.10 +/- 14.78) and yielded consistently higher ACT values (median = 220, IQR: 210-229.5) compared with other systems. The ACT values reported by the i-STAT Handheld and Test Cartridge Blood Analysis System (153.30 +/- 7.87) were consistently lower (median = 154, IQR: 147-161) in comparison to the ACT Plus and Medtronic HMS Plus Hemostasis Management System (180.60 +/- 7.60, median = 181, IQR: 175-186). There was no statistical difference in results between the two testing sites (p > .05) or the operators (p > .05). The significant finding of this study was the affect each system has on the ACT value. This investigation demonstrates the variability that exists among different ACT monitoring systems at our institution. The discrepant variation in ACT values that exists with the Hemochron system questions the reliability of its use in the management of patients undergoing heparin therapy.     

Impact on ART initiation of point-of-care CD4 testing at HIV diagnosis among HIV-positive youth in Khayelitsha,South Africa

Introduction

Despite the rapid expansion of antiretroviral therapy (ART) programmes in developing countries, pre-treatment losses from care remain a challenge to improving access to treatment. Youth and adolescents have been identified as a particularly vulnerable group, at greater risk of loss from both pre-ART and ART care. Point-of-care (POC) CD4 testing has shown promising results in improving linkage to ART care. In Khayelitsha township, South Africa, POC CD4 testing was implemented at a clinic designated for youth aged 12–25 years. We assessed whether there was an associated reduction in attrition between HIV testing, assessment for eligibility and ART initiation.

Methods

A before-and-after observational study was conducted using routinely collected data. These were collected on patients from May 2010 to April 2011 (Group A) when baseline CD4 count testing was performed in a laboratory and results were returned to the clinic within two weeks. Same-day POC CD4 testing was implemented in June 2011, and data were collected on patients from August 2011 to July 2012 (Group B).

Results

A total of 272 and 304 youth tested HIV-positive in Group A and Group B, respectively. Group B patients were twice as likely to have their ART eligibility assessed compared to Group A patients: 275 (90%) vs. 183 (67%) [relative risk (RR)=2.4, 95% CI: 1.8–3.4, p<0.0001]. More patients in World Health Organization (WHO) Stage 1 disease (85% vs. 69%), with CD4 counts≥350 cells/µL (58% vs. 35%) and more males (13% vs. 7%) were detected in Group B. The proportion of eligible patients who initiated ART was 50% and 44% (p=0.6) in Groups B and A, respectively; and 50% and 43% (p=0.5) when restricted to patients with baseline CD4 count≤250 cells/µL. Time between HIV-testing and ART initiation was reduced from 36 to 28 days (p=0.6).

Discussion

POC CD4 testing significantly improved assessment for ART eligibility. The improvement in the proportion initiating ART and the reduction in time to initiation was not significant due to sample size limitations.

Conclusions

POC CD4 testing reduced attrition between HIV-testing and assessment of ART eligibility. Strategies to improve uptake of ART are needed, possibly by improving patient support for HIV-positive youth immediately after diagnosis.     

前降钙素在临床外科中的应用前景

前降钙素是一种判断全身感染的标志物,临床上已广泛的应用于脓毒症及急性胰腺炎的诊断治疗中.本文简要综述前降钙素在临床外科中的应用,以助于临床医师判断细菌感染,指导抗生素的应用.     

降钙素原和内毒素在重症急性胰腺炎患者合并感染诊断中的应用

目的 研究血清降钙素原（PCT）与内毒素在重症急性胰腺炎（SAP）合并感染诊断中的实用价值。方法 回顾性研究SAP患者62例,根据感染存在诊断标准分为感染组（32例）和非感染组（30例）,检测2组PCT和内毒素值,将2组数据进行统计学比较。结果 感染组患者血清中PCT增高较非感染组差异有统计学意义（P＜0.05）。内毒素增高较非感染组差异有统计学意义（P＜0.05）。PCT对SAP合并感染患者诊断敏感度为90.6%,特异度为86.7%;内毒素对SAP合并感染患者诊断敏感度为65.6%,特异度为60.0%。PCT对SAP合并感染患者诊断敏感度和特异度均较内毒素高,差异有统计学意义（P＜0.05）。结论 监测PCT值对SAP合并感染患者具有明显的临床诊断价值。     

