临床儿科杂志 ›› 2014, Vol. 32 ›› Issue (8): 763-.doi: 10.3969 j.issn.1000-3606.2014.08.017

• 综合报道 • 上一篇    下一篇

降钙素原鉴别儿童血流感染与污染的临床价值

张晔1,张林2,吴国雄1,刘英1   

  1. 1.湖南省常宁市人民医院(湖南常宁 421500);2.湖南省儿童医院(湖南长沙 410007)
  • 收稿日期:2014-08-15 出版日期:2014-08-15 发布日期:2014-08-15
  • 通讯作者: 张林 E-mail:juujing@sina.com

Clinical significance of procalcitonin in the differentiation of blood stream infection and contamination

Zhang Ye1, Zhang Lin2, Wu Guoxiong1, Liu Ying1   

  1. 1.People’s Hospital of Changning City, Hunan Province, Changning 421500, Hunan, China; 2.Hunan Children’s Hospital, Changsha 410007, Hunan, China
  • Received:2014-08-15 Online:2014-08-15 Published:2014-08-15

摘要: 目的 探讨血清降钙素原(PCT)鉴别儿童血液培养检出凝固酶阴性葡萄球菌(CNS)血流感染与污染的临床价值。方法 回顾性收集湖南省常宁市人民医院2013年1月–12月连续就诊的经血液培养检出凝固酶阴性葡萄球菌患儿的病例资料,将病例分为血流感染组及污染组,分别比较两组患儿的一般人口学特征、病例来源、C反应蛋白(CRP)、血培养阳性结果报警时间(TP)、降钙素原等实验室检测结果,并根据受试者工作特征(ROC)曲线分析降钙素原的鉴别诊断性能。结果 共83例纳入研究,血流感染组(38例)与污染组(45例)患儿的月龄、性别、CRP、TP的差异无统计学意义(P均>0.05);外科病房住院患儿的血流感染比例(70.59%)高于内科(39.39%),差异有统计学意义(χ2=5.30,P<0.05);血流感染组的PCT水平高于污染组(Z=5.17,P=0.000)。PCT鉴别血流感染组及污染组的灵敏度、特异度、准确度分别为86.8%、82.2%、84.3%,最佳截断值为0.195 ng/ml,ROC曲线下面积(AUC)为0.822(95%CI:0.726~0.918)。结论 PCT对于鉴别儿童凝固酶阴性葡萄球菌血流感染与污染具有一定的临床价值,可帮助临床医师正确诊断血流感染、减少抗生素滥用。

Abstract: Objective To preliminarily explore the role of serum procalcitonin (PCT) quantization in differntiating coagulase-negative staphylococci (CNS) blood stream infection and contamination derived from blood culture in children. Methods Clinical data of 83 cases of CNS derived from blood culture in People’s Hospital of Changning city, Hunan province between January, 2013 and December, 2013 were retrospectively reviewed. The cases were divided into blood stream infection group and contamination group. The basic demographic characteristics, origins of patients, C reactive protein, time to positivity of blood culture (TP), procalcitonin were compared between the two groups, and the diagnostic performance of PCT according to the ROC curve were analyzed. Results Age, gender, C reactive pretein and TP showed no difference between blood stream infection group (n=38) and contamination group (n=45)(P>0.05), while the proportion of contamination of patients from medical wards was higher than that from surgery wards (P<0.05). PCT was significantly higher in blood stream infection group than that of contamination group (P<0.001). The diagnostic sensitivity, spectivity, accuracy of PCT in differentiating the two groups were 86.8%, 82.2% and 84.3%, respectively, at the best cutoff of 0.195 ng/ml. Conclusions PCT may be a good marker for differentiating CNS blood stream infection and contamination derived from blood culture in children, and may help clinicians make early and reasonable selection of antibiotics.