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題名 | 前降鈣素原與發炎指標對菌血症預測準確度之比較=Comparison between Procalcitonin and Inflammation Markers during Bacteremia |
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作者 | 廖有霜; 邱亦文; 張惠芳; 張寶琪; 焦錫孝; 魯子全; | 書刊名 | 北市醫學雜誌 |
卷期 | 8:4 2011.12[民100.12] |
頁次 | 頁300-310 |
分類號 | 415.27 |
關鍵詞 | 前降鈣素原; C-反應蛋白; 白血球數目; 血液培養; Procalcitonin; C-reactive protein; Leukocyte count; Blood culture; |
語文 | 中文(Chinese) |
中文摘要 | 比較前降鈣素原(procalcitonin, PCT)、C-反應蛋白(C-reactive protein, CRP)、白血球數目(leukocyte count, WBC)在預測細菌感染之能力,並分析菌種與PCT濃度之間的關係。方法:分別偵測48支血液培養陽性與49支血液培養陰性的檢體之血液PCT、WBC和CRP 濃度,以其血液培養結果作為標準進行統計分析。結果:若以PCT = 0.5ng/ml 作為臨界值時,PCT的專一性(88%)、準確性(67%)和陽性預測值(79%)比CRP的和WBC的好。分析CRP、WBC和PCT等檢測結果都為陽性時,有83.3%的機率血液培養結果為陽性。血液培養結果陰性中有87.8%檢體的PCT小於0.5 ng/ml。菌種與PCT濃度的相關性,在PCT小於0.5、0.5~10和大於10 ng/mL的組別中,分別是coagulase (-) Staphylococcus、Candida和Escherichia coli最為常見。結論:PCT在專一度、準確度和陽性預測值比CRP和WBC高,在早期偵測細菌感染有其效益,有效的提高治療的成效並降低不必要的抗生素使用成本。 |
英文摘要 | Recent studies have shown that systemic bacterial, fungal and parasitic infections, result in a significant increase in serum procalcitonin (PCT). Monitoring PCT levels is most helpfully when investigating systemic microbial infection because the results provide support at the levels of diagnosis, prognosis and antibiotic treatment. Methods: In order to compare PCT level, C-reactive protein (CRP) level and leukocyte count (WBC) as means of predicting the presence of microbial infection, blood specimens were used to measure PCT, WBC and CRP levels in 48 positive blood culture samples and 49 negative blood culture samples. Results: Using a PCT cut-off value of 0.5 ng/ml, a specificity of 88%, an accuracy of 67%, and positive predictive value of 79% were obtained, which is better than when CRP or WBC are used. When all three test results, PCT, CRP and WBC, were positive, then 83.3% of the blood culture results were positive. In the blood culture negative group, 87.8% of the samples had a PCT level that was less than 0.5 ng/ml, which indicates that when the concentration of PCT is <0.5 ng/mL, microbial infection is much less likely. Among the PCT <0.5 ng/mL subgroup, coagulase (-) Staphylococcus spp. were the largest group of microorganisms (26%). In the subgroup with PCT levels between 0.5~10 ng/mL group, Candida spp. were the most common microorganism isolated. In the subgroup with PCT levels >10 ng/mL, the most commonly found microorganism was Escherichia coli. Conclusions: The specificity, accuracy and positive predictive value of PCT were better than when CRP and WBC were used to diagnose microbial infection. Measuring PCT levels not only help rule out the contamination of the blood culture, but also help doctors to obtain an early diagnosis, to instigate early treatment and to improve treatment effectiveness, all of which, in turn, reduce unnecessary antibiotic use and help to limit medical costs. |
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