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探讨血清降钙素原(PCT)水平对不同病原菌血流感染的诊断价值。选取2015年7月~2016年7月我院收治的血培养阳性的血流感染患者77例,其中革兰氏阳性菌感染41例(53.25%),革兰氏阴性菌感染36例(46.75%)。检测患者的PCT水平,绘制ROC曲线,计算曲线下面积(AUC)。革兰氏阳性菌组的血清PCT水平明显低于革兰氏阴性菌组,(0.62±0.17)ng/m L vs(12.87±3.43)ng/m L,差异具有统计学意义(t=2.193,p<0.05);血清PCT区分革兰氏阳性和阴性菌的诊断价值较高(ACU=0.759),最佳阈值为4.45 ng/L。当血清PCT水平>4.45 ng/L时诊断革兰氏阴性菌感染的敏感度、特异度和准确度分别为80.34%、86.91%、88.14%,阳性预测值92.1%,阴性预测值84.9%。在革兰氏阴性菌中,大肠埃希菌组的血清PCT水平明显高于鲍氏不动杆菌组,鲍氏不动杆菌组明显高于肺炎克雷伯菌组,差异具有统计学意义(p<0.05);在革兰氏阳性菌中,金黄色葡萄球菌组的血清PCT水平明显高于肠球菌属组,肠球菌属组明显高于酿脓链球菌组,差异具有统计学意义(p<0.05)。不同病原菌血流感染患者的血清PCT水平存在差异,血清PCT水平对早期区分革兰氏阳性菌和阴性菌感染具有较高的诊断价值。
To investigate the diagnostic value of serum procalcitonin (PCT) level in different pathogenic bloodstream infections. Totally 77 patients with blood-culture-positive bloodstream infection admitted to our hospital from July 2015 to July 2016 were selected, of which 41 (53.25%) were Gram-positive bacteria, 36 (46.75%) were Gram-negative bacteria, ). The patient’s PCT level was measured, the ROC curve was plotted, and the area under the curve (AUC) was calculated. The level of serum PCT in Gram-positive bacteria group was significantly lower than that in Gram-negative bacteria group (0.62 ± 0.17 ng / m L vs 12.87 ± 3.43 ng / m L, t = 2.193, p <0.05). The diagnostic value of PCT in distinguishing Gram-positive and -negative bacteria was high (ACU = 0.759). The optimal threshold was 4.45 ng / L. The sensitivity, specificity and accuracy of serum PCT level> 4.45 ng / L were 80.34%, 86.91% and 88.14% respectively, the positive predictive value was 92.1% and the negative predictive value was 84.9%. In Gram-negative bacteria, the serum PCT level of Escherichia coli group was significantly higher than that of Acinetobacter baumannii group, Acinetobacter baumannii group was significantly higher than that of K. pneumoniae group, the difference was statistically significant (p <0.05). In Gram-positive bacteria, the level of serum PCT in Staphylococcus aureus group was significantly higher than that in Enterococcus group and that in Enterococcus group was significantly higher than that in Streptococcus pyogenes group (p < 0.05). The serum PCT levels of patients with different pathogenic bloodstream infections are different, and the serum PCT levels have a high diagnostic value for the early distinction between Gram-positive and -negative bacterial infections.