不同炎症指标对恶性肿瘤患者细菌性血流感染早期诊断的价值分析

摘要

目的 探讨降钙素原(PCT)、C反应蛋白(CRP)、中性粒细胞百分比(NEUT％)在恶性肿瘤患者细菌性血流感染(BSI)早期诊断的应用价值.方法 回顾性分析该院2015年1-12月413例在当日同时送检了PCT、CRP、血常规检测及血培养的肿瘤发热患者的临床资料.根据血培养结果分为观察组(211例)与对照组(202例).将观察组分成革兰阴性菌(G-)组与革兰阳性菌(G+)组,采用受试者工作特征曲线(ROC)评估PCT、CRP、NEUT％对细菌性BSI的诊断效能.结果 观察组中PCT的特异度最高,CRP的灵敏度最高;观察组的PCT、CRP、NEUT％水平均明显高于对照组,差异有统计学意义(P＜0.05).G-组的PCT水平明显高于G+组,差异有统计学意义(P＜0.05),CRP和NEUT％水平差异无统计学意义(P＞0.05).观察组中PCT、CRP、NEUT％的ROC曲线下面积(AUC)分别为0.848、0.796、0.718,G-和G+菌组PCT的AUC分别为0.877和0.767.结论 恶性肿瘤患者细菌性BSI后,PCT、CRP和NEUT％均明显升高,PCT的诊断效能优于CRP和NEUT％,且对于区分G-和G+菌的感染类型具有一定价值,联合检测PCT、CRP、NEUT％有助于恶性肿瘤患者细菌性BSI的早期诊断.%Objective To explore the value of procalcitonin,C-reactive protein and neutrophil percentage in early diagnosis of bacterial bloodstream infection in patients with malignant tumor.Methods Retrospectively analyzed the clinical data of 413 cases with tumor fever who were performed PCT,CRP,blood test and blood culture in the same day in our hospital from January to December in 2015.According to blood culture results,they were divided into observation group(211 cases) and control group(202 cases).The observation group was divided into Gram-negative(G-) group and Gram-positive(G+) group.The diagnostic efficacy of PCT,CRP and NEUT％ on bacterial bloodstream infection was evaluated by receiver operating characteristic curve (ROC).Results The specificity of PCT in the observation group was the highest and the sensitivity of CRP was the highest.The levels of PCT,CRP and NEUT％ in the observation group were significantly higher than those in the control group(P＜0.05).PCT level in the G-group were apparently higher than that of G+ group(P＜0.05),while CRP and NEUT％ levels had no statistical significance between the two groups(P＞0.05).According to ROC curve,In the observation group,The AUC of PCT,CRP and NEUT％ were 0.848,0.796 and 0.718,respectively.In G-and G+ group,the AUC of PCT were 0.877 and 0.767,respectively.Conclusion PCT,CRP and NEUT％ were significantly increased in the malignant patient with bloodstream infection,PCT has showed better diagnostic efficiency compared to CRP or NEUT％ and better clinical value in distinguish between G-and G+ bacterial infection type.Combined detection of PCT,CRP,NEUT％ can help for early diagnosing malignant tumor with bacterial bloodstream infection.