摘要
目的完全随机评价降钙素原(PCT)与(1,3)-β-D葡聚糖(G试验)单独以及联合的情况下诊断肺部感染的实际价值。方法收集2013年1月24日-2014年1月25日1 027例拟诊下呼吸道感染患者;统计痰培养阳性分离菌分布组成;分别以痰涂片及培养和胸部CT为参照对比研究PCT和G试验的诊断价值;观察特定条件下PCT分布;研究以痰培养与CT诊断为参照时G试验值分布;痰培养与血培养结果相同的单独讨论;最后,分别评价PCT与G试验阈值上下4种组合情况下,G试验与PCT联合应用对肺部曲霉菌及细菌感染的检出能力。结果病原菌分离以烟曲霉菌、多重耐药菌、结核分枝杆菌为主;在疾病时,PCT为一偏态分布,中位数为2.06 ng/m L。PCT单独与联合痰培养具有相似分布;以痰培养作为参照时PCT特异度为66.4%,灵敏度为41.2%;在痰培养与CT均诊断为肺曲霉菌感染的病例中,G试验中位数与均数均小于临界值;以痰培养为参照,G试验特异度为84.1%,灵敏度为13.2%;在痰培养与G试验均阳性病例中,G试验中位数为112.91 pg/m L;以CT为参照,G试验特异度为75.0%,灵敏度为21.4%;痰培养与血培养结果相同病例中,PCT的中位数为7.51 pg/m L,3例PCT低于阈值;3例G试验假阳性。在PCT与G试验联合诊断评价中,认为同时阳性不能确认,同时阴性不能排除肺部感染。结论对于PCT与G试验测定应该谨慎对待,合理分析,综合评价后有选择性地参考。
Objective To assess the diagnostic value ofprocalcitonin （PCT） and/or （1,3）-β-D-glucan test （serum BG assay） for pulmonary infection. Methods We collected 1 027 cases randomly from January 24th, 2013 to January 25th, 2014. First, we accumulated isolates from these cases in sputum culture. Second, we compared PCT and sputum culture, serum BG assay and sputum culture, CT and serum BG assay. Then we accumulated these PCT and studied its distribution when PCT 〉 0.5 ng/mL and when their sputum culture was positive. We also accumulated these serum BG assay results and studied its distribution when their sputum culture was positive for aspergillus or suggested aspergillus infection by CT. Finally, we estimated the significance of the combined use of PCT and serum BG assay for diagnosis of pulmonary infection. Results In these cases, pathogens were mainly multiple drug-resistant organisms and tuberculosis, or fungi. We found that PCT value presented a skew distribution in disease with a median of 2.06 ng/mL. Single PCT or combination of PCT and sputum culture had similar distribution. With sputum culture as the reference, PCT sensitivity was 41.2% and specificity was 66.4%. In the cases of sputum culture aspergillus and CT suggestion of aspergiUus infection, serum BG assay value distribution was similar, and the median and average were both lower than cut-off. With sputum culture as the reference, serum BG assay sensitivity was 13.2% and specificity was 84.1%. In the 12 cases with positive sputum culture and serum BG assay, serum BG assay median was 112.91 pg/mL. With CT as the reference, serum BG assay sensitivity was 21.4% and specificity was 75.0%. In the 17 cases with the same sputum and blood culture result with the PCT median of 7.51 pg/mL, there were three cases whose PCT value was under the cutoff and three cases whose serum BG assay value was above the cutoff. In evaluation of the combination of PCT and serum BG assay, the analysis had yielded that we could neither diagnose pulmonary infection with both being positive, nor exclude the disease with both being negative. Conclusion With regard to PCT and serum BG assay, we should be prudent and wise and use it after reasonable evaluation and entire analysis.
出处
《华西医学》
CAS
2015年第2期222-226,共5页
West China Medical Journal
基金
四川省卫生厅科研课题(110048)~~
