血清presepsin(sCD14-ST)、降钙素原、C反应蛋白和白介细胞素-6诊断血流细菌感染的诊断性能比较

doi:10.16150/j.1671-2870.2018.05.019

摘要/Abstract

摘要： 目的：探讨感染性标志物presepsin[可溶性CD14分子亚型（soluble CD14 molecular subtype,sCD14-ST）]在血流细菌感染疾病中的诊断价值,并分析sCD14-ST、降钙素原（procalcitonin,PCT）、C反应蛋白（C-reactive protein,CRP）及白细胞介素-6（interlukin 6,IL-6）检测对细菌感染的诊断价值。方法：选取2016年12月至2017年5月期间经血培养确诊为细菌感染的患者79例（≥18岁成人组,34例;<18岁儿童组,45例）,并纳入同期57名正常健康体检者作为对照组,检测所有研究对象的血清presepsin、PCT,CRP、IL-6浓度,采用受试者工作特征（receiver operating characteristic,ROC）曲线评估不同生物标志物对细菌感染的诊断价值,并探讨应用presepsin辅助诊断细菌感染在不同年龄阶段患者间是否存在差异。结果：细菌感染组（688.32 pg/mL）与对照组（34.89 pg/mL）间的血清presepsin浓度差异有统计学意义（P<0.05）;将细菌感染组按照年龄分层,成人感染组与儿童感染组间的血清presepsin浓度差异无统计学意义（P>0.05）。通过ROC曲线分析,比较各生物标志物,细菌感染患者血清presepsin的曲线下面积为0.854,高于PCT（0.802）、CRP（0.772）和IL-6（0.693）,且血清presepsin诊断细菌感染的灵敏度和特异度均优于PCT、CRP及IL-6。血清PCT区分革兰阴阳性菌的曲线下面积最大,为0.944,高于presepsin的0.915和IL-6的0.904和CRP的0.780。结论：感染标志物presepsin对细菌感染疾病的辅助诊断具有较高的灵敏度和特异度其,诊断价值优于PCT、CPR,且血清presepsin浓度没有年龄差异,在不同年龄阶段中都可以应用;而各项指标中,血清PCT区分革兰阴阳性菌的诊断效能高于presepsin。

关键词: 细菌性感染, presepsin, 生物标志物, 降钙素原, 白细胞介素6, C反应蛋白

Abstract: Objective: To explore the diagnostic value of a new infection biomarker presepsin (soluble CD14 molecular subtype) in bacterial infection, and compared with procalcitonin (PCT), C-reactive protein (CRP) and interleukin-6 (IL-6) for the diagnosis of bacterial infection. Methods: Patients with positive blood culture admitted between December 2016 and May 2017 were enrolled, and 57 cases of normal healthy subjects at the same period were served as controls.The levels of serum presepin, procalcitonin, CRP and IL-6 were determined. Using ROC curve and survival analysis to evaluate the value of different biomarkers for the diagnosis of bacterial infection, and to explore whether there were differences between different age groups. Results: The level of serum presepsin was significantly high in bacterial infection group than in non-infectioncontrol group （P<0.05）. In the infection group, there was no significant difference in serum presepsin le-vel between patients of different age groups (P>0.05). Compared with other diagnostic biomarkers through ROC curve analysis, the area under curve（AUC） of presepsin was 0.854, higher than 0.802 of PCT and 0.772 of CRP and 0.693 of IL-6, respectively. AUC of serum PCT level for differentiating gram-negative from gram-positive bacterial infection was 0.944, higher than those of presepsin and IL-6. Conclusion: The infection biomarkers presepsin has high sensitivity and specificity for the diagnosis of bacterial infection, and it can be applied in patients of different age group and in differentiating gram-negative from gram-positive bacterial infection.

Key words: Bacterial infection, Presepsin, Biomarkers, Procalcitonin (PCT), IL-6, CRP

中图分类号:

R446

杜坤, 杨喜, 卞炳贤, 任懿倩, 张广慧. 血清presepsin(sCD14-ST)、降钙素原、C反应蛋白和白介细胞素-6诊断血流细菌感染的诊断性能比较[J]. 诊断学理论与实践, 2018, 17(05): 581-585.

DU Kun, YANG Xi, BIAN Binxian, REN Yiqian, ZHANG Guanghui. Comparison of diagnostic value of new infection biomarker presepsin with procalcitonin, C-reactive protein and interleukin-6 in diagnosis of bacterial infection[J]. Journal of Diagnostics Concepts & Practice, 2018, 17(05): 581-585.

