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。
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.
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