应用ROC曲线评价血清PCT、CRP对菌血症的诊断价值分析
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摘要
目的以ROC曲线评价血清PCT、CRP诊断菌血症的临床价值。方法采用回顾性研究选取医院2016年1月-2017年12月临床诊断为菌血症患者48例,设为菌血症组,选择同期健康体检人员53例,设为对照组,分别检测两组研究对象血清PCT、CRP水平,制定ROC曲线。结果两组研究对象年龄、性别均衡可比,菌血症组患者血清PCT、CRP高于健康体检人群(Z=-5.442、-3.329,P<0.05)。血清PCT检测菌血症ROC曲线面积为0.813,血清CRP检测菌血症ROC曲线面积为0.692,血清PCT、CRP联合试验检测菌血症ROC曲线面积为0.825。血清PCT检测ROC曲线面积大于血清CRP检测结果(P=0.030),联合试验ROC曲线面积大于血清CRP检测结果(P=0.002),而与血清PCT检测结果差异无统计学意义。联合检测试验灵敏度为77.08%,特异度为81.13%,血清PCT诊断最佳临界值为0.17ng/ml,灵敏度为70.83%,特异度为81.13%,血清CRP诊断最佳临界值为40.3mg/L,灵敏度为56.25%,特异度为75.47%。结论血清PCT在菌血症中的诊断价值优于血清CRP,且与联合试验诊断效能差别不大。
OBJECTIVE To evaluate clinical values of serum PCT and CRP with ROC curve for diagnosis of bacteremia.METHODS A total of 48 patients with bacteremia were selected as bacteremia group and 53 healthy subjects were recruited as control group from Jan.2016 to Dec.2017 for retrospective analysis.The levels of serum PCT and CRP in the two groups were respectively detected and the ROC curves were drawn.RESULTS There was no difference in age and gender sbetween the two groups.Levels of serum PCT and CRP in patients with bacteremia were significantly higher than those in healthy subjects(Z=-5.442,-3.329,P<0.05).The ROC curve area of serum PCT was 0.813 for diagnosis of bacteremia,the ROC curve area of serum CRP was 0.692 for diagnosis of bacteremia,and the ROC curve area of combination of serum PCT and CRP was 0.825 for diagnosis of bacteremia.The area of ROC curve of serum PCT was significantly larger than that of serum CRP(P=0.030),the area of ROC curve of combination test was significantly larger than that of serum CRP(P=0.002),but there was no significant difference with serum PCT.The sensitivity and specificity of combination test were 77.08% and 81.13%.The best threshold value of diagnosis of serum PCT was 0.17 ng/ml,and the sensitivity and specificity were70.83% and 81.13%.The best threshold value of diagnosis of serum CRP was 40.3 mg/L,and the sensitivity and specificity were 56.25% and 75.47%.CONCLUSION The diagnostic value of serum PCT in bacteremia is better than that of serum CRP,and there was no significant difference with combination test.
OBJECTIVE To evaluate clinical values of serum PCT and CRP with ROC curve for diagnosis of bacteremia.METHODS A total of 48 patients with bacteremia were selected as bacteremia group and 53 healthy subjects were recruited as control group from Jan.2016 to Dec.2017 for retrospective analysis.The levels of serum PCT and CRP in the two groups were respectively detected and the ROC curves were drawn.RESULTS There was no difference in age and gender sbetween the two groups.Levels of serum PCT and CRP in patients with bacteremia were significantly higher than those in healthy subjects(Z=-5.442,-3.329,P<0.05).The ROC curve area of serum PCT was 0.813 for diagnosis of bacteremia,the ROC curve area of serum CRP was 0.692 for diagnosis of bacteremia,and the ROC curve area of combination of serum PCT and CRP was 0.825 for diagnosis of bacteremia.The area of ROC curve of serum PCT was significantly larger than that of serum CRP(P=0.030),the area of ROC curve of combination test was significantly larger than that of serum CRP(P=0.002),but there was no significant difference with serum PCT.The sensitivity and specificity of combination test were 77.08% and 81.13%.The best threshold value of diagnosis of serum PCT was 0.17 ng/ml,and the sensitivity and specificity were70.83% and 81.13%.The best threshold value of diagnosis of serum CRP was 40.3 mg/L,and the sensitivity and specificity were 56.25% and 75.47%.CONCLUSION The diagnostic value of serum PCT in bacteremia is better than that of serum CRP,and there was no significant difference with combination test.
引文
[1]林锦喜,崔敏涛,孔燕南.血清降钙素原与血流感染患者的相关性研究[J].国际检验医学杂志,2015,36(1):112-113.
[2]Sancho S,Artero A,Zaragoza R,et al.Impact of nosocomial polymicrobial bloodstream infections on the outcome in critically ill patients[J].Eur J Clin Microbiol Infect Dis,2012,31(8):1791-1796.