Role of serum and synovial procalcitonin in differentiating septic from non-septic arthritis- a prospective study

IntroductionSeptic arthritis is a serious orthopaedic emergency that must be diagnosed and managed early to prevent devastating complications. The current gold standard for diagnosing septic arthritis is synovial fluid culture, but results are delayed by 48–72 h, and the sensitivity of the test is very low. Differentiating Septic from non-septic arthritis is vital to prevent unnecessary use of antibiotics and prevent complications. Serum Procalcitonin (PCT) is a useful marker in differentiating septic from non-septic arthritis but there are very few studies that have studied the role of synovial PCT for the same.AimTo determine the role of serum and synovial PCT in differentiating acute Septic from non-septic arthritis.Materials and methodsProspective clinical study in which 60 patients presenting with acute inflammatory arthritis (<2 weeks duration) were enrolled from May 2018 to May 2020. Serum and synovial fluid samples were drawn at presentation and routine blood investigations, synovial fluid culture sensitivity, and Procalcitonin levels were measured. Patients were divided into 3 groups, with group-1 having confirmed pyogenic, group-2 having presumed pyogenic, and group-3 having non –pyogenic patients, respectively. All data was tabulated and statistically analysed using appropriate tests.ResultsMean serum PCT values in groups 1, 2 and 3 were 1.06 ± 1.11, 0.85 ± 0.74, and 0.11 ± 0.24, respectively. Patients in the Pyogenic group (group1 and group 2) had significantly higher mean serum PCT as compared to group3 (p < 0.0001). Group 1 had higher serum PCT as compared to group 2, but the difference was not significant (p = 0.58). Mean synovial PCT in group 1, 2 and 3 were 2.42 ± 1.98, 1.89 ± 1.18, and 0.22 ± 0.40, respectively. Patients in the Pyogenic group (Group1 and Group2) had significantly higher mean synovial PCT as compared to Group 3 (p < 0.0001). Group 1 had higher mean synovial PCT as compared to group 2, but the difference was not significant (p = 0.54). The area under the ROC curve of the serum levels of PCT was 0.0.895, and the area under the ROC curve of the synovial fluid levels of PCT was 0.914, which was higher than the serum PCT level.ConclusionSerum and synovial Procalcitonin may be used as a diagnostic marker in differentiating septic from inflammatory arthritis and can help in reducing unnecessary use of antibiotics and early diagnosis and management of septic arthritis, thereby preventing complications.     

Clinical evaluation of the ABL-77 for point-of-care analysis in the cardiovascular operating room

As a small portable instrument, which can be dedicated to the perfusionist, the Radiometer model ABL-77 point-of-care blood gas, electrolyte, and hematocrit analyzer has come to provide an alternative to in-line monitoring of such parameters. This is not to say that it can necessarily replace the utility of in-line monitoring. However, point of care instruments, such as the ABL-77, can provide faster results than a more remote lab. This study was done as part of an ongoing quality assurance program in conjunction with the main lab department to maintain accreditation. The hypothesis being tested is that during cardiopulmonary bypass (CPB) the ABL-77 is in agreement with alternative instruments used outside the cardiovascular operating room. With the appropriate institutional approval, a total of 20 blood samples were randomly gathered among five patients after initiation of CPB. This was done over a five-day period for pH, pCO2, pO2, potassium, sodium, and hematocrit determinations. Analysis results from the ABL-77 were compared to those made by three other bench top models. These included a Radiometer model ABL-720 analyzer, a Dale Dimension model RxL analyzer, and a Beckerman model LH 750 Coulter Counter. A statistically significant difference is demonstrated for all parameters when each of these instruments is compared to the ABL-77. However, the observed mean differences are only judged to be clinically significant in the case of hematocrit. The ABL-77 is found to demonstrate a negative bias with respect to the different methodologies used by the ABL-720 and the Coulter Counter. This bias may be due to the hemodilution of plasma with crystalloid solution during CPB. This causes error in hematocrit results as the methodology of many point of care instruments is based on the electrical conductivity of whole blood. This may be corrected by using a relationship determined from linear regression analysis. This error adjustment has been implemented as part of a concerted blood conservation effort. Otherwise, the ABL-77 has been found to be reliable and consistent for point of care blood analysis.