降钙素原、C反应蛋白检测在新生儿血流感染诊断中的价值

doi:10.3969/j.issn.1673-8640.2018.07.007

摘要/Abstract

摘要：

目的探讨降钙素原（PCT）、C反应蛋白（CRP）在新生儿血流感染诊断中的价值,为血流感染的早期诊断和抗菌药物治疗提供依据。方法选取血培养阳性且行PCT、CRP检测的患儿55例为实验组,以血培养阴性、临床诊断为非血流感染的患儿55例为对照组。实验组根据血培养结果再分为革兰阳性菌组和革兰阴性菌组。对比各组PCT、CRP检测结果。采用受试者工作特征（ROC）曲线评估PCT、CRP诊断血流感染的效能。结果实验组PCT水平为0.65（0.25~7.0）ng/mL,显著高于对照组[0.17（0.12~0.24）ng/mL]（P=0.000）;CRP水平为10.97（1.04~23.82）mg/L,高于对照组[2.49（0.62~9.62）mg/L,P=0.002]。革兰阴性菌组PCT水平高于革兰阳性菌组（P<0.05）,而2个组之间CRP水平差异无统计学意义（P>0.05）。ROC曲线分析显示,以PCT=0.245 ng/mL为诊断新生儿血流感染的临界值,其敏感性、特异性、阳性预测值、阴性预测值和准确度分别为76.4%、78.2%、77.8%、76.8%和77.3%,曲线下面积（AUC）为0.830;以CRP= 9.185 mg/L为诊断新生儿血流感染的临界值,其敏感性、特异性、阳性预测值、阴性预测值和准确度分别为56.4%、72.7%、67.4%、62.5%和64.5%,AUC为0.669。结论 PCT和CRP检测对新生儿血流感染的诊断有一定价值。PCT的敏感性、特异性优于CRP。革兰阴性菌血流感染者的PCT水平较革兰阳性菌血流感染者高。

关键词: 降钙素原, C反应蛋白, 革兰阴性菌, 革兰阳性菌, 血流感染

Abstract:

Objective To investigate the roles of procalcitonin （PCT） and C-reactive protein （CRP） in the diagnosis of neonatal bloodstream infection,and to provide a reference for the early diagnosis and antibiotic treatment of bloodstream infection. Methods A total of 55 patients with blood culturing positive were enrolled as experimental group,and they were determined for PCT and CRP. Totally,55 cases with blood culturing negative confirmed by clinical diagnosis in the same period were enrolled as control group. The experimental group were sub-classified according to Gram-positive and Gram-negative bacteria,and the difference of PCT and CRP levels among these groups was compared. The efficiencies of PCT and CRP for the diagnosis of neonatal bloodstream infection were analyzed and compared according to receiver operating characteristic （ROC）curve. Results In the experimental group,PCT was 0.65（0.25-7.00） ng/mL,which was higher than that in control group [0.17（0.12-0.24） ng/mL]（P=0.000）. CRP in the experimental group was 10.97（1.04-23.82） mg/L,and that in control group was 2.49（0.62-9.62） mg/L （P=0.002）. The PCT in Gram-negative bacteria was higher than that in Gram-positive bacteria （P<0.05）,and CRP level had no statistical significance between the 2 subgroups （P>0.05）. ROC curve analysis showed that when PCT was 0.245 ng/mL as the cut-off value of neonatal bloodstream infection,the sensitivity,specificity,positive predictive value, negative predictive value and accuracy were 76.4%,78.2%,77.8%,76.8% and 77.3%. The area under curve （AUC） was 0.830. The sensitivity,specificity,positive predictive value,negative predictive value and accuracy were 56.4%,72.7%,67.4%,62.5% and 64.5%,respectively,when CRP was 9.185 mg/L as the cut-off value of neonatal bloodstream infection. The AUC was 0.669. Conclusions The determinations of PCT and CRP play roles in diagnosing neonatal bloodstream infection. The sensitivity and specificity of PCT determination are superior to those of CRP determination. PCT level is high in bloodstream infection patients infected with Gram-negative bacteria than that with Gram-positive bacteria.

Key words: Procalcitonin, C-reactive protein, Gram-negative bacterium, Gram-positive bacterium, Bloodstream infection

中图分类号:

R446.5

王昭蓉, 邵雪峰. 降钙素原、C反应蛋白检测在新生儿血流感染诊断中的价值[J]. 检验医学, 2018, 33(7): 608-611.

WANG Zhaorong, SHAO Xuefeng. Procalcitonin and C-reactive protein in the diagnosis of neonatal bloodstream infection[J]. Laboratory Medicine, 2018, 33(7): 608-611.

图/表 4

参考文献 11

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组别	例数	PCT（ng/mL）	PCT阳性数（%）	CRP（mg/L）	CRP阳性数（%）
实验组	55	0.65（0.25~7.00）	42（76.4）	10.97（1.04~23.82）	31（56.3）
对照组	55	0.17（0.12~0.24）	12（21.8）	2.49（0.62~9.62）	15（27.3）
P值		0.000		0.002

组别	例数	PCT（ng/mL）	PCT阳性数（%）	CRP（mg/L）	CRP阳性数（%）
实验组	55	0.65（0.25~7.00）	42（76.4）	10.97（1.04~23.82）	31（56.3）
对照组	55	0.17（0.12~0.24）	12（21.8）	2.49（0.62~9.62）	15（27.3）
P值		0.000		0.002

细菌种类	株数	构成比（%）
革兰阳性菌	38	69.1
金黄色葡萄球菌	14	25.6
凝固酶阴性葡萄菌	13	23.6
肠球菌	2	3.6
链球菌	6	10.9
真菌	2	3.6
产单核李斯特菌	1	1.8
革兰阴性菌	17	30.9
大肠埃希菌	5	9.1
肺炎克雷伯菌	7	12.7
阴沟肠杆菌	3	5.5
其他	2	3.6
合计	55	100.0

细菌种类	株数	构成比（%）
革兰阳性菌	38	69.1
金黄色葡萄球菌	14	25.6
凝固酶阴性葡萄菌	13	23.6
肠球菌	2	3.6
链球菌	6	10.9
真菌	2	3.6
产单核李斯特菌	1	1.8
革兰阴性菌	17	30.9
大肠埃希菌	5	9.1
肺炎克雷伯菌	7	12.7
阴沟肠杆菌	3	5.5
其他	2	3.6
合计	55	100.0

组别	株数	PCT（ng/mL）	PCT阳性数（%）	CRP（mg/L）	CRP阳性数（%）
革兰阴性菌组	17	4.32（0.42~16.0）	14（82.4）	19.84（2.17~74.07）	10（58.8）
革兰阳性菌组	38	0.50（0.22~1.68）	28（73.7）	10.35（0.91~22.31）	21（55.3）
P值		<0.05		>0.05