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目的：探究血清降钙素原（PCT）、C 反应蛋白（CRP）及内毒素在革兰阳性(G+)杆菌与革兰阴性(G-)球菌血流感染所致脓毒症患者中的早期诊断价值。方法：回顾性分析2010 年5 月~2015 年5月期间我院收治确诊的细菌性血流感染所致脓毒症患者123 例，测定其血清PCT、CRP及内毒素水平，通过受试者工作特征曲线（ROC）曲线探究三者对细菌性血流感染所致脓毒症的评估价值。结果：血样培养结果显示，35例患者感染G+ 菌，88 例患者感染G-菌；G-菌组患者血清PCT、CRP 及内毒素水平均显著高于 G+菌组（P<0.05）；且G+ 菌组、G- 菌组及所有细菌组患者血清PCT、CRP、内毒素间均呈正相关关系（P<0.05）；ROC曲线显示，血清PCT、CRP 和内毒素诊断G+菌血流感染所致脓毒症患者的截断值分别为1.58 ug/L、95.25 mg/L与16.71ng/L，其灵敏度和特异度别为（65.92%，88.37%）、（67.39%，84.38%）与（56.34%，78.93%），诊断G- 菌血流感染所致脓毒症患者的截断值分别为2.45 滋g/L、79.45 mg/L 与15.54 ng/L，其灵敏度和特异度别为（78.73%，97.13%）、（68.89%，92.38%）与（65.39%，95.33%）。结论：检测血清 PCT、CRP、内毒素水平有利于鉴别G- 菌和G+ 菌血流感染所致脓毒症患者，且敏感度、特异度均较高，可用于早期诊断细菌性血流感染所致脓毒症。

英文摘要:

Objective:To explore the early diagnostic value of serumprocalcitonin(PCT),C reactive protein(CRP)and endotoxin in patients with sepsis induced by gram positive (G+)and gram negative (G-)bacteria bloodstream infection.Methods:Retrospectively analyzed 123 cases of patients diagnosed with sepsis induced by bacterial bloodstream infection in our hospital from May 2010 to May 2015, detected their serum PCT, CRP and endotoxin levels, and analyzed the evaluation value of these three indexes for sepsis induced by bacterial bloodstream infection by receiver-operating characteristic curve (ROC).Results:Bacterial etiology training results showed that 35 patients infected with G+ bacteria and 88 patients infected with G- bacteria;The serum PCT, CRP and endotoxin levels in Ggroup were significant higher than G+group (P<0.05); The serum PCT,CRP and endotoxin levels was positive correlated with each other among G+ group, G- group and all bacteria group; ROC curves showed that the cutoff value of serum PCT, CRP and endotoxin for diagnosis of patients with sepsis induced by G+ bacteria bloodstream infection were 1.58 ug/L, 95.25 mg/L and 16.71 ng/L, and their sensitivity and specificity were (65.92%, 88.37%), (67.39%, 84.38%) and (56.34%,78.93%) respectively; and the cutoff value for diagnosis of patients with sepsis induced by G- bacteria bloodstream infection were 2.45 ug/L, 79.45 mg/L and 15.54 ng/L, their sensitivity and specificity were(78.73%,97.13%), (68.89%, 92.38%) and (65.39%,95.33%) respectively.Conclusion:Detecting the serum PCT, CRP and endotoxin levels is helpful to identify patients with sepsis induced by G+ or G- bacteria bloodstream infection, with high sensitivity and specificity, which can be used in the early diagnosis of sepsis induced by bacterial bloodstreaminfection.

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