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1、PCT和CRP在败血症、SIRS和系统性念珠菌感染中的诊断作用ProcalcitoninandC-reactiveproteininthediagnosisofbacterialsepsis,SIRSandsystemiccandidiasis目的评价PCT、C反应蛋白(C-reactiveprotein,CRP)、血小板(PLT)和乳酸脱氢酶(LDH)对ICU患者败血症、SIRS和系统性念珠菌感染的早期诊断意义。方法选择我院150例ICU患者,根据血培养结果,将其分成三组,其中败血症73人,SIRS44人,系统性念珠菌感染33人,在其败血症发作时第0天和第2天采集血液检测PC
2、T、CRP、LDH和PLT,收集数据然后进行统计学分析。结果革兰阴性细菌性感染中PCT明显高于革兰阳性菌感染,但无显著性差异(P=0.095)。细菌性败血症组PCT、CRP、PLT和LDH明显高于系统性念珠菌感染组。PCT的AUC(AUC:0.892,P<0.001)高于CRP(AUC:0.738,P<0.001)。PCT和CRP的cutoff值分别为0.99ng/mL和76.2mg/L。PCT的灵敏度和特异性分别为84.3%和81.8%,而CRP灵敏度和特异性分别为77.2%和63.6%。然而PCT不足以区别SIRS和系统性念珠菌感染(P=0.093).结论PCT可作为系统性
3、念珠菌感染的早期诊断指标,但当其<0.99ng/mL时不能区别念珠菌感染和SIRS,需结合其他真菌感染指标来诊断系统性念珠菌感染。关键词:PCT,败血症,系统性念珠菌感染,LDHAbstractObjectiveToevaluateprocalcitonin(PCT),C-reactiveprotein(CRP),plateletcount(PLT)andserumlactatedehydrogenase(LDH)asearlymarkersfordiagnosisofSIRS,bacterialsepsisandsystemiccandidiasisinintensiveca
4、reunit(ICU)patients.MethodsBasedonbloodcultureresults,thepatientsweredividedintoasepsisgroup(73patients),aSIRSgroup(44patients)andasystemiccandidiasisgroup(33patients).PCT,CRP,LDHandPLTlevelsweremeasuredonday0andonday2fromthesepsissymptomonset.Thedatawerecollectedandanalyzedstatistically.Res
5、ultsPCTlevelswerehigherinGramnegativesepsisthanthoseinGrampositivesepsis,althoughtheP-valuebetweenthetwosubgroupsisnotsignificant(P=0.095).BacterialsepsisgrouphadhigherPCT,CRP,PLTandLDHlevelscomparedwiththesystemiccandidiasisgroup.TheAUCforPCT(AUC:0.892,P<0.001)waslargerthanforCRP(AUC:0.738,
6、P<0.001).ThebestcutoffvaluesforPCTandCRPwere0.99ng/mLand76.2mg/L,respectively.DiagnosticsensitivityandspecificityforPCTwere84.3%and81.8%whereasCRPshowedasensitivityof77.2%andaspecificityof63.6%.However,PCTwasunabletodiscriminatebetweenSIRSandsystemiccandidiasisgroups(P=0.093).ConclusionsPCTc
7、anbeusedasapreliminarymarkerintheeventofclinicalsuspicionofsystemiccandidiasis;however,lowPCTlevels(<0.99ng/mL)necessarilyrequiretheuseofotherspecificmarkersofcandidaemiatoconfirmthediagnosis,duetogreatuniformityofPCTlevelsinsystemiccandidiasisandS