摘要
目的探讨降钙素原（PCT）、D-二聚体（DD）、纤维蛋白原（FIB）、C-反应蛋白（CRP）、白细胞计数（WBC）、中性粒细胞计数（NEU）和血小板计数（PLT）对老年女性患者细菌性血流感染的早期诊断价值。方法选取2015年1月至2016年12月我院收治的60岁及以上怀疑细菌性血流感染的女性患者共308例，其中血培养阳性者210例为研究组，血培养阴性者98例为对照组；比较7种炎性因子在两组患者中表达水平的差异和相关性，通过Logistic回归分析确定老年女性细菌性血流感染早期诊断的独立相关因子、组建具有诊断价值的最佳生物标志物候选组合，并通过受试者工作特征曲线（ROC）评价单个生物标志物和候选组合对老年女性细菌性血流感染早期诊断的价值。结果7种炎性因子在细菌培养阳性和阴性组的表达差异均有统计学意义，PCT、CRP是诊断细菌性血流感染的独立相关因素（OR=1．001、1．069，均P〈0．05）；PCT和CRP这2种生物标志物组合用于诊断细菌性血流感染时的ROC曲线下面积（AUC）为0．794，优于PCT、CRP单独使用时的AuC（分别为0．628和0．627）；同时标志物组合的敏感度（86．2％）、特异度（59．1％）、阳性预测值（65．1％）和阴性预测值（81．3％）也比单独使用PCT（63．4％、58．2％、60．3％、61．4％）、CRP（62．4％、58．2％、59．9％、60．7％）时提高。结论将PCT、CRP联合检测可以有效提高老年女性细菌性血流感染的诊疗能力。
Objective To investigate the expression of different inflammatory variables, such as procalcitonin（ PCT）, C-reactive protein （ CRP）, D-dimer （ DD）, fibrinogen （ FIB）, white blood cell （WBC）, neutrophils and platelet （PLT）in septic elderly female patients with bacterial bloodstream infection,in order to assess the early diagnostic value of these variables. Methods A total of 308 elderly female patients with systemic inflammatory response syndrome（SIRS）were enrolled for this prospective study in Beijing Hospital between January 2014 and December 2015. Patients were divided into the sepsis group （n = 210）and non-sepsis group （n = 98）based on the diagnostic criteria of sepsis. The early inflammatory variables in blood, including PCT, CRP, DD, FIB, WBC, neutrophils and PLT,were detected within 6 hours of bloodstream infection, and their correlations were analyzed. The receiver operating eharacteristic（ROC）curve of inflammatory variables for the diagnosis of bloodstream infection was plotted, and the area under ROC curve（AUC）was calculated and used to evaluate diagnostic value for bloodstream infection. The best diagnostic cut-off points were identified based on the best（largest）AUC and the best sensitivity and specificity of inflammatory variables for bloodstream infection. Results The levels of all the inflammatory variables were significantly higher in the sepsis group than in non-sepsis group（all P〈0.05）. Additionally,PCT and CRP were independent factors for diagnosis of blood stream infection. AUC of the combination of two biomarkers of PCT and CRP was 0. 694 for diagnosis of sepsis,which was higher than the either biomarkers alone with AUC of 0. 628 for PCT and 0. 627 for CRP. The combination group of PCT and CRP showed better values of sensitivity, specificity, positive predictive, and negative predictive （86.2 %, 59.1%, 65.1 %, 81.5%）, as compared with those used individually（63.4% ,58.2% ,60.3%,61.4% for PCT;and 62.4% ,58.2%, 59.9%,60.7% for CRP, resp
出处
《中华老年医学杂志》
CAS
CSCD
北大核心
2018年第2期192-196,共5页
Chinese Journal of Geriatrics
基金
国家自然科学基金青年基金（81302277）
