血清降钙素原在诊断慢性肾脏病合并细菌感染中的临床价值-东南大学学报医学版

血清降钙素原在诊断慢性肾脏病合并细菌感染中的临床价值

单位：1. 南京医科大学鼓楼临床医学院肾内科, 江苏南京 210008;
2. 南京大学医学院附属鼓楼医院肾内科, 江苏南京 210008

分类号：R692

出版年·卷·期（页码）：2016·35·第四期（550-554）

摘要：

目的：探讨血清降钙素原（PCT）在慢性肾脏病（CKD）合并细菌感染中的诊断价值。方法：将在南京大学医学院附属鼓楼医院肾内科住院的153例CKD患者，分为细菌感染组70例与非感染组83例，了解肾功能对PCT水平的影响，并比较组间PCT、C反应蛋白水平的差异，分析它们对细菌感染诊断的特异度和灵敏度。结果：非感染组中，非透析患者血清PCT水平与肾功能呈负相关关系。血液透析（HD）患者的PCT水平显著高于任何一期CKD及腹膜透析（PD）患者（P<0.05）。细菌感染组的PCT水平显著高于非感染组（P<0.05）。ROC曲线分析表明PCT较CRP有着较好的诊断特异性。结论：显著升高的血清PCT水平可作为临床CKD患者诊断细菌感染的有用指标。

Objective:To investigate the significance of serum procalcitonin(PCT) in the diagnosis of bacterial infection in patients with chronic kidney disease(CKD). Methods:A total of 153 patients with CKD treated in Drum Tower Hospital Affiliated to Medical College of Nanjing University were involved in this study. They were divided into bacterial infection group(70 patients) and non-infection group(83 patients). The influence of renal function on the level of PCT was investigated, and the levels of PCT and C-reactive protein between the two groups were compared. The specificity and sensitivity of these parameters in the diagnosis of bacterial infection were analyzed. Results:In the non-infection group, PCT was negatively correlated with renal function evaluated by estimated glomerular filtration rate. Hemodialysis patients had a significantly higher level of PCT than non-dialysis patients and peritoneal dialysis patients(P<0.05).The PCT levels in bacterial infection group were significantly higher than those in the non-infection group(P<0.05). ROC analysis showed that PCT had a better diagnostic specificity than CRP. Conclusion:Our research revealed that significantly elevated serum PCT can be used as a valuable marker for the diagnosis of bacterial infection in patients with CKD.

参考文献：

[1] ASSICOT M,GENDREL D,CARSIN H,et al.High serum procalcitonin concentrations in patients with sepsis and infection[J].Lancet,1993,341(8844):515-518.
[2] HERGET-ROSENTHAL S,KLEIN T,MARGGRAF G,et al.Modulation and source of procalcitonin in reduced renal function and renal replacement therapy[J].Scand J Immunol,2005,61(2):180-186.
[3] LEVEY A S,CORESH J,BALK E,et al.National Kidney Foundation practice guidelines for chronic kidney disease:evaluation,classification,and stratification[J].Ann Intern Med,2003,139(2):137-147.
[4] National Kidney Foundation.K/DOQI clinical practice guidelines for chronic kidney disease:evaluation,classification,and stratification[J].Am J Kidney Dis,2002,39(2 Suppl 1):S1-266.
[5] 中华医学会呼吸病学分会.社区获得性肺炎诊断和治疗指南[J].中华结核和呼吸杂志,2006,29(10):651-655.
[6] 葛均波,徐永健.内科学[M].8版.北京:人民卫生出版社,2008:41-45,496-502.
[7] 《维持性腹膜透析》专家协作组.维持性腹膜透析共识[J].中华肾脏病杂志,2006,22(8):513-516.
[8] 中华医学会重症医学分会.血管内导管相关感染的预防与治疗指南(2007)[J].中国实用外科杂志,2008,28(6):413-421.
[9] 王卫明,单其俊,曹克将.C反应蛋白的研究进展[J].心血管病学进展,2005,26(1):73-75.
[10] PANICHI V,MIGLIORI M,de PIETRO S,et al.C-reactive protein as a marker of chronic inflammation in uremic patients[J].Blood Purif,2000,18(3):183-190.
[11] ORTEGA O,RODEIGUEZ I,GALLAR P,et al.Significance of high C-reactive protein levels in pre-dialysis patients[J].Nephrol Dial Transplant,2002,17(6):1105-1109.
[12] 王涵,俞雨生.微炎症状态与腹膜透析[J].肾脏病与透析肾移植杂志,2012,21(2):183-189.
[13] GILBERT D N.Use of plasma procalcitonin levels as an adjunct to clinical microbiology[J].J Clin Microbiol,2010,48(7):2325-2329.
[14] BECKER K L,SNIDER R,NYLEN E S.Procalcitonin assay in systemic inflammation,infection,and sepsis:clinical utility and limitations[J].Crit Care Med,2008,36(3):941-952.
[15] RAJKUMARI N,MATHUR P,SHARMA S,et al.Procalcitonin as a predictor of sepsis and outcome in severe trauma patients:a prospective study[J].J Lab Physician,2013,5(2):100-108.
[16] TIAN G,PAN S Y,MA G,et al.Serum levels of procalcitonin as a biomarker for differentiating between sepsis and systemic inflammatory response syndrome in the neurological intensive care unit[J].J Clin Neurosci,2014,21(7):1153-1158.
[17] 张声,张卫星,罗华,等.脓毒症患者血清降钙素原和C反应蛋白水平检测的临床价值[J].现代医学,2015,43(3):303-306.
[18] 张立,林勇.降钙素原在呼吸系统感染性疾病诊断及治疗中的应用[J].东南大学学报:医学版,2011,30(4):643-648.
[19] MEISNER M,LOHS T,HUETTEMANN E,et al.The plasma elimination rate and urinary secretion of procalcitonin in patients with normal and impaired renal function[J].Eur J Anaesthesiol,2001,18(2):79-87.
[20] GHORBANI G.Procalcitonin role in different diagnosis of infection stages and non infection inflammation[J].Pak J Biol Sci,2009,12(4):393-396.
[21] 钟驾云,周庭银.血流感染实验诊断的研究进展[J].检验医学,2012,27(8):692-696.

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