降钙素原在革兰阳性菌和革兰阴性菌感染鉴别诊断中的价值探讨

doi:10.3969/j.issn.1673-8640.2015.11.013

摘要/Abstract

摘要： 目的

研究血浆降钙素原(PCT)、血浆C反应蛋白(CRP)、血浆中性粒细胞表面CD64(CD64)、血清白细胞介素-6(IL-6)和血清肿瘤坏死因子-α(TNF-α)在革兰阳性菌和革兰阴性菌感染时的水平,探讨这些感染指标在鉴别诊断2种不同细菌感染中的价值。

方法

选取204例患者,按细菌培养结果分为革兰阳性菌组(25例)、革兰阴性菌组(89例)和阴性对照组(90例),同时测定各组PCT、CRP、CD64、IL-6和TNF-α水平。采用受试者工作特征(ROC)曲线评价PCT等感染指标的诊断性能。

结果

革兰阴性菌组、革兰阳性菌组和阴性对照组PCT平均浓度分别为10.01、5.80和1.06 μg/L,3组之间差异均有差异有统计学意义(P<0.01);CRP、IL-6和TNF-α水平3组之间差异也均有统计学意义(P<0.05);革兰阴性菌组、革兰阳性菌组CD64明显高于阴性对照组(P<0.01),但革兰阴性菌组和革兰阳性菌组之间差异无统计学意义(P>0.05)。当PCT的Cut-off值为0.41 μg/L时,鉴别细菌感染的ROC曲线下面积为0.882,灵敏度和特异性分别为85.1%、82.2%,均高于其他4项指标。PCT、CRP、IL-6、TNF-α鉴别革兰阳性菌(≤Cut-off值)和革兰阴性菌(>Cut-off值)感染的Cut-off值分别为1.25 μg/L、79.34 mg/L、27.4 pg/mL、20.5 pg/mL,此时曲线下面积分别为0.671、0.625、0.654、0.619,阳性预测值分别为88.6%、83.1%、88.5%、90.4%,其中PCT的曲线下面积最大,其灵敏度和特异性分别为69.7%和72%,阳性预测值也达到了88.6%。

结论

PCT可用于细菌感染的早期诊断,也可以初步鉴别革兰阳性菌和革兰阴性菌感染,但诊断性能较弱。

关键词: 降钙素原, 革兰阳性菌, 革兰阴性菌, 感染

Abstract: Objective

Through the study of the different levels of procalcitonin (PCT), C reactive protein (CRP) and neutrophil CD64(CD64) in plasma and interleukin-6 (IL-6), tumor necrosis factor alpha (TNF-α) in serum for the infections of Gram-positive and Gram-negative bacteria, to discuss the significance of these indices in the differential diagnosis of 2 different bacterium infections.

Methods

A total of 204 patients were classified into Gram-positive bacterium group (25 cases), Gram-negative bacterium group (89 cases) and negative control group (90 cases). The levels of PCT, CRP, CD64, IL-6 and TNF-α among the groups were determined. The diagnosis performance of PCT and other indices was evaluated by receiver operating characteristic (ROC) curve.

Results

The PCT levels in Gram-negative bacterium group, Gram-positive bacterium group and negative control group were 10.01, 5.80 and 1.06 μg/L, and there was statistical significance among the 3 groups(P<0.01). The differences of CRP, IL-6 and TNF-α among the 3 groups had statistical significance (P<0.05). The levels of CD64 in Gram-positive and Gram-negative bacterium groups were obviously higher than that in negative control group (P<0.01), but there was no statistical significance between Gram-positive and Gram-negative bacterium groups (P>0.05). When the cut-off value of PCT was 0.41 μg/L, the area under the ROC curve of PCT for identifying bacterium infection was 0.882. The sensitivity was 85.1%, and the specificity was 82.2%, which were higher than those of the other 4 indices. For the differential diagnosis of Gram-positive and Gram-negative bacterium groups, the cut-off values of PCT, CRP, IL-6 and TNF-α were 1.25 μg/L, 79.34 mg/L, 27.4 pg/mL and 20.5 pg/mL, and the areas under the ROC curves were 0.671, 0.625, 0.654 and 0.619. The positive predictive values were 88.6%, 83.1%, 88.5% and 90.4%. The area under the ROC curve of PCT was biggest. The sensitivity was 69.7%, and the specificity was 72%. The positive predictive value reached 88.6%.

Conclusions

PCT can be used to the early diagnosis bacterium infection and the differential diagnosis of Gram-positive bacterium and Gram-negative bacterium infections, but the diagnosis performance is weak.

Key words: Procalcitonin, Gram-positive bacterium, Gram-negative bacterium, Infection

中图分类号:

R446.1

张群, 胡晓波. 降钙素原在革兰阳性菌和革兰阴性菌感染鉴别诊断中的价值探讨[J]. 检验医学, 2015, 30(11): 1113-1118.

ZHANG Qun, HU Xiaobo. Investigation on the significance of procalcitonin in the differential diagnosis of Gram-positive bacterium and Gram-negative bacterium infections[J]. Laboratory Medicine, 2015, 30(11): 1113-1118.

