摘要
目的探索降钙素原（PCT）在长期接受免疫抑制治疗的重症患者感染诊断中的价值。方法前瞻性研究，连续纳入2008年1月至2009年12月北京协和医院ICU中伴有长期应用糖皮质激素或免疫抑制剂的基础疾病患者，怀疑感染时测定血PCT。结果入选103例，年龄（47．9±21．9）岁，其中女性65例。感染组84例，非感染组19例。感染组PCT高于非感染组[2．58（0．08-44．65）pg／L比0．62（0．15-6．00）pg／L，P=0．002]；不同病原菌感染的患者，其PCT水平依次为细菌3．41（0．45-44．65）pg／L、真菌0．99（0．28-6．67）pg／L、病毒0．11（0．08-0．20）pg,／L（P=0．018）；PCT诊断细菌感染的AUCRoc为0．867（P=0．000）。PCT水平与年龄、肾功能、感染部位及预后无关（P〉0．05），而与细菌感染（OR=5．1，P=0．031）及感染性休克（OR：7．5，P=0．027）独立相关。结论免疫抑制治疗不影响PCT释放，PCT水平检测在该人群感染，特别是细菌感染诊断中发挥重要作用。
Objective To assess the value of procalcitonin （PCT） measurement to difierentiate infection from non-infection in critically ill patients requiring long-term immunosuppressive therapy. Methods A prospective study was conducted in patients with underlying diseases requiring corticosteroids or chemotherapy in ICU from January 2008 to December 2009. Patients were divided into the infection group and the non-infection group and their PCT levels were compared. Results A total of 103 patients （65 women） were enrolled in this prospective study [ aged （47.9 ± 21.9） years old] with 84 in the infection group and 19 in the non-infection group. The baseline level of PCT was significantly higher in infection than in non-infection patients [ 2. 58 （0. 08-44. 65 ） pg/L vs 0. 62 （0. 15-6. 00 ） pg/L, P = 0. 002 ]. Different levels of PCT were manifested in different pathogen groups with 3.41 （ 0. 45-44. 65 ） pg/L in bacteria infection, 0. 99（0. 28-6. 67） pg/L in fungus infection, 0. 11 （0. 08-0. 20） pg/L in virus infection group （P = 0.018）. The AUCRoc of PCT was 0. 867 for diagnostic bacterial infection. By multivariate analysis, the factors associated with the level of PCT were bacteria infection （ OR 5.1, P = 0. 031 ） and septic shock （ OR 7.5, P = 0. 027）, while the factors not associated with the level of PCT were age, renal function, infection site and prognosis （ P 〉 0. 05 ）. Conclusions The level of PCT is increased in the critically ill patients requiring immunosuppressive therapy with infection and it can be used for diagnosis for bacterial infection.
出处
《中华内科杂志》
CAS
CSCD
北大核心
2012年第3期192-196,共5页
Chinese Journal of Internal Medicine
关键词
感染
降钙素原
重症患者
免疫抑制治疗
Infection
Procalcitonin
Critically ill patients
Immunosuppressive therapy
