降钙素原和C反应蛋白在儿童血流感染中血培养阳性标本预测中应用

摘要

目的：探讨降钙素原(PCT)和C反应蛋白(CRP)在预测儿童血流感染(BSI)血培养阳性标本中的应用价值，为BSI的早期诊断和治疗提供依据。方法整群选择2013年12月—2014年12月该院急诊科收治的血培养阳性BSI患儿（观察组）和血培养阴性BSI患儿（对照组）各79例，回顾性对比分析患儿采血当日CRP、PCT结果。结果观察组患儿CRP、PCT水平显著高于对照组。以血培养结果为金标准，PCT预测的敏感度、特异度显著高于CRP (PCT、CRP对应的ROC曲线下面积分别为0.831和0.513）。观察组中革兰阴性菌感染PCT水平（50.85 ng/mL）显著高于革兰阳性菌，差异有统计学意义(P<0.05)。结论 PCT与CRP可作为检测血流感染的重要指标，联合血培养具有早期诊断细菌感染的指导意义。 PCT对BSI血培养阳性标本预测中的敏感性和特异性优于CRP，值得在临床中推广。%Objective To explore the value of procalcitonin (PCT) and c-reactive protein (CRP) in the prediction of the re-sult of blood culture for bloodstream infection (BSI) in children so as to provide guidance for the early detection and treat-ment of this disease. Methods 79 BSI-positive children (the observation group) and 79 BSI-negative children (the control group) after blood culture who were admitted to emergency department of this hospital between December 2013 and Decem-ber 2014 were included in this study, and the levels of CRP and PCT at the time of blood collection were retrospectively analyzed. Results The levels of CRP and PCT were all higher in the observation group than in the control group. Taking blood culture results as the gold standard, the sensitivity and specificity of PCT were obviously than that of CRP, and area under the ROC curve was 0.831 and 0.513 respectively. In the observation group, the PCT level was 50.85ng/mL in patients with gram-negative infections, significantly higher than that in the patients with gram-positive infections, and the difference was statistically significant (P<0.05). Conclusion PCT and CRP can be used as the important indicators in detection of bloodstream infections, and they in combination with blood culture can provide guidance for early diagnosis of bacterial in-fection, and in this process PCT is more worthy of promotion due to its higher sensitivity and specificity over BSI.