【摘要】 目的探讨降钙素原（PCT）联合血常规检测在糖尿病酮症酸中毒（DKA）合并感染中的诊断价值。方法回顾性分析2014年3月-2016年3月收治住院的糖尿病患者350例,年龄18～80岁,随机选取同期体检的健康者70例作为对照组。研究对象根据DKA诊断指标纳入,并明确患者有无感染。依据入院时的情况将患者分为对照组、糖尿病组、单纯感染组、糖尿病合并感染组、DKA组、DKA合并感染组,各组患者均测定PCT、血常规和C-反应蛋白（CRP）;比较6组患者血清PCT值、白细胞计数、中性粒细胞百分比和CRP水平的差异,采用ROC曲线评估上述检测指标在诊断糖尿病酮症酸中毒合并感染中的灵敏度、特异度及Youden指数。结果 （1）上述6组检测指标均值:白细胞计数分别为（6.86±0.72）×10⁹,（7.38±1.05）×10⁹,（10.63±2.24）×10⁹,（11.32±4.69）×10⁹,（7.73±1.10）×10⁹及（11.89±4.79）×10⁹ L^-1;中性粒细胞百分比分别为（57.23±7.14）%,（58.99±7.67）%,（79.69±10.91）%,（77.51±11.84）%,（67.21±6.52）%及（73.97±10.24）%;CRP分别为（2.34±1.18）,（3.42±1.92）,（79.21±35.10）,（84.90±50.27）,（9.41±6.44）及（96.18±65.58）mg/L;PCT分别为（0.015±0.007）,（0.021±0.009）,（5.830±3.243）,（6.630±4.860）,（0.036±0.016）及（7.159±4.511）ng/L;（2）诊断试验检测:在DKA合并感染的患者中,白细胞计数、中性粒细胞百分比、CRP、PCT、PCT联合血常规检测的Youden指数分别为0.586,0.471,0.543,0.829及0.686。结论 PCT检测可提高DKA患者是否存在感染的诊断准确度,有利于指导临床尽早合理使用抗生素;PCT联合血常规检测可提高诊断的特异度,并可判断抗感染治疗的有效率。更多还原

【Abstract】 Objective To explore the procalcitonin and routine blood test in the patients diagnosed with diabetic ketoacidosis and infection. Methods Retrospective analysis of 350 patients diagnosed with diabetes during March 2014 to March 2016 from our hospital, age 18 to 80 years old. 70 healthy individuals who had physical examination in our hospital were selected as control group. The subjects were included according to DKA diagnostic indicators, and confirmed whether the patients were infected or not. The patients were chosen according to inclusion criteria, and divided into control group, diabetes group, simple infection group, diabetes + infection group, diabetic ketoacidosis group, and diabetic ketoacidosis + infection group. All groups underwent tests of PCT, routine blood, and CRP. Finally, the mean differences between 6 groups including serum PCT, leukocyte counting, percentage of neutrophil and CRP measurements were analyzed. We used the curve of ROC to analyze the sensitivity, specificity and Youden index in the patients diagnosed with diabetic ketoacidosis and infection. Results（1） Each group values mean comparison: 1) The average white blood cell count of each group was as follows:（6.86±0.72）×10⁹,（7.38±1.05）×10⁹,（10.63±2.24）×10⁹,（11.32±4.69）×10⁹,（7.73±1.10）×10⁹,（11.89±4.79）×10⁹ L^-1. The neutrophil percentage average of each group was as follows:（57.23±7.14）%,（58.99±7.67）%,（79.69±10.91）%,（77.51±11.84）%,（67.21 6.52）%,（73.97±10.24）%. The C-reactive protein average value of each group was as follows:（2.34±1.18）,（3.42±1.92）,（79.21±35.10）,（84.90±50.27）,（9.41±6.44）,（96.18±65.58） mg/L. The PCT average value of each group was as follows:（0.015±0.007）,（0.021±0.009）,（5.83±3.243）,（6.63±4.860）,（0.036±0.016）,（7.159±4.511） ng/L.（2） Diagnostic test: In the diagnostic test for patients with DKA combined infection, the Youden index of white blood cell count, neutrophil percentage, CRP, PCT, and PCT combined with routine blood test were 0.586, 0.471, 0.543, 0.829 and 0.686. Conclusions The application of PCT in clinical practice can improve the diagnosis accuracy of infection in DKA patients and help guide the rational use of antibiotics as soon as possible. In the diagnostic experiment of PCT combined with blood routine, it was found that combined detection could improve specificity and judge the efficacy rate of anti-infection clinical treatment.更多还原