摘要目的 比较降钙素原、C反应蛋白、内毒素等炎性生物标记物对革兰氏阴性菌血流感染患者其早期诊断的预测价值.方法 回顾性分析北京世纪坛医院病房住院的血培养阳性的革兰氏阴性菌感染患者79例,收集其性别、年龄、病情严重程度(APACHEⅡ评分)、血培养细菌种类等资料,同时分析这些患者入科6h内的白细胞(WBC)计数、中性粒细胞(NEU)百分比、C-反应蛋白(CRP)、降钙素原(PCT)、内毒素(endotoxin)的水平.结果 ①革兰氏阴性菌性血流感染患者的炎症生物标记物呈正相关的分别为PCT与endotoxin(r=0.916),PCT与CRP (r=0.496),CRP与endotoxin(r=0.387);且与APACHEⅡ呈明显相关(PCT/APACHEⅡ=0.408,endotoxin/APACHEⅡ=0.399,CRP/APACHEⅡ=0.425).②受试者工作特征曲线(ROC曲线)显示,在革兰氏阴性菌血流感染的脓毒症患者的AUCPCT=0.715(敏感性64.6％,特异性80.7％),AUCCRP =0.666(敏感性67.7％,特异性78.6％),AUCendotoxin=0.771(敏感性78.8％,特异性81.8％);③ROC曲线显示,在革兰氏阴性菌血流感染的严重脓毒症/脓毒性休克患者的AUCPCT＝0.865(敏感性86.2％,特异性77.5％),AUCCRP=0.733(敏感性72.4％,特异性75.0％),AUCendotoxin=0.618(敏感性70.7％,特异性67.5％).结论 血清PCT、CRP、内毒素水平在革兰阴性菌血流感染患者早期诊断有预测价值,在脓毒症期内毒素最为特异,而严重脓毒症期或休克期,PCT最为特异,均与疾病的严重程度呈正相关.

abstractsObjective To investigate the value of inflammatory biomarkers such as procalcitonin (PCT),C-reactive protein (CRP),and endotoxin in early diagnosis of bacteriemia patients infected with gram-negative bacteria.Methods A cohort of 79 bacteriemia patients infected with gram-negative bacteria admitted from February 2011 to May 2013 were enrolled for retrospective study.Collected data for analysis included gender,age,disease severity (APACHE Ⅱ score),bacterial isolates from blood culture and other general information.The inflammatory biomarkers such as white blood cell (WBC),neutrophils (NEU),Creactive protein (CRP),procalcitonin (PCT),and endotoxin were assayed within 6 hours after admission.SPSS version 16.0 software was used for statistical analysis.The test of normality was used for analysis of continuous variables,t-test for inter-group comparison and non-parametric statistics for non-normal distribution variables.The AUC of ROC was calculated for determining the sensitivity and specificity of biomarkers for diagnosis of bacteriemia.Results (1) Statistically positive correlations were found among serum PCT,CRP,and endotoxin levels (PCT/CRP =0.916,PCT/endotoxin =0.496,Endotoxin/CRP =0.387),and between those and APACHE Ⅱ score were (PCT/APACHE Ⅱ =0.505,Endotoxin/APACHE Ⅱ =0.467,CRP/APACHE Ⅱ =0.278),respectively,in bacteriemia patients infected with gram-negative bacteria.(2) The receiver operating characteristic (ROC) curve indicated that AUC PCT =0.715 (sen 64.6％,spe 80.7％),AUC CRP =0.666 (sen 67.7％,spe 78.6％),AUC endotoxin =0.771 (sen 78.8％,spe 81.8％) in gram-negative bacteria bloodstream infection patients.(3) The AUC PCT =0.865 (sen 86.2％,spe 77.5％),AUC CRP =0.733 (sen 72.4％,spe 75.0％),AUCendotoxin =0.618 (sen 70.7％,spe 67.5％) in bacteriemia patients infected with gram-negative bacteria in severe sepsis and septic shock group.Conclusions The plasma PCT,CRP,and endotoxin have early predictive value in bacteriemia patients infected with Gram-negative bacteria.In sepsis stage,the level of serum endotoxin has the most significant value for diagnosis.In severe sepsis and septic shock stages,the PCT is the most value for diagnosis of bacteriemia.All biomarkers are positively correlated with severity of the disease.