王萍 王华彬 涂琼

【摘要】 目的：探討降钙素原（PCT）、红细胞体积分布宽度（RDW）及内毒素联合检测在儿童血流感染患儿中的应用价值。方法：回顾性选择2016年9月-2020年12月赣南医学院第一附属医院收治的疑似儿童血流感染患儿150例，根据血培养结果分为血流感染组（阳性，n=70）与非血流感染组（阴性，n=80，对照组）;血流感染组根据培养结果分为革兰阳性菌组（n=32）和革兰阴性菌组（n=38）。比较各组PCT、RDW及内毒素水平;绘制ROC曲线，分析PCT、RDW、内毒素及联合检测在儿童血流感染中的诊断效能。结果：血流感染组PCT、RDW及内毒素水平均高于对照组，差异均有统计学意义（P<0.05）;革兰阳性菌组PCT、RDW及内毒素水平均低于革兰阴性菌组（P<0.05）;PCT、RDW、内毒素及联合检测在儿童血流感染中的诊断灵敏度高于单一PCT、RDW及内毒素（P<0.05）。结论：PCT、RDW及内毒素在儿童血流感染尤其是革兰阴性菌患儿中呈高表达，三者联合检测用于诊断儿童血流感染能获得较高的灵敏度，可指导临床诊疗，值得推广应用。

【关键词】 降钙素原 红细胞体积分布宽度 内毒素 血流感染

[Abstract] Objective： To explore the value of combined detection of procalcitonin （PCT）， red blood cell volume distribution width （RDW） and endotoxin in children with bloodstream infection. Method： A retrospective selection of 150 children with suspected bloodstream infection in children admitted to the First Affiliated Hospital of Gannan Medical College from September 2016 to December 2020， according to the blood culture results， the children were divided into the bloodstream infection group （positive， n=70） and the non-bloodstream infection group （negative， n=80， the control group）; the bloodstream infection group was divided into Gram-positive bacteria group （n=32） and Gram-negative bacteria group （n=38） according to the culture results. PCT， RDW and endotoxin levels in each group were compared. The ROC curve was drawn to analyze the diagnostic efficacy of PCT， RDW， endotoxin and combined detection in children bloodstream infection. Result： PCT， RDW and endotoxin levels in the bloodstream infection group were higher than those in the control group， the differences were statistically significant （P<0.05）; PCT， RDW and endotoxin levels in the Gram-positive bacteria group were lower than those of the Gram-negative bacteria group （P<0.05）; the diagnostic sensitivity of PCT， RDW， endotoxin and combined detection in childrens bloodstream infection was higher than those of single PCT， RDW and endotoxin （P<0.05）. Conclusion： PCT， RDW and endotoxin are highly expressed in children with bloodstream infections， especially in children with Gram-negative bacteria. The combined detection of the three can be used to diagnose childrens bloodstream infections with high sensitivity， which can guide clinical diagnosis and treatment， it is worthwhile Promote applications.

[Key words] PCT RDW Endotoxin Blood flow infection

First-authors address： The First Affiliated Hospital of Gannan Medical College， Ganzhou 341000， China

doi：10.3969/j.issn.1674-4985.2021.18.042

血流感染是临床上较为严重的感染之一，能发生在不同年龄段人群中。近年来，随着抗感染药物的不合理使用，导致细菌耐药性不断增加，使得血流感染面临巨大挑战[1]。既往研究表明：细菌性血流感染能引起脓毒血症，可发生在不同部位，如：腹膜炎、蜂窝织炎、胆管炎及泌尿系感染等[2]。

文献[3]研究表明：血流感染好发于小儿人群中，是菌血症、败血症及脓毒血症的总称，常规方法以“血培养”为诊断金标准。……