首页|D-二聚体、PCT及CRP对革兰阴性菌和革兰阳性菌所致脓毒症的鉴别诊断价值

D-二聚体、PCT及CRP对革兰阴性菌和革兰阳性菌所致脓毒症的鉴别诊断价值

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目的 探讨D-二聚体(DD)、血清降钙素原(PCT)及C反应蛋白(CRP)对革兰阴性菌(G-菌)和革兰阳性菌(G+菌)所致脓毒症的鉴别诊断价值.方法 选取2020 年8 月至2021 年9月绍兴市人民医院收治的296例血培养阳性脓毒症患者为研究对象,依据已明确的致病菌将其分为G-菌脓毒症组(181 例)和G+菌脓毒症组(115例);另选取同期收治的非脓毒症血流感染者为对照,其中G-菌非脓毒症组(70 例)和G+菌非脓毒症组(43例).检测所有研究对象的DD、PCT、CRP水平,以多元Logistic回归分析筛选诊断脓毒症最有价值的炎症指标,并建立受试者工作特征(ROC)曲线评价诊断效能.结果 ROC曲线结果显示,DD区分G-菌所致脓毒症与G-菌所致非脓毒症的曲线下面积(AUC)为 0.797;PCT的AUC为0.699;CRP无法区分G-菌所致脓毒症与G-菌所致非脓毒症(P>0.05).DD区分G+菌所致脓毒症与G+菌所致非脓毒症的AUC为0.697;PCT、CRP均无法区分G+菌所致脓毒症与G+菌所致非脓毒症(P>0.05).PCT区分G-菌所致脓毒症与G+菌所致脓毒症的AUC为0.618;CRP、DD均无法区分G-菌所致脓毒症与G+菌所致脓毒症(P>0.05).结论 DD对G-菌所致脓毒症的诊断价值最高,PCT次之,CRP无诊断价值;DD对G+菌所致脓毒症诊断价值最高,PCT、CRP均无诊断价值;而在鉴别何种类型细菌导致的脓毒症中PCT的鉴别能力最强.
Differential diagnosis value of sepsis caused by Gram-negative bacteria and Gram-positive bacteria by D-dimer,PCT and CRP
Objective To investigate the differential diagnostic value of D-dimer(DD),serum procalcitonin(PCT)and C-reactive protein(CRP)in sepsis caused by Gram-negative bacteria(G-bacteria)and Gram positive bacteria(G+bacteria).Methods A total of 296 sepsis patients with positive blood culture admitted in Shaoxing People's Hospital from August 2020 to September 2021 were selected as the research objects.According to the identified pathogenic bacteria,the patients were divided into G-bacteria sepsis group(181 cases)and G+bacteria sepsis group(115 cases);in addition,non-sepsis bloodstream infection patients admitted in the same period were selected as the control,including G-bacteria non-sepsis group(70 cases)and G+bacteria non-sepsis group(43 cases).The levels of DD,PCT and CRP in all subjects were detected.Multivariate Logistic regression analysis was used to screen the most valuable inflammatory markers for the diagnosis of sepsis,and the receiver operating characteristic(ROC)curve was established to evaluate the diagnostic efficacy.Results ROC curve results showed that the area under the curve(AUC)of DD in distinguishing sepsis caused by G-bacteria from non-sepsis caused by G-bacteria was 0.797;the AUC of PCT was 0.699;CRP could not distinguish sepsis caused by G-bacteria from non-sepsis caused by G-bacteria(P>0.05).The AUC of DD in distinguishing sepsis caused by G+bacteria from non-sepsis caused by G+bacteria was 0.697;PCT and CRP could not distinguish sepsis caused by G+bacteria from non-sepsis caused by G+bacteria(P>0.05).The AUC of PCT in distinguishing sepsis caused by G-bacteria from sepsis caused by G+bacteria was 0.618;CRP and DD could not distinguish sepsis caused by G-bacteria from sepsis caused by G+bacteria(P>0.05).Conclusion DD has the highest diagnostic value for sepsis caused by G-bacteria,followed by PCT,and CRP has no diagnostic value;DD has the highest diagnostic value for sepsis caused by G+bacteria,while PCT and CRP has no diagnostic value;PCT has the strongest ability to identify which type of bacteria causes sepsis.

sepsisD-dimerprocalcitoninGram-negative bacteriaGram-positive bacteria

喻松涛、杨娣、李明晖

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绍兴文理学院医学院,浙江 绍兴,312000

浙江省绍兴市人民医院感染科,浙江 绍兴,312000

脓毒症 D-二聚体 降钙素原 革兰氏阴性菌 革兰氏阳性菌

浙江省卫生健康科技计划(2021)

2021KY1138

2024

临床医学研究与实践

临床医学研究与实践

ISSN:
年,卷(期):2024.9(18)