[3]Hall KK,Lyman JA.Updated review of blood culture contamination[J].Clin Microbiol Rev,2006,19(4):788-802.
[4]王志文,刘占利,林争,等.脓毒症血流感染患儿血清C-反应蛋白、降钙素原水平变化及临床诊断分析[J].中华医院感染学杂志,2017,27(4):919-922.
[5]刘波,张苏明,李琳,等.降钙素原区分血流感染病原体的效果研究[J].中国医院感染学杂志,2017,27(8):1732-1735.
[6]呼新建,常晓悦.降钙素原的研究进展[J].医学综述,2010,16(12):1795-1797.
[7]侯伟伟,肖倩茹,江涟,等.血清降钙素原作为菌血症预示因子临床价值的研究[J].检验医学,2014,29(8):802-805.
[8]茅国峰,何秋丽,徐兵.降钙素原对急性发热患者菌血症的诊断价值研究[J].中国全科医学,2014,17(32):3823-3825.
[9]杜利国,杨志清,许喜喜.外周血不同感染性指标在血流感染早期诊断价值的研究[J].中华临床感染病杂志,2017,10(3):194-198.
[10]Lichtenstern C,Brenner T,Bardenheuer HJ,et al.Predictors of survival in sepsis:what is the best inflammatory marker to measure[J].Curr Opin Infect Dis,2012,25(3):328-336.
[11]邢正皓.PCT、CRP、WBC联合试验在儿科感染性疾病早期诊断中的临床意义[J].临床输血与检验,2015,17(6):509-511.
[12]丁爽,闫玲,李若倩,等.PCT和CRP对菌血症的诊断价值比较[J].国际检验医学杂志,2014,35(7):892-893.
[13]Ma S,Duan J,Li W,et al.Exploration of the value of MRCP combined with tumor marker CA 19-9in the diagnosis of pancreatic cancer[J].Artif Cells Nanomed Biotechnol,2016,44(2):717-721.
[14]Kruse JM,Enghard P,Schroder T,et al.Weak diagnositic performance of troponin,creatine kinase and creatine kinaseMB to diagnose or exclude myocardial infarction after successful resuscitation[J].Int J Cardiol,2014,173(2):216-221.
[2]Sancho S,Artero A,Zaragoza R,et al.Impact of nosocomial polymicrobial bloodstream infections on the outcome in critically ill patients[J].Eur J Clin Microbiol Infect Dis,2012,31(8):1791-1796.
[3]Hall KK,Lyman JA.Updated review of blood culture contamination[J].Clin Microbiol Rev,2006,19(4):788-802.
[4]王志文,刘占利,林争,等.脓毒症血流感染患儿血清C-反应蛋白、降钙素原水平变化及临床诊断分析[J].中华医院感染学杂志,2017,27(4):919-922.
[5]刘波,张苏明,李琳,等.降钙素原区分血流感染病原体的效果研究[J].中国医院感染学杂志,2017,27(8):1732-1735.
[6]呼新建,常晓悦.降钙素原的研究进展[J].医学综述,2010,16(12):1795-1797.
[7]侯伟伟,肖倩茹,江涟,等.血清降钙素原作为菌血症预示因子临床价值的研究[J].检验医学,2014,29(8):802-805.
[8]茅国峰,何秋丽,徐兵.降钙素原对急性发热患者菌血症的诊断价值研究[J].中国全科医学,2014,17(32):3823-3825.
[9]杜利国,杨志清,许喜喜.外周血不同感染性指标在血流感染早期诊断价值的研究[J].中华临床感染病杂志,2017,10(3):194-198.
[10]Lichtenstern C,Brenner T,Bardenheuer HJ,et al.Predictors of survival in sepsis:what is the best inflammatory marker to measure[J].Curr Opin Infect Dis,2012,25(3):328-336.
[11]邢正皓.PCT、CRP、WBC联合试验在儿科感染性疾病早期诊断中的临床意义[J].临床输血与检验,2015,17(6):509-511.
[12]丁爽,闫玲,李若倩,等.PCT和CRP对菌血症的诊断价值比较[J].国际检验医学杂志,2014,35(7):892-893.
[13]Ma S,Duan J,Li W,et al.Exploration of the value of MRCP combined with tumor marker CA 19-9in the diagnosis of pancreatic cancer[J].Artif Cells Nanomed Biotechnol,2016,44(2):717-721.
[14]Kruse JM,Enghard P,Schroder T,et al.Weak diagnositic performance of troponin,creatine kinase and creatine kinaseMB to diagnose or exclude myocardial infarction after successful resuscitation[J].Int J Cardiol,2014,173(2):216-221.