血流感染实验诊断的研究进展

摘要/Abstract

摘要： 　　血流感染的发病率较高，常导致患者死亡。据报道，美国每年有65万~75万人死于脓毒症。有学者通过对美国400家急诊中心的调查显示，约2.8％的急诊患者因为怀疑存在血流感染而需要做血培养[1]。早期做出血流感染的诊断对患者的预后有重要意义。血流感染的诊断依赖于血培养和非培养的辅助检测，自动化血培养仪、一些生物标志物的检测和分子生物学检测技术对血流感染的快速及准确诊断起了重要作用，现将其综述如下。　　一、自动化血培养系统　　1. BacT/ALERT自动化血培养系统　　2. Bactec 9000自动化血培养系统　　3. VITAL自动化血培养系统　　4. VersaTREK和ESP自动化血培养系统　　二、生物标志物检测　　除了血培养以外，还有降钙素原（PCT）、C反应蛋白（CRP）、白细胞介素6（IL-6）和内毒素等检测可辅助诊断血流感染。　　1. PCT 　　2. CRP 　　3. IL-6 　　4. 内毒素　　三、分子生物学检测技术　　近年来,分子生物学技术逐步用于血流感染诊断中，由于其可直接快速地从阳性血培养瓶中鉴定细菌种类和检测耐药基因，正被更多的临床实验室所认可。其中又以荧光标记原位分子杂交（FISH）、聚合酶链反应（PCR）和基因芯片技术最为常用^[17]。质谱技术和流式细胞术也在逐步运用于临床。　　1. FISH 　　2. PCR 　　3. 基因芯片技术　　4. 质谱技术　　5. 流式细胞术　　综上所述，自动化血培养仪主要的检测手段是监测培养瓶中CO₂的产生和气压的变化，可及时发出阳性报警。虽然血培养是诊断血流感染的金标准，但时间依然过长，无法满足临床需求。生物标志物检测虽然报告时间较短，但特异性差，无法区分血流感染和其他重症感染。分子生物学技术（FISH、PCR、基因芯片、质谱技术和流式细胞术）可以快速鉴定阳性血培养液中的细菌或真菌种类及耐药性，其技术敏感性和特异性较高，甚至可以直接从全血中鉴定微生物，但生产成本亦高，很多实验室无法承担。

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钟驾云综述;周庭银审校. 血流感染实验诊断的研究进展[J]. 检验医学, 2012, 27(8): 692-696.

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