血浆肝素结合蛋白和降钙素原对血流感染的诊断价值

摘要

Objective To investigate the roles of heparin binding protein(HBP) and procalcitonin(PCT) in the diagnosis of bloodstream infection and the severity of infection. Methods A total of 57 patients with bloodstream infection were enrolled,and 50 healthy subjects and 50 non-bacterial infection patients were enrolled as well. HBP and PCT levels were determined. PCT and HBP levels between Gram-negative and Gram-positive bacteria in bloodstream infection group were compared. Receiver operating characteristic(ROC) curve was used to analyze the efficiency of parameters. Sequential organ failure assessment(SOFA) was performed,and the relationship of SOFA score with PCT and HBP levels was evaluated by SNK method and single factor multiple Logistic regression analysis. Results The levels of PCT and HBP in Gram-negative bacteria were 6.8(4.2-15.6) ng/mL and (105.3±51.8) ng/mL,respectively. The levels of PCT and HBP in Gram-positive bacteria were 6.2(4.5-7.8) ng/mL and (168.1±79.2)ng/mL,respectively. The sensitivities of PCT and HBP for the diagnosis of bloodstream infection were 91.2% and 73.7%,and the specificities were 94.0% and 88.0%,and areas under ROC curves(AUC) were 0.983 and 0.880. The PCT levels in patients with SOFA score 19-24 and 13-18 were higher than those with SOFA score 1-6 and 7-12,and there was no statistical significance between SOFA score 19-24 and 13-18. The HBP levels were increased with SOFA score increasing. Conclusions PCT is superior than HBP in the diagnosis of bloodstream infection,and HBP can predict the severity of infection.%目的 探讨降钙素原(PCT)和肝素结合蛋白(HBP)在血流感染及其感染严重程度中的诊断意义.方法 选取确诊为血流感染并血培养为阳性的患者57例(血流感染组),同时选取同期体检健康者50名(对照组)和非细菌感染患者50例(非细菌感染组)作为对照,测定各组的HBP、PCT水平,比较革兰阴性菌和革兰阳性菌血流感染者的PCT和HBP水平,利用单因素方差分析和SNK比较各组间检测指标的差异;通过受试者工作特征(ROC)曲线分析各检测指标对血流感染的检测效能;对血流感染者进行序贯器官衰竭估计(SOFA)评分,对评分结果 进行分段,采用SNK和单因素多项Logistic回归比较SOFA评分和PCT、HBP的关系.结果 革兰阴性菌血流感染组中的PCT和HBP平均水平分别是6.8(4.2~15.6)ng/mL和(105.3±51.8)ng/mL,革兰阳性菌血流感染组中的PCT和HBP平均水平是6.2(4.5~7.8)ng/mL和(168.1±79.2)ng/mL.PCT和HBP对诊断血流感染的敏感性分别为91.2%、73.7%,特异性分别为94.0%、88.0%,曲线下面积(AUC)分别为0.983、0.880,SOFA评分19~24分和13~18分的患者PCT结果高于1~6分和7~12分的患者,但19~24分和13~18分的患者PCT结果差异无统计学意义(P>0.05);HBP结果随着评分升高血清水平也升高.结论 PCT比HBP在诊断血流感染方面具有优势,但HBP能更好地显示患者感染的严重程度.