降钙素原在血液透析患者导管相关性血行感染中的应用价值

摘要

目的 研究降钙素原(Procalcitonin,PCT)在血液透析患者导管相关性血行感染(catheter related bloodstream infection,CRBSI)中的应用价值.方法 62例行中心静脉临时置管后临床怀疑导管相关性血行感染的血液透析患者,采集血常规、C反应蛋白(CRP)、降钙素原血样后拔除导管,同时留取血培养及导管标本.62例患者根据诊断标准分为CRBSI组27例和非CRBSI组35例,比较2组患者的年龄、性别、导管类型、导管留置时间、血白细胞计数(WBC)值、CRP值及降钙素原值(PCT值),并对比CRBSI组治疗前后的PCT值. 结果 CRBSI组患者年龄、导管留置时间明显大于非CRBSI组,CRBSI组及非CRBSI组拔管时的血清PCT水平分别为7.16±5.84μ g/L和0.97±1.44 μ g/L(F =11.759,t=5.387,P＜0.001),具有统计学意义,其WBC (109/L)分别为9.52±3.10及8.65±2.19 (F =0.860 t=1.291 P=0.202),CRP值分别为10.57±3.74mg/L及10.66±4.94mg/L(F=1.641,t=0.081 P=0.935),2组均无统计学意义.CRBSI组拔管前后的降钙素原值(PCT值)分别为7.16±5.84 μ g/L及0.63±0.43 μ g/L (t=5.904,P＜0.001),具有统计学意义. 结论 PCT在早期诊断CRBSI方面具有较高的指导价值.%Objective To study the value of procalcitonin for the evaluation of catheter-related bloodstream infection (CRBSI) in hemodialysis patients. Methods Blood samples from 62 hemodialysis patients suspected to have catheter-related bloodstream infection were obtained for the assays of blood routine examinations, procalcitonin and C-reactive protein (CRP). Blood and the catheter taken from the patients were cultured for bacteria. Patients were assigned into CRBSI group (n=27 cases) or non-CRBSI group (n=35 cases) based on the diagnostic criteria. Age, gender, catheter type, catheter retention period, WBC, CRP and procalcitonin were compared between the two groups. Procalcitonin levels were also compared before and after treatment. Results Age and catheter retention period were significantly higher in CRBSI group than in non-CRBSI groups. At the time of catheter withdrawal, procalcitonin level was significantly higher in CRBSI group (7.16 ± 5.84 ug/L) than in non-CRBSI group (0.97 ± 1.44 ug/L; F=11.759, t= 5.387, P < 0.001). WBC were 9.52 ±3.10 × 109/L in CRBSI group and 8.65 ± 2.19× 107L in non-CRBSI group (F=0.860, t=l .291, P=0.202), and CRP level was 10.57 + 3.74 mg/L in CRBSI group and 10.66 + 4.94 mg/L in non-CRBSI group (F=1.641, t=-0.081, P =0.935), without statistical significances between the two groups. In CRBSI group, procalcitonin level was 7.16 ± 5.84 ng/L before catheter withdrawal, and decreased significantly after catheter withdrawal (0.63 ± 0.43 μg/L; t=5.904, P < 0.001). Conclusion Procalcitonin level is a valuable parameter for the early diagnosis of CRBSI.