降钙素原在长期接受免疫抑制治疗的重症患者感染诊断中的作用

摘要

Objective To assess the value of procalcitonin(PCT)measurement to differentiate infection from non-infection in critically ill patients requiring long-term immunosuppressive therapy.Methods A prospective study was conducted in patients with underlying diseases requiring corticosteroids or chemotherapy in ICU from January 2008 to December 2009.Patients were divided into the infection group and the non-infection group and their PCT levels were compared.Results A total of 103 patients (65 women)were enrolled in this prospective study[aged(47.9 ± 21.9)years old]with 84 in the infection group and 19 in the non-infection group.The baseline level of PCT was significantly higher in infection than in non-infection patients[2.58(0.08-44.65)pg/L vs 0.62(0.15-6.00)pg/L,P =0.002].Different levels of PCT were manifested in different pathogen groups with 3.41(0.45-44.65)pg/L in bacteria infection,0.99(0.28-6.67)pg/L in fungus infection,0.11(0.08-0.20)pg/L in virus infection group(P =0.018).The AUCROC of PCT was 0.867 for diagnostic bacterial infection.By multivariate analysis,the factors associated with the level of PCT were bacteria infection(OR 5.1,P =0.031)and septic shock(OR 7.5,P =0.027),while the factors not associated with the level of PCT were age,renal function,infection site and prognosis(P ＞ 0.05).Conclusions The level of PCT is increased in the critically ill patients requiring immunosuppressive therapy with infection and it can be used for diagnosis for bacterial infection.%目的 探索降钙素原(PCT)在长期接受免疫抑制治疗的重症患者感染诊断中的价值.方法 前瞻性研究,连续纳入2008年1月至2009年12月北京协和医院ICU中伴有长期应用糖皮质激素或免疫抑制剂的基础疾病患者,怀疑感染时测定血PCT.结果 入选103例,年龄(47.9±21.9)岁,其中女性65例.感染组84例,非感染组19例.感染组PCT高于非感染组[2.58(0.08～44.65)pg/L比0.62(0.15～6.00)pg/L,P=0.002]；不同病原菌感染的患者,其PCT水平依次为细菌3.41(0.45～44.65)pg/L、真菌0.99(0.28～6.67)pg/L、病毒0.11(0.08～0.20)pg/L(P=0.018);PCT诊断细菌感染的AUCROC为0.867(P=0.000).PCT水平与年龄、肾功能、感染部位及预后无关(P＞0.05),而与细菌感染(OR =5.1,P=0.031)及感染性休克(OR =7.5,P=0.027)独立相关.结论 免疫抑制治疗不影响PCT释放,PCT水平检测在该人群感染,特别是细菌感染诊断中发挥重 要作用.