【摘要】 目的探讨降钙素原(PCT)对骨髓移植后菌血症早期诊断的价值。方法选取2016年7月—2017年3月在北京大学人民医院血液科收治的骨髓移植后菌血症的病人143例,根据血培养结果分为革兰阴性菌菌血症组(A组)、革兰阳性菌菌血症组(B组)及真菌菌血症组(C组)。分别采用电化学发光法、免疫比浊法检测病人血清中PCT、C反应蛋白(CRP)及D-二聚体(D-Dimer)的水平。建立受试者工作特征曲线,计算受试者工作曲线下面积(AUC),并分析PCT、CRP及D-Dimer对3种不同类型菌血症的诊断价值。结果 A、B、C组病人血清中PCT值中位数(四分位数间距)分别为2.60(10.07)、0.31(0.60)及0.23(0.67)μg/L,3组比较差异具有统计学意义(χ~2=27.44,P<0.05);PCT鉴别革兰阴性菌与革兰阳性菌感染的AUC为0.778,诊断阈值为3.61μg/L,灵敏度为59%,特异度为90%。结论 PCT能够快速初步辅助诊断骨髓移植后病人菌血症的感染类型,可为临床医生合理有效应用抗菌药物提供依据。更多还原

【Abstract】 Objective To investigate the value of procalcitonin(PCT)in the early diagnosis of bacteremia after bone marrow transplantation. Methods A total of 143 patients with bacteremia after bone marrow transplantation who were admitted to Department of Hematology in People’s Hospital,Peking University,from June 2016 to March 2018 were enrolled.According to the results of blood culture,they were divided into Gram-negative bacteremia group(group A),Gram-positive bacteremia group(group B),and fungal bacteremia group(group C).Electrochemical luminescence and immunoturbidimetric assay were used to measure the serum levels of PCT,C-reactive protein(CRP),and D-dimer.The receiver operating characteristic(ROC)curve was plotted,the area under the ROC curve(AUC)was calculated,and the value of PCT,CRP,D-dimer in the diagnosis of different types of bacteremia was analyzed. Results The median(inter-quartile range)PCT was 2.60(10.07)μg/L in group A,0.31(0.60)μg/L in group B,and 0.23(0.67)μg/L in group C,and there was a significant difference between groups(χ~2=27.44,P<0.05).PCT had a testing threshold of 3.61μg/L,an AUC of 0.778,a sensitivity of 59%,and a specificity of 90% in the differential diagnosis of Gram-negative and Gram-positive bacteremia. Conclusion PCT can help to determine the type of bacteremia early after bone marrow transplantation and thus provides a basis for rational use of antimicrobial agents among clinicians.更多还原