上海交通大学学报（医学版）

上海交通大学学报（医学版）

• 论著（临床研究） • 上一篇    下一篇

降钙素原和白介素6对危重患者导管相关性血行感染的早期诊断及预后价值

隋明亮，吴长江，黄超发，朱团结   

  1. 上海交通大学  医学院苏州九龙医院重症医学科， 苏州 215028
  • 出版日期:2013-11-28 发布日期:2013-12-03
  • 作者简介:隋明亮（1981—）， 男， 主治医师， 学士; 电子信箱: mingliangs@sina.com。

Early diagnostic and prognostic value of procalcitonin and interleukin 6 for catheter-related bloodstream infections in critically ill patients

SUI Ming-liang, WU Chang-jiang, HUANG Chao-fa, ZHU Tuan-jie   

  1. Department of Critical Care Medicine, Suzhou Kowloon Hospital, Shanghai Jiaotong University School of Medicine, Suzhou 215028, China
  • Online:2013-11-28 Published:2013-12-03

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摘要：

目的 探讨降钙素原（PCT）、白介素6（IL-6）和PCT动态变化对危重病患者中心静脉导管相关性血行感染（CRBSI）的早期诊断及预后价值。方法 对苏州九龙医院收治的36例中心静脉导管置管后怀疑CRBSI的危重病患者进行前瞻性研究。入组当天采集血样分析PCT、IL-6水平，同时留取血培养和导管标本，并于感染后第1、2、3、7天对患者行PCT监测。将患者分为CRBSI组与非CRBSI组，其中CRBSI组再分为感染控制组和感染未控制组，观察PCT动态变化与预后的关系。结果 共有15例患者（41.67%）符合CRBIS诊断标准。在怀疑感染当天，CRBIS组的PCT和IL-6水平均明显高于非CRBIS组，差异有统计学意义（P<0.001和P<0.005）。ROC曲线分析显示：PCT和IL-6曲线下面积分别为0.832和0.78，理想的阳性和阴性预测CRBIS水平为4.3 μg/L和464.5 ng/L，该临界值的敏感度为80.0%和77.3%，特异度为95.2%和66.7%，阳性预测值为92.25%和61.12%，阴性预测值为86.95%和77.76%。在感染后第1、2、3、7天，感染控制组的PCT水平呈逐渐下降趋势，但感染未控制组仍保持在较高水平。结论 PCT和IL-6在早期诊断CRBSI中具有较高的特异性和阴性预测值，PCT的动态变化对病情预后有一定的预测价值。

关键词: 危重病, 导管插入术, 中心静脉, 导管相关性血行感染, 降钙素原, 白介素6

Abstract:

Objective To evaluate the early diagnostic and prognosis value of procalcitonin  (PCT), interleukin 6 (IL-6), and PCT kinetics for central venous catheter related bloodstream infections (CRBSI) in selected critically ill patients. Methods Thirty-six patients received central venous catheter, who were suspected of having CRBSI. All the patient blood samples were obtained for detection of PCT, IL-6 levels, and for blood culture on the first day, and catheter were also obtained for culture. PCT levels were measured on day 1, 2, 3, and 7 after infection. The patients were divided into CRBSI group and non-CRBSI group. The CRBSI group was divided into controlled infection group and non-controlled infection group, and PCT kinetics for prognostic value was observed. Results Fifteen patients were diagnosed as CRBIS (41.67%). Levels of PCT and IL-6 were significantly higher in patients with CRBIS than those without CRBIS on the first infection day (P＜0.001 and P＜0.005). The ROC curves indicated that the area under the curve (AUC) for PCT and IL-6 was 0.832 and 0.78, respectively. The cutoff points of PCT and IL-6 were set to be 4.3 μg/L and 464.5 ng/L for patients with proven CRBSI, respectively. The corresponding sensitivity, specificity, positive predictive value, and negative predictive value were 80.0% and 77.3%, 95.2% and 66.7%, 92.25% and 61.12%, and 86.95% and 77.76%, respectively. PCT serum levels tended to decrease in patients with controlled CRBSI, whereas in non-controlled patients was proven to remain stably in high level. Conclusion PCT and IL-6 might be valuable early diagnostic parameters for CRBIS with high specificity and negative predictive value, and PCT kinetics has certain predictive value for the prognosis of CRBSI.

Key words: critical illness, catheterization, central venous, catheter-related bloodstream infection, procalcitonin, interleukin 6