血清降钙素原在急诊感染患者细菌感染病原学分型中的价值分析

毛小强; 陈毓; 金晶

doi:10.16766/j.cnki.issn.1674-4152.002278

血清降钙素原在急诊感染患者细菌感染病原学分型中的价值分析

doi: 10.16766/j.cnki.issn.1674-4152.002278

毛小强^1, ,,
陈毓¹,
金晶²

1.
衢州市人民医院急诊科，浙江衢州 324000
2.
衢州市人民医院普外科，浙江衢州 324000

基金项目:

浙江省医药卫生科技计划项目 2017KY699

详细信息

通讯作者:
毛小强，E-mail：maoxiaoqiang@163.com

中图分类号: R63 R446.5
计量
- 文章访问数: 219
- HTML全文浏览量: 62
- PDF下载量: 11
- 被引次数: 0
出版历程
- 收稿日期: 2020-08-10
- 网络出版日期: 2022-03-03

Value of serum procalcitonin in the pathogenic classification of bacterial infection in emergency patients

1.
Department of Emergency, Quzhou People's Hospital, Quzhou, Zhejiang 324000, China

摘要

摘要: 目的探究血清降钙素原(PCT)在急诊感染患者细菌感染病原学分型中的价值，为临床抗菌治疗合理用药提供参考依据。方法选择2016年1月—2020年6月衢州市人民医院急诊科诊治的感染患者240例，同时在体检中心选择120名健康受试者纳入研究。酶联免疫反应定量检测血清PCT浓度，通过设计诊断试验全面评价PCT在急诊感染患者细菌感染病原学分型中的价值：对照组和细菌感染者诊断试验；革兰氏染色阳性与阴性患者诊断试验。结果细菌感染组血清PCT浓度高于对照组水平(P < 0.05)，革兰氏染色阴性组PCT浓度显著高于革兰氏染色阳性组(P < 0.05)。细菌感染组与对照组进行诊断试验结果显示：AUC曲线下面积为0.978(95% CI：0.958~0.991，P < 0.001)，灵敏度为91.5%，特异度为99.4%，PCT最佳截断值为1.36 ng/mL；G⁺组与G^-组间诊断试验结果：AUC曲线下面积为0.817(95% CI：0.757~0.868，P < 0.001)，灵敏度为80.0%，特异度为97.3%，PCT最佳截断值为3.61 ng/mL。结论血清PCT为良好的细菌病原学分型的生物标记物，能够为急诊抗菌药物的合理使用提供参考依据。
- 血清降钙素原 /
- 感染 /
- 细菌 /
- 病原学分型
Abstract: Objective To explore the value of serum procalcitonin (PCT) in the pathogen classification of bacterial infection in emergency patients and to provide reference for rational drug use in clinical antibacterial treatment. Methods A total of 240 infectious patients were selected in the Emergency Department of our hospital, and 120 healthy people were also selected for this study in the physical examination centre. Enzyme-linked immunosorbent assay was used to quantitatively detect serum PCT concentration. The diagnostic test was designed to comprehensively evaluate the value of PCT in the pathogen classification of bacterial infection in emergency patients, including the diagnostic test in the control group and bacterial infection group, diagnostic tests in gram-positive and gram-negative patients. Results The concentration of serum PCT was higher in the bacterial infection group than in the control group (P < 0.05). The PCT concentration in the gram-negative group was significantly higher than that in the gram-positive group. Results of diagnostic test between the bacterial infection and control groups showed that the area under AUC curve was 0.978 (95% CI: 0.958-0.991, P < 0.001), with a sensitivity of 91.5% and a specificity of 99.4% on the best cut-off value of 1.36 ng/mL. Diagnostic test results between gram-positive and gram-negative bacterial infection patients were that the area under AUC curve was 0.817 (95% CI: 0.757-0.868, P < 0.001), with a sensitivity of 80.0% and a specificity of 97.3% when the best cut-off value was 3.61 ng/mL. Conclusion Serum PCT is a good biomarker for pathogen classification in bacterial infection, and it may serve as a reference for the rational use of antibacterial drugs.
- Serum procalcitonin /
- Infection /
- Bacteria /
- Pathogen classification

HTML全文

图 1 血清PCT诊断细菌感染和总体对照的ROC曲线

下载: 全尺寸图片幻灯片

图 2 血清PCT诊断G⁺细菌感染和G^-细菌感染的ROC曲线

下载: 全尺寸图片幻灯片

表 1 血清PCT在细菌感染病原学分型中诊断试验结果

比较组别	最佳截断值(ng/mL)	AUC (95% CI)	灵敏度(%)	特异度(%)
细菌感染组vs. 总体对照组	1.36	0.978(0.958~0.991)	91.5	99.4
G^-组vs. G⁺组	3.61	0.817(0.757~0.868)	80.0	97.3

下载: 导出CSV

参考文献(16)