参考文献

[1] 金胜鑫, 石海矾, 李伟. 血清降钙素原与超敏C反应蛋白及白介素6在新生儿早期感染中的诊断价值[J]. 中华医院感染学杂志,2013,23(7):1601-1637.
[2] Marazzi MG, Randelli F, Brioschi M, et al.Presepsin: A potential biomarker of PJI? A comparative analysis with known and new infection biomarkers[J]. Int J Immunopathol Pharmacol,2018,31:394632017749356.
[3] Plesko M, Suvada J, Makohusova M, et al.The role of CRP, PCT, IL-6 and presepsin in early diagnosis of bacterial infectious complications in paediatric haemato-oncological patients[J]. Neoplasma,2016,63(5):752-760.
[4] 张明霞, 赵瑞卿, 李庆霞, 等. 胎膜早破对新生儿宫内细菌感染的影响及与脐血IL-6、PCT、CRP、TNF-α相关性研究[J]. 中华医院感染学杂志,2016,26(21):4968-4970.
[5] Hoshino K, Irie Y, Mizunuma M, et al.Incidence of elevated procalcitonin and presepsin levels after severe trauma: a pilot cohort study[J]. Anaesth Intensive Care,2017,45(5):600-604.
[6] Koeze J, Hendrix MG, van den Bergh FA, et al. In critically ill patients the procalcitonin level can be mislea-ding[J]. Crit Care,2011,15(2):422.
[7] Wolff M, Bouadma L.What procalcitonin brings to mana-gement of sepsis in the ICU[J]. Crit Care,2010,14(6):1007.
[8] Zhu F, Wei H, Li W.Significance of Serum Procalcitonin Levels in Differential Diagnosis of Pediatric Pneumonia[J]. Cell Biochem Biophys,2015,73(3):619-622.
[9] Poddar B, Gurjar M, Singh S, et al.Reduction in procalcitonin level and outcome in critically ill children with severe sepsis/septic shock-A pilot study[J]. J Crit Care,2016,36:230-233.
[10] Liu B, Chen YX, Yin Q, et al.Diagnostic value and prognostic evaluation of Presepsin for sepsis in an emergency department[J]. Crit Care,2013,17(5):R244.
[11] Pieteris L, Baksyte G, Cesnaitis T, et al.New strategies in sepsis diagnosis[J]. Acta Med Lituanica,2012,19:160-162.
[12] Okamura Y, Yokoi H.Development of a point-of-care assay system for measurement of presepsin (sCD14-ST)[J]. Clin Chim Acta,2011,412(23-24):2157-2161.
[13] Yaegashi Y, Shirakawa K, Sato N, et al.Evaluation of a newly identified soluble CD14 subtype as a marker for sepsis[J]. J Infect Chemother,2005,11(5):234-238.
[14] Wright SD, Ramos RA, Tobias PS, et al. CD14, a receptor for complexes of lipopolysaccharide(LPS) andLPS binding protein[J]. Science,1990 Sep 21,249(4975):1431-1433.
[15] 宋剑峰, 陈尔真. Apelin与脓毒症[J]. 内科理论与实践,2017,12(6):416-417.
[16] Romualdo LG, Torrella PE, González MV, et al.Diagnostic accuracy of presepsin (soluble CD14 subtype) for prediction of bacteremia in patients with systemic inflammatory response syndrome in the Emergency Department[J]. Clin Biochem,2014,47(7-8):505-508.
[17] 贾文婷, 丁周志. 降钙素原联合超敏C反应蛋白检测在新生儿细菌感染诊断中的价值[J]. 安徽医学,2018, 39(4):478-479.
[18] 杨爱龙, 陈曦, 高宏伟, 等. 脓毒症的诊断和预后评估中presepsin的临床价值[J]. 中华检验医学杂志,2015, 38(2):124-127.
[19] Ali FT, Ali MA, Elnakeeb MM, et al.Presepsin is an early monitoring biomarker for predicting clinical outcome in patients with sepsis[J]. Clin Chim Acta,2016, 460:93-101.
[20] Poggi C, Bianconi T, Gozzini E, et al.Presepsin for the detection of late-onset sepsis in preterm newborns[J]. Pediatrics,2015,135(1):68-75.
[21] Osman AS, Awadallah MG, El-Mageed HA, et al.Presepsin as a Novel Diagnostic Marker in Neonatal Septicemia[J]. Egypt J Med Microbiol,2015,24:21-26.
[22] Wu CC, Lan HM, Han ST, et al.Comparison of diagnostic accuracy in sepsis between presepsin, procalcitonin, and C-reactive protein: a systematic review and meta-analysis[J]. Ann Intensive Care,2017,7(1):91.
[23] Tanır Basaranoglu S, Karadag-Oncel E, Aykac K, et al.Presepsin: A new marker of catheter related blood stream infections in pediatric patients[J]. J Infect Chemother,2018,24(1):25-30.
[24] Stoma I, Karpov I, Uss A, et al.iagnostic value of sepsis biomarkers in hematopoietic stem cell transplant recipie-nts in a condition of high prevalence of gram-negative pathogens[J]. Hematol Oncol Stem Cell Ther,2017,10(1):15-21.