图/表 7

参考文献 15

[1]	降钙素原急诊临床应用专家共识组. 降钙素原(PCT)急诊临床应用的专家共识[J]. 中华急诊医学杂志,2012,21(9):944-951
[2]	中华人民共和国国家卫生和计划生育委员会. WS/T 420-2013 临床实验室对商品定量试剂盒分析性能的验证[S]. 2013.
[3]	OVED K,COHEN A,BOICO O,et al.A novel host-proteome signature for distinguishing between acute bacterial and viral infections[J].PLoS One,2015,10(3):e0120012.
[4]	肖政辉,易著文,胥志跃,等. 重症肺炎患儿血浆IL-1、IL-6、IL-8、TNF-α变化及临床意义[J]. 医学临床研究,2007,24(8):1345-1346.
[5]	OPPEGAARD O,SKODVIN B,HALSE AK,et al.CD64 as a potential biomarker in septic arthritis[J]. BMC Infect Dis,2013,13:278.
[6]	HOSHINA T,NANISHI E,KANNO S,et al.The utility of biomarkers in differentiating bacterial from non-bacterial lower respiratory tract infection in hospitalized children: difference of the diagnostic performance between acute pneumonia and bronchitis[J]. J Infect Chemother,2014,20(10):616-620.
[7]	DARYAPEYMA A,PEDERSEN G,LAXDAL E,et al.Neutrophil CD64 as a marker for postoperative infection: a pilot study[J]. Eur J Vasc Endovasc Surg,2009,38(1):100-103.
[8]	张洲,徐元宏,李涛,等. 细胞因子IL-1β、IL-6、IL-8、TNF-α在细菌性血流感染中的诊断价值[J]. 安徽医科大学学报,2012,47(9):1079-1081.
[9]	GHILLANI PP,MOTTÉ P,TROALEN F,et al.Identification and measurement of calcitonin precursors in serum of patients with malignant diseases[J]. Cancer Res,1989,49(23):6845-6851.
[10]	艾红梅,王昌富. 降钙素原在感染性疾病中的临床应用[J]. 中华医院感染学杂志,2012,22(18):4178-4180.
[11]	王胜云,陈德昌. 降钙素原和C-反应蛋白与脓毒症患者病情严重程度评分的相关性研究及其对预后的评估价值[J]. 中华危重病急救医学,2015,27(2):97-101.
[12]	GIAMARELLOS-BOURBOULIS EJ,GRECKA P,POULAKOU G,et al.Assessment of procalcitonin as a diagnostic marker of underlying infection in patients with febrile neutropenia[J]. Clin Infect Dis,2001,32(12):1718-1725.
[13]	PHUA J,NGERNG W,SEE K,et al.Characteristics and outcomes of culture-negative versus culture-positive severe sepsis[J]. Crit Care,2013,17(5):R202
[14]	KÖKTÜRK N,KANBAY A,BUKAN N,et al. The value of serum procalcitonin in differential diagnosis of pulmonary embolism and community-acquired pneumonia[J]. Clin Appl Thromb Hemost,2011,17(5): 519-525.
[15]	刘英其. 血清降钙素原在不同种类细菌脓毒症的早期鉴别诊断价值[J]. 中华医院感染学杂志,2013,23(3):500-502.

细菌名称	例数	百分比(%)
鲍曼不动杆菌	32	28.1
大肠埃希菌	24	21.1
肺炎克雷伯菌	17	14.9
铜绿假单胞菌	9	7.9
金黄色葡萄球菌	8	7.0
奇异变形杆菌	7	6.1
溶血葡萄球菌	5	4.4
粪肠球菌	4	3.5
其他	8	7.0
合计	114	100

细菌名称	例数	百分比(%)
鲍曼不动杆菌	32	28.1
大肠埃希菌	24	21.1
肺炎克雷伯菌	17	14.9
铜绿假单胞菌	9	7.9
金黄色葡萄球菌	8	7.0
奇异变形杆菌	7	6.1
溶血葡萄球菌	5	4.4
粪肠球菌	4	3.5
其他	8	7.0
合计	114	100

标本类型	例数	百分比(%)
痰	66	57.9
全血	26	22.8
分泌物	6	5.3
胆汁	3	2.6
其他	13	11.4
合计	114	100

标本类型	例数	百分比(%)
痰	66	57.9
全血	26	22.8
分泌物	6	5.3
胆汁	3	2.6
其他	13	11.4
合计	114	100

组别	例数	PCT (μg/L)	CRP (mg/L)	CD64 (%)	IL-6 (pg/mL)	TNF-α (pg/mL)
革兰阳性菌组	25	5.80 (0.26~42.60)^*#	69.02 (9.23~142.11)^*#	62.28 (8.83~99.78)^*	37.25 (8.33~62.88)^*#	17.00 (9.15~32.06)^*#
革兰阴性菌组	89	10.01 (0.11~50.00)^*	93.27 (10.94~194.53)^*	61.95 (10.40~99.45)^*	111.50 (4.28~828.00)^*	31.09 (7.14~85.12)^*
阴性对照组	90	1.06 (0.10~3.77)	39.07 (2.07~135.14)	40.47 (2.64~98.62)	45.29 (2.00~155.25)	14.66 (4.00~32.20)