[1]	VARELA-PATIÑO M, LOPEZ-IZQUIERDO R, VELAYOS-GARCIA P, et al. Usefulness of infection biomarkers for diagnosing bacteremia in patients with a sepsis code in the emergency department[J]. Infez Med, 2020, 28(1): 29-36. http://www.researchgate.net/publication/339984332_Usefulness_of_infection_biomarkers_for_diagnosing_bacteremia_in_patients_with_a_sepsis_code_in_the_emergency_department
[2]	WISS A, TURNER S, NEGRETE A, et al. Improving antibiotic administration efficiency and patient outcomes in the emergency department[J]. Am J Emerg Med, 2020, 38(6): 1275-1276. http://www.sciencedirect.com/science/article/pii/S0735675719307065
[3]	BURNHAM J P, WALLACE M A, FULLER B M, et al. Clinical effect of expedited pathogen identification and susceptibility testing for gram-negative bacteremia and candidemia by use of the Accelerate Pheno^TM system[J]. J Appl Lab Med, 2019, 3(4): 569-579. doi: 10.1373/jalm.2018.027201
[4]	LIM C K, ABOLHASSANI H, APPELBERG S K, et al. IL2RG hypomorphic mutation: Identification of a novel pathogenic mutation in exon 8 and a review of the literature[J]. Allergy Asthma Clin Immunol, 2019, 15(1): 2. doi: 10.1186/s13223-018-0317-y
[5]	WU S C, LIANG C X, ZHANG Y L, et al. Elevated serum procalcitonin level in patients with chronic kidney disease without infection: A case-control study[J]. J Clin Lab Anal, 2020, 34(2): e23065. doi: 10.1002/jcla.23065
[6]	王芳, 顾纪芳, 刘庆芬, 等. 多学科合作的流程管理在急诊危重症患者院内转运中的应用效果[J]. 中华全科医学, 2019, 17(4): 674-677. https://www.cnki.com.cn/Article/CJFDTOTAL-SYQY201904042.htm
[7]	YANG Y, LIU G, YE C, et al. Bacterial community and climate change implication affected the diversity and abundance of antibiotic resistance genes in wetlands on the Qinghai-Tibetan Plateau[J]. J Hazard Mater, 2019, 361(5): 283-293. http://www.sciencedirect.com/science/article/pii/S0304389418307891
[8]	石婷婷, 李双庆, 梁利波. 降钙素原在感染中的应用及研究进展[J]. 中华全科医学, 2018, 16(4): 620-625. https://www.cnki.com.cn/Article/CJFDTOTAL-SYQY201804033.htm
[9]	HASHIM R M, ABDELAZIZ M M, HASSAN R M. Higher accuracy of concurrent use of corrected QT interval and procalcitonin serum level to predict sepsis related mortality in ICU patients[J]. Egypt J Anaesth, 2020, 36(1): 38-43. doi: 10.1080/11101849.2020.1757383
[10]	TENG F, WAN T T, GUO S B, et al. Outcome prediction using the Mortality in Emergency Department Sepsis score combined with procalcitonin for influenza patients[J]. Med Clin(Barc), 2019, 153(11): 411-417. http://www.sciencedirect.com/science/article/pii/S2387020619305042
[11]	孙景巍, 彭万胜, 黄玉柱, 等. 小儿肺炎支原体肺炎合并全身炎症反应综合征时超敏CRP、PCT、WBC变化及临床意义研究[J]. 中华全科医学, 2019, 17(2): 245-247, 255. https://www.cnki.com.cn/Article/CJFDTOTAL-SYQY201902023.htm
[12]	王丽伟, 刘丽红, 李达. 降钙素原对儿童不同类型病原菌血流感染的诊断价值[J]. 临床血液学杂志(输血与检验), 2019, 32(6): 423-425, 431. https://www.cnki.com.cn/Article/CJFDTOTAL-LCXZ201906005.htm
[13]	佟小芳, 崔元璐. 脓毒症生物标记物的研究进展[J]. 天津中医药大学学报, 2019, 38(1): 100-104. https://www.cnki.com.cn/Article/CJFDTOTAL-TZYY201901029.htm
[14]	THOMAS-RVDDEL D O, POIDINGER B, KOTT M, et al. Influence of pathogen and focus of infection on procalcitonin values in sepsis patients with bacteremia or candidemia[J]. Crit Care, 2018, 22(1): 128. doi: 10.1186/s13054-018-2050-9
[15]	马英, 乔晓霞, 索磊, 等. 降阶梯疗法治疗新生儿重症感染性肺炎的临床疗效[J]. 实用临床医药杂志, 2019, 23(1): 56-58, 62. https://www.cnki.com.cn/Article/CJFDTOTAL-XYZL201901016.htm
[16]	闵小彦, 黄凡, 蔡薇薇, 等. ICU多重耐药铜绿假单胞菌感染肺炎的治疗及降钙素原对抗菌药物使用的指导意义[J]. 中国预防医学杂志, 2019, 20(3): 178-181. https://www.cnki.com.cn/Article/CJFDTOTAL-ZGYC201903006